# Subclinical Cardiac Disturbances After Rickettsia spp. Infection in an Endemic Region of Mexico

## TL;DR

This study found that some adults who recovered from rickettsial infections in Mexico showed hidden heart issues, suggesting the need for more detailed cardiac monitoring.

## Contribution

The study reveals subclinical cardiac effects in rickettsiosis survivors and highlights the sensitivity of Holter monitoring over standard ECG.

## Key findings

- Subclinical cardiac abnormalities were found in 18 asymptomatic rickettsiosis survivors.
- QTc prolongation was detected only through Holter monitoring, not standard ECG.
- Right ventricular dilation and reduced heart rate variability were observed in a subset of patients.

## Abstract

Background: Rickettsial diseases are endemic in southeastern Mexico, yet their potential subclinical cardiac effects remain poorly understood. Although severe spotted fever and typhus group infections may cause myocarditis and arrhythmias, limited evidence exists regarding cardiac alterations in individuals previously diagnosed with rickettsiosis who later show Rickettsia spp. IgG seropositivity. Methods: This follow-up observational study was conducted at a tertiary referral hospital in the Yucatan Peninsula. From an initial cohort of 390 patients evaluated for suspected rickettsial disease, 284 were confirmed as IgG-positive during follow-up. Among them, 18 adults who were asymptomatic for acute rickettsiosis at reassessment, but reported mild or nonspecific cardiac symptoms, underwent standardized cardiological evaluation. Procedures included a 12-lead electrocardiogram (ECG), transthoracic echocardiography, and 24 h Holter monitoring. All studies were reviewed independently by two blinded cardiologists with senior adjudication. Results: Global systolic function was preserved in all participants. However, subclinical abnormalities were identified, including right ventricular dilation in 16.7%, clinically relevant QTc prolongation in 22.2%, sinus pauses in 11.1%, reduced heart rate variability in 11.1%, atrial flutter in one patient, and complete left bundle branch block in one patient. QTc prolongation was detected exclusively through Holter monitoring. Conclusions: Adults previously diagnosed with rickettsiosis may exhibit subclinical cardiac involvement despite apparent recovery. Holter monitoring appears more sensitive than ECG for identifying electrical disturbances, warranting larger prospective studies.