Rickettsiae are a family of ectoparasite-borne bacteria that can produce high morbidity and mortality among humans. There are scarce data on rickettsial ecology in rural areas of the Peruvian Amazon basin, where seroprevalence has not been determined, and the identities of animals acting as reservoirs of these bacteria are not known. We conducted a cross-sectional study in Zungarococha (between 2019 and 2021), a rural community located approximately 20 km away from Iquitos city. Blood samples were collected from humans (175), dogs (123), and cats (12). Blood samples and tissues were collected from black rats (84). Finally, we collected fleas from dogs and cats (222), ticks from dogs (91), and mites from black rats (32). Blood samples from humans, dogs, cats, and black rats were analyzed by indirect immunofluorescence assays (IFA) to detect IgG antibodies against rickettsias. We screened ectoparasites and black rat tissues by real-time-PCR (qPCR). Positive ectoparasites were further assessed by PCR and DNA amplicon sequencing. Non-parametric tests were used to evaluate factors associated with being seropositive among human adults. IgG seroprevalences were 38.3 %, 58.5 %, 16.7 % and 48.1 % among humans, dogs, cats, and rats, respectively. Among humans, only male gender was statistically associated with having IgG antibodies against Rickettsia spp. (p-value=0.049, chi-square test). Different ectoparasites were identified, including Ctenocephalides felis from cats and dogs, Rhipicephalus sanguineus s.l. from dogs, and Laelaps nuttalli from black rats. Rhipicephalus sanguineus s.l. (2/91 ticks) and Ct. felis (53/56 fleas and 55/55 flea pools) were qPCR-positive for Rickettsia spp. Recovered genetic material from 53 Ct. felis was sequenced and all were identified as Rickettsia asembonensis. All tissue samples from black rats were negative by qPCR. Humans, dogs, cats, and black rats are exposed to spotted fever group rickettsiae in rural areas surrounding Iquitos. As reported in urban areas, R. asembonensis is the main Rickettsia species circulating in rural areas surrounding Iquitos and Ct. felis appears to be the main vector.

Objectives: Antimicrobial resistant (AMR) Campylobacter is a global health threat; however, there is limited information on genomic determinants of resistance in low- and middle-income countries. We evaluated genomic determinants of AMR using a collection of whole genome sequenced Campylobacter jejuni and C. coli isolates from Iquitos, Peru. Methods: Campylobacter isolates from two paediatric cohort studies enriched with isolates that demonstrated resistance to ciprofloxacin and azithromycin were sequenced and mined for AMR determinants. Results: The gyrA mutation leading to the Thr86Ile amino acid change was the only gyrA mutation associated with fluoroquinolone resistance identified. The A2075G mutation in 23S rRNA was present, but three other 23S rRNA mutations previously associated with macrolide resistance were not identified. A resistant-enhancing variant of the cmeABC efflux pump genotype (RE-cmeABC) was identified in 36.1% (35/97) of C. jejuni genomes and 17.9% (12/67) of C. coli genomes. Mutations identified in the CmeR-binding site, an inverted repeat sequence in the cmeABC promoter region that increases expression of the operon, were identified in 24/97 C. jejuni and 14/67 C. coli genomes. The presence of these variants, in addition to RE-cmeABC, was noted in 18 of the 24 C. jejuni and 9 of the 14 C. coli genomes. Conclusions: Both RE-cmeABC and mutations in the CmeR-binding site were strongly associated with the MDR phenotype in C. jejuni and C. coli. This is the first report of RE-cmeABC in Peru and suggests it is a major driver of resistance to the principal therapies used to treat human campylobacteriosis in this setting.