Caso fatal pediatrico coinfectado por Rickettsia rickettsii y SARS-CoV-2

BACKGROUND: Rocky Mountain spotted fever (RMSF) presents with non-specific clinical manifestations that may be mistaken for other febrile illnesses, including COVID-19. Coinfection by SARS-CoV-2 with other pathogens has been previously reported, however, not between this virus and R. rickettsii. We hereby present a fatal case in a child hospitalized in an endemic RMSF region. CLINICAL CASE: An 11 -year-old male patient presented with a 7-day history of exanthematous fever accompanied by neurological deterioration and respiratory distress. Acute SARS-CoV-2 infection was confirmed through antigen testing and polymerase chain reaction (PCR) on a respiratory sample. The patient had documented tick exposure, raising simultaneous suspicion of RMSF. Blood samples and pathology revealed R. rickettsii infection. Rapid systemic deterioration, unresponsive to implemented management, led to death within five hours of admission. CONCLUSIONS: This fatal case demonstrated acute coinfection by R. rickettsii and the SARS-CoV-2 virus, likely contributing to complications and expediting the fatal outcome. Medical personnel should contemplate the presence of coinfections involving both pathogens, particularly in endemic regions of the country.