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Guglielmone AA, Nava S, Mastropaolo M, Mangold AJ. Distribution and genetic variation of Amblyomma triste (Acari: Ixodidae) in Argentina. Ticks Tick Borne Dis 2013; 4:386-90. [DOI: 10.1016/j.ttbdis.2013.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
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52
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Ogrzewalska M, Pacheco RC, Uezu A, Richtzenhain LJ, Ferreira F, Labruna MB. Rickettsial infection inAmblyommanodosumticks (Acari: Ixodidae) from Brazil. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 103:413-25. [DOI: 10.1179/136485909x451744] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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53
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Comparative evaluation of infected and noninfected Amblyomma triste ticks with Rickettsia parkeri, the agent of an emerging rickettsiosis in the New World. BIOMED RESEARCH INTERNATIONAL 2013; 2013:402737. [PMID: 23936795 PMCID: PMC3722777 DOI: 10.1155/2013/402737] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
The distribution of Rickettsia parkeri in South America has been associated with Amblyomma triste ticks. The present study evaluated under laboratory conditions two colonies of A. triste: one started from engorged females that were naturally infected by R. parkeri (designated as infected group); the other started from noninfected females (designated as control group). Both colonies were reared in parallel for five consecutive generations. Tick-naïve domestic rabbits were used for feeding of each tick stage and generation. R. parkeri was preserved by transstadial maintenance and transovarial transmission in A. triste ticks for five consecutive generations, because all tested larvae, nymphs, and adults from the infected group were shown by PCR to contain rickettsial DNA. All rabbits infested by larvae, nymphs, and adults from the infected group seroconverted, indicating that these tick stages were all vector competent for R. parkeri. Expressive differences in mortality rates were observed between engorged nymphs from the infected and control groups, as indicated by 65.9% and 92.4% molting success, respectively. Our results indicate that A. triste can act as a natural reservoir for R. parkeri. However, due to deleterious effect caused by R. parkeri on engorged nymphs, amplifier vertebrate hosts might be necessary for natural long-term maintenance of R. parkeri in A. triste.
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In vitroisolation fromAmblyomma ovale(Acari: Ixodidae) and ecological aspects of the Atlantic rainforestRickettsia, the causative agent of a novel spotted fever rickettsiosis in Brazil. Parasitology 2013; 140:719-28. [DOI: 10.1017/s0031182012002065] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARYRecently, a novel human rickettsiosis, namely Atlantic rainforest spotted fever, was described in Brazil. We herein report results of a survey led around the index case in an Atlantic rainforest reserve in Peruibe municipality, southeastern Brazil. ARickettsia parkeri-like agent (Rickettsiasp. Atlantic rainforest genotype) andRicketsia belliiwere isolated from adultAmblyomma ovaleticks collected from dogs. Molecular evidence of infection with strain Atlantic rainforest was obtained for 30 (12·9%) of 232A. ovaleadult ticks collected from dogs. As many as 88·6% of the 35 examined dogs had anti-Rickettsiaantibodies, with endpoint titres at their highest toR. parkeri. High correlation among antibody titres in dogs,A. ovaleinfestations, and access to rainforest was observed.Amblyomma ovalesubadults were found predominantly on a rodent species (Euryoryzomys russatus). From 17E. russatustested, 6 (35·3%) displayed anti-Rickettsiaantibodies, with endpoint titres highest toR. parkeri. It is concluded that Atlantic rainforest genotype circulates in this Atlantic rainforest area at relatively high levels. Dogs get infected when bitten byA. ovaleticks in the forest, and carry infected ticks to households. The role ofE. russatusas an amplifier host ofRickettsiatoA. ovaleticks deserves investigation.
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55
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Venzal JM, Estrada-Peña A, Portillo A, Mangold AJ, Castro O, De Souza CG, Félix ML, Pérez-Martínez L, Santibánez S, Oteo JA. Rickettsia parkeri: a Rickettsial pathogen transmitted by ticks in endemic areas for spotted fever rickettsiosis in southern Uruguay. Rev Inst Med Trop Sao Paulo 2012; 54:131-4. [PMID: 22634883 DOI: 10.1590/s0036-46652012000300003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/20/2012] [Indexed: 11/22/2022] Open
Abstract
At first Rickettsia conorii was implicated as the causative agent of spotted fever in Uruguay diagnosed by serological assays. Later Rickettsia parkeri was detected in human-biting Amblyomma triste ticks using molecular tests. The natural vector of R. conorii, Rhipicephalus sanguineus, has not been studied for the presence of rickettsial organisms in Uruguay. To address this question, 180 R. sanguineus from dogs and 245 A. triste from vegetation (flagging) collected in three endemic localities were screened for spotted fever group (SFG) rickettsiosis in southern Uruguay. Tick extracted DNA pools were subjected to PCR using primers which amplify a fragment of the rickettsial gltA gene. Positive tick DNA pools with these primers were subjected to a second PCR round with primers targeting a fragment of the ompA gene, which is only present in SFG rickettsiae. No rickettsial DNA was detected in R. sanguineus. However, DNA pools of A. triste were found to be positive for a rickettsial organism in two of the three localities, with prevalences of 11.8% to 37.5% positive pools. DNA sequences generated from these PCR-positive ticks corresponded to R. parkeri. These findings, joint with the aggressiveness shown by A. triste towards humans, support previous data on the involvement of A. triste as vector of human infections caused by R. parkeri in Uruguay.
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Affiliation(s)
- José M Venzal
- Departamento de Parasitología Veterinaria, Facultad de Veterinaria, Universidad de la República, Salto, Uruguay.
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56
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Romer Y, Seijo AC, Crudo F, Nicholson WL, Varela-Stokes A, Lash RR, Paddock CD. Rickettsia parkeri Rickettsiosis, Argentina. Emerg Infect Dis 2012; 17:1169-73. [PMID: 21762568 PMCID: PMC3381406 DOI: 10.3201/eid1707.101857] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rickettsia parkeri, a recently identified cause of spotted fever rickettsiosis in the United States, has been found in Amblyomma triste ticks in several countries of South America, including Argentina, where it is believed to cause disease in humans. We describe the clinical and epidemiologic characteristics of 2 patients in Argentina with confirmed R. parkeri infection and 7 additional patients with suspected R. parkeri rickettsiosis identified at 1 hospital during 2004-2009. The frequency and character of clinical signs and symptoms among these 9 patients closely resembled those described for patients in the United States (presence of an inoculation eschar, maculopapular rash often associated with pustules or vesicles, infrequent gastrointestinal manifestations, and relatively benign clinical course). Many R. parkeri infections in South America are likely to be misdiagnosed as other infectious diseases, including Rocky Mountain spotted fever, dengue, or leptospirosis.
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57
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Jiang J, Stromdahl EY, Richards AL. Detection of Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Gulf Coast ticks collected from humans in the United States. Vector Borne Zoonotic Dis 2011; 12:175-82. [PMID: 22022815 DOI: 10.1089/vbz.2011.0614] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rickettsia parkeri, a spotted fever group (SFG) rickettsia recently found to be pathogenic to humans, causes an eschar-associated febrile illness. The R. parkeri rickettsiosis, Tidewater spotted fever, has been misdiagnosed as Rocky Mountain spotted fever due to serologic cross reactivity and the lack of specific diagnostic methods. Candidatus Rickettsia andeanae, also a SFG rickettsia, is a recently described agent of unknown pathogenicity originally identified in ticks collected from domestic animals during a fever outbreak investigation in northern Peru. Among 37 Amblyomma maculatum (collected from humans (n=35) and questing (n=2)) obtained from the southern United States during 2000-2009, nine and four A. maculatum nucleic acid preparations were found positive for R. parkeri and