Phylogeography of Rickettsia rickettsii Genotypes Associated with Fatal Rocky Mountain Spotted Fever

Christopher D. Paddock Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Amy M. Denison Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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R. Ryan Lash Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Lindy Liu Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Brigid C. Bollweg Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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F. Scott Dahlgren Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Cristina T. Kanamura Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Rodrigo N. Angerami Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Fabiana C. Pereira dos Santos Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Roosecelis Brasil Martines Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Sandor E. Karpathy Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil

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Rocky Mountain spotted fever (RMSF), a tick-borne zoonosis caused by Rickettsia rickettsii, is among the deadliest of all infectious diseases. To identify the distribution of various genotypes of R. rickettsii associated with fatal RMSF, we applied molecular typing methods to samples of DNA extracted from formalin-fixed, paraffin-embedded tissue specimens obtained at autopsy from 103 case-patients from seven countries who died of RMSF. Complete sequences of one or more intergenic regions were amplified from tissues of 30 (29%) case-patients and revealed a distribution of genotypes consisting of four distinct clades, including the Hlp clade, regarded previously as a non-pathogenic strain of R. rickettsii. Distinct phylogeographic patterns were identified when composite case-patient and reference strain data were mapped to the state and country of origin. The phylogeography of R. rickettsii is likely determined by ecological and environmental factors that exist independently of the distribution of a particular tick vector.

Author Notes

* Address correspondence to Christopher D. Paddock, Rickettsial Zoonoses Branch, Mailstop G-13, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. E-mail: cdp9@cdc.gov

Authors' addresses: Christopher D. Paddock, F. Scott Dahlgren, and Sandor E. Karpathy, Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: cdp9@cdc.gov, iot0@cdc.gov, and evu2@cdc.gov. Amy M. Denison, Lindy Liu, and Brigid C. Bollweg, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: crk6@cdc.gov, fuz3@cdc.gov, and fvt6@cdc.gov. R. Ryan Lash, Traveler's Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: gnk6@cdc.gov. Cristina T. Kanamura, Fabiana C. Pereira dos Santos, and Roosecelis Brasil Martines, Instituto Adolfo Lutz, Núcelo de Anatomia Patológica, São Paulo, São Paulo, Brazil, E-mails: criskanamura@yahoo.com.br, fabianacp@yahoo.com, and roosebrasil@hotmail.com. Rodrigo N. Angerami, Secretaria Municipal de Saúde de Campinas, Departamento de Vigilância em Saúde, Campinas, São Paulo, Brazil, E-mail: rodrigo.angerami@gmail.com.

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