Human Infections by Multiple Spotted Fever Group Rickettsiae in Tennessee

Josie Delisle Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Josie Delisle in
Current site
Google Scholar
PubMed
Close
,
Nicole L. Mendell Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Nicole L. Mendell in
Current site
Google Scholar
PubMed
Close
,
Annica Stull-Lane Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Annica Stull-Lane in
Current site
Google Scholar
PubMed
Close
,
Karen C. Bloch Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Karen C. Bloch in
Current site
Google Scholar
PubMed
Close
,
Donald H. Bouyer Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Donald H. Bouyer in
Current site
Google Scholar
PubMed
Close
, and
Abelardo C. Moncayo Vector-Borne Diseases Section, Communicable and Environmental Diseases, Tennessee Department of Health, Nashville, Tennessee; Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston, Texas; Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

Search for other papers by Abelardo C. Moncayo in
Current site
Google Scholar
PubMed
Close
Restricted access

Rocky Mountain spotted fever is the most common tick-borne disease in Tennessee. However, Rickettsia rickettsii has rarely been isolated from endemic ticks, suggesting rickettsioses may be caused by other species. A total of 56 human serum samples that were serologically positive for exposure to Rickettsia were obtained from commercial laboratories in 2010 and 2011. In addition, 20 paired sera from patients with encephalitis and positive Rickettsia serology were obtained from the Tennessee Unexplained Encephalitis Surveillance (TUES) study. Using an immunofluorescence assay, reactivity of the sera to R. rickettsii, Rickettsia montanensis, Rickettsia parkeri, and Rickettsia amblyommii was tested, and a comparison of endpoint titers was used to determine the probable antigen that stimulated the antibody response. Cross-absorption was conducted for 94.8% (N = 91) of the samples due to serologic cross-reactivity. Of the commercial laboratory samples, 55.4% (N = 31) had specific reactivity to R. amblyommii and 44.6% (N = 25) were indeterminate. Of the paired TUES samples, 20% (N = 4) had specific reactivity to R. amblyommii, 5% (N = 1) to R. montanensis, and 5% (N = 1) to R. parkeri. Patients with specific reactivity to R. amblyommii experienced fever (75%), headache (68%) and myalgia (58%). Rash (36%) and thrombocytopenia (40%) were less common. To our knowledge, this is the first time R. amblyommii has been reported as a possible causative agent of rickettsioses in Tennessee.

Author Notes

* Address correspondence to Abelardo C. Moncayo, Tennessee Department of Health, 630 Hart Lane, Nashville, TN 37216. E-mail: abelardo.moncayo@tn.gov

Financial support: Josie Delisle and Annica Stull-Lane were supported by the Emerging Infectious Diseases (EID) Fellowship Program administered by the Association of Public Health Laboratories (APHL) and funded by the Centers for Disease Control and Prevention (CDC).

Authors' addresses: Josie Delisle, Annica Stull-Lane, and Abelardo C. Moncayo, Tennessee Department of Health, Nashville, TN, E-mails: josie.delisle@tn.gov, annica.ren@gmail.com, and abelardo.moncayo@tn.gov. Nicole L. Mendell and Donald H. Bouyer, University of Texas Medical Branch at Galveston, Galveston, TX, E-mails: nlmendel@utmb.edu and dobouyer@utmb.edu. Karen C. Bloch, Vanderbilt University School of Medicine, Nashville, TN, E-mail: karen.bloch@vanderbilt.edu.

  • 1.

    Parola P, Paddock CD, Socolovschi C, Labruna MB, Mediannikov O, Kernif T, Abdad MY, Stenos J, Bitam I, Fournier P-E, 2013. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 26: 657702.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, Schley AW, Anderson WJ, Grigoryan A, Aranas AE, Wodajo MS, Abellera JP, Centers for Disease Control and Prevention, 2014. Summary of notifiable diseases—United States, 2012. MMWR 61: 1121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Openshaw JJ, Swerdlow DL, Krebs JW, Holman RC, Mandel E, Harvey A, Haberling D, Massung RF, McQuiston JH, 2010. Rocky Mountain spotted fever in the United States, 2000–2007: interpreting contemporary increases in incidence. Am J Trop Med Hyg 83: 174182.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Burgdorfer W, 1975. A review of Rocky Mountain spotted fever (tick-borne typhus), its agent, and its tick vectors in the United States. J Med Entomol 12: 269278.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Pagac BB, Miller MK, Mazzei MC, Nielsen DH, Jiang J, Richards AL, 2014. Rickettsia parkeri and Rickettsia montanensis, Kentucky and Tennessee, USA. Emerg Infect Dis 20: 17501752.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Gaines DN, Operario DJ, Stroup S, Stromdahl E, Wright C, Gaff H, Broyhill J, Smith J, Norris DE, Henning T, Lucas A, Houpt E, 2014. Ehrlichia and spotted fever group rickettsiae surveillance in Amblyomma americanum in Virginia through use of a novel six-plex real-time PCR assay. Vector Borne Zoonotic Dis 14: 307316.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Stromdahl EY, Jiang J, Vince M, Richards AL, 2011. Infrequency of Rickettsia rickettsii in Dermacentor variabilis removed from humans, with comments on the role of other human-biting ticks associated with spotted fever group rickettsiae in the United States. Vector Borne Zoonotic Dis 11: 969977.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Nadolny RM, Wright CL, Sonenshine DE, Hynes WL, Gaff HD, 2014. Ticks and spotted fever group rickettsiae of southeastern Virginia. Ticks Tick Borne Dis 5: 5357.

  • 9.

