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

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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

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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

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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

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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

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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

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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.

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