Tick bites in humans are associated with the transmission of pathogens, anaphylactic shock, paralysis, and secondary infections. In this work we described six cases of tick bites in patients from Panama and Costa Rica. These bites were provoked for adults of Ornithodoros puertoricensis, Amblyomma cf. oblongoguttatum, Amblyomma ovale, and Ixodes cf. boliviensis, and a nymph of Amblyomma mixtum. The relationships of these species of ticks with the environment are explained. Among the reactions observed in the patients there are blisters, maculo-papular rash, granuloma, lymphadenopathy, and erythema migrans-like rash, but none referred symptoms compatible with an infectious disease. In the collected ticks a PCR battery was developed to rule out Borrelia, Rickettsia, Anaplasmataceae, and Coxiella diseases to the ticks from the cases 1, 2, 3 and 4, with negative results. Although no pathogen infections were evidenced, these finding indicate that the tick bites constitute a public health problem what goes unnoticed in many countries.

Rickettsia rickettsii is the most virulent agent of the genus Rickettsia that causes one of the most relevant vector-borne diseases in the Americas (RRSF). RRSF manifests with many non-specific acute clinical symptoms complicating its diagnosis and can lead to death if not treated appropriately. RRSF has been reported in Canada, the United States of America, Mexico, Costa Rica, Panama, Colombia, Brazil, and Argentina. In addition to R. rickettsii, mild and severe spotted fever group rickettsioses (SFGR) have been reported in the Americas; however, the true prevalence of these diseases is unknown. In Panama, RRSF have been reported in four of 14 provinces during two outbreak periods: five cases including two fatalities were identified in 1950–1951, and 23 cases including 17 fatalities between 2004 and 2025. This paper presents the clinical characterization of a fatal case of RRSF in Coclé province and a severe case of SFGR in a mountainous area of the Gnäbe Buglé Indigenous Comarca (GBIC). Laboratory confirmation was performed by molecular analysis of tissues obtained from necropsies in the case of RRSF and by immunofluorescence assay (IFA) in the case of SFGR. Furthermore, this paper identifies existing gaps in the initial clinical suspicion and pertinent to SFGR in Panama, which may be applicable to other countries in the region. In the last 21 years, cases have occurred upon contact with ticks in rural areas (13), urban and suburban locations (7), rural woodlands (2), and forests (1). Provinces with more cases are Panamá (7 of 23, 6 died), Coclé (5 of 23, 5 died), Colón (3 of 23, 1 died), Panamá Oeste (1 of 23, 1 died), and GBIC (7 of 23, 4 died), including a cluster of seven cases in 2019. Therefore, Coclé province is considered one of the endemic areas for RRSF in Panama, while the latest cases from the GBIC since 2019 indicate that mountainous areas are an eco-epidemiological scenario to include in the transmission of these diseases. Although this disease has a low prevalence, patients who present symptoms commonly associated with more common diseases such as dengue, other arboviruses, malaria, and leptospirosis, among others, should be included in the diagnostic suspicion. Without diagnostic suspicion and adequate treatment, the patient can die.

This paper reports the finding and identification of a partially engorged nymph of Amblyomma tholloni in the City of Panama, Panama, from a person with a history of travel to South Africa. The tick was identified by sequencing the 16S rDNA gene. Although the affected woman did not report any discomfort, the tick was evaluated for the presence of Rickettsia using the gltA and ompA genes, testing negative. Amblyomma tholloni is a parasite of elephants, rhinoceroses, and to a lesser extent other mammals; humans are considered sporadic hosts. To our knowledge, this is the first record of this species in a transcontinental traveler. This finding highlights the relevance of monitoring exotic ticks in international travelers.