    Fritzen CM, Huang J, Westby K, Freye JD, Dunlap B, Yabsley MJ, Schardein M, Dunn JR, Jones TF, Moncayo AC, 2011. Infection prevalences of common tick-borne pathogens in adult lone star ticks (Amblyomma americanum) and American dog ticks (Dermacentor variabilis) in Kentucky. Am J Trop Med Hyg 85: 718723.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Moncayo AC, Cohen SB, Fritzen CM, Huang E, Yabsley MJ, Freye JD, Dunlap BG, Huang J, Mead DG, Jones TF, Dunn JR, 2010. Absence of Rickettsia rickettsii and occurrence of other spotted fever group rickettsiae in ticks from Tennessee. Am J Trop Med Hyg 83: 653657.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Paddock CD, Sumner JW, Comer JA, Zaki SR, Goldsmith CS, Goddard J, McLellan SL, Tamminga CL, Ohl CA, 2004. Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the United States. Clin Infect Dis 38: 805811.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Whitman TJ, Richards AL, Paddock CD, Tamminga CL, Sniezek PJ, Jiang J, Byers DK, Sanders JW, 2007. Rickettsia parkeri infection after tick bite, Virginia. Emerg Infect Dis 13: 334336.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Paddock CD, Finley RW, Wright CS, Robinson HN, Schrodt BJ, Lane CC, Ekenna O, Blass MA, Tamminga CL, Ohl CA, McLellan SL, Goddard J, Holman RC, Openshaw JJ, Sumner JW, Zaki SR, Eremeeva ME, 2008. Rickettsia parkeri rickettsiosis and its clinical distinction from Rocky Mountain spotted fever. Clin Infect Dis 47: 11881196.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    McQuiston JH, Zemtsova G, Perniciaro J, Hutson M, Singleton J, Nicholson WL, Levin ML, 2012. Afebrile spotted fever group Rickettsia infection after a bite from a Dermacentor variabilis tick infected with Rickettsia montanensis. Vector Borne Zoonotic Dis 12: 10591061.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Apperson CS, Engber B, Nicholson WL, Mead DG, Engel J, Yabsley MJ, Dail K, Johnson J, Watson DW, 2008. Tick-borne diseases in North Carolina: is “Rickettsia amblyommii” a possible cause of rickettsiosis reported as Rocky Mountain spotted fever? Vector Borne Zoonotic Dis 8: 597606.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Billeter SA, Blanton HL, Little SE, Levy MG, Breitschwerdt EB, 2007. Detection of Rickettsia amblyommii in association with a tick bite rash. Vector Borne Zoonotic Dis 7: 607610.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Marshall GS, Stout GG, Jacobs RF, Schutze GE, Paxton H, Buckingham SC, DeVincenzo JP, Jackson MA, San Joaquin VH, Standaert SM, Woods CR, Tick-Borne Infections in Children Study Group, 2003. Antibodies reactive to Rickettsia rickettsii among children living in the southeast and south central regions of the United States. Arch Pediatr Adolesc Med 157: 443448.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Graf PC, Chretien JP, Ung L, Gaydos JC, Richards AL, 2008. Prevalence of seropositivity to spotted fever group rickettsiae and Anaplasma phagocytophilum in a large, demographically diverse US sample. Clin Infect Dis 46: 7077.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Dumler JS, 2004. Serodiagnosis of rickettsial infections: indirect immunofluorescent-antibody test. Isenberg HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: ASM Press.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Ammerman NC, Beier-Sexton M, Azad AF, 2008. Laboratory Maintenance of Rickettsia rickettsii. Current Protocols in Microbiology. John Wiley and Sons, Inc.

  • 21.

    Vaughn MF, Delisle J, Johnson J, Daves G, Williams C, Reber J, Mendell NL, Bouyer DH, Nicholson WL, Moncayo AC, Meshnick SR, 2014. Seroepidemiologic study of human infections with spotted fever group rickettsiae in North Carolina. J Clin Microbiol 52: 39603966.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Jiang J, Yarina T, Miller MK, Stromdahl EY, Richards AL, 2010. Molecular detection of Rickettsia amblyommii in Amblyomma americanum parasitizing humans. Vector Borne Zoonotic Dis 10: 329340.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Blanton LS, Walker DH, Bouyer DH, 2014. Rickettsiae and ehrlichiae within a city park: is the urban dweller at risk? Vector Borne Zoonotic Dis 14: 168170.

  • 24.

    Barrett A, Little SE, Shaw E, 2014. Rickettsia amblyommii” and R. montanensis infection in dogs following natural exposure to ticks. Vector Borne Zoonotic Dis 14: 2025.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    La Scola B, Rydkina L, Ndihokubwayo JB, Vene S, Raoult D, 2000. Serological differentiation of murine typhus and epidemic typhus using cross-adsorption and western blotting. Clin Diagn Lab Immunol 7: 612616.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Parola P, Vestris G, Martinez D, Brochier B, Roux V, Raoult D, 1999. Tick-borne rickettiosis in Guadeloupe, the French West Indies: isolation of Rickettsia africae from Amblyomma variegatum ticks and serosurvey in humans, cattle, and goats. Am J Trop Med Hyg 60: 888893.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Jensenius M, Fournier PE, Vene S, Ringertz SH, Myrvang B, Raoult D, 2004. Comparison of immunofluorescence, Western blotting, and cross-adsorption assays for diagnosis of African tick bite fever. Clin Diagn Lab Immunol 11: 786788.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 805 631 149
Full Text Views 461 21 0
PDF Downloads 201 20 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save