Abstract / Description
BackgroundRickettsial diseases, particularly typhus group rickettsioses, remain underrecognized across the Americas despite ecological conditions favorable for transmission. Concurrently, Central America is experiencing one of its largest dengue epidemics, with an unexpectedly low proportion of laboratory-confirmed cases.ObjectiveWe aimed to explore whether typhus group rickettsioses may contribute to dengue-like febrile illness in Central America in the context of low dengue diagnostic confirmation.Materials and methodsAn analytical narrative review was conducted integrating secondary epidemiological data from the Pan American Health Organization (PAHO) Arbovirus Surveillance Portal and the peer-reviewed literature. Data from seven Central American countries (2024) were analyzed to estimate the proportion of laboratory-confirmed dengue cases. A focused literature review examined epidemiological, clinical, and ecological evidence supporting rickettsial transmission.ResultsOf 543,006 reported dengue cases in Central America in 2024, only 62,285 (11%) were laboratory-confirmed. Evidence from Costa Rica and regional serologic studies suggests ongoing rickettsial transmission. Ecological and socioeconomic conditions-including vector abundance, peridomestic reservoirs, and climate variability-mirror those of South Texas, where murine typhus is endemic.ConclusionsThe discrepancy between reported and confirmed dengue cases suggests a potential diagnostic gap. Typhus group rickettsioses represent a plausible, underrecognized contributor to febrile illness in Central America. Strengthening surveillance, diagnostics, and clinical awareness is essential to address this hidden burden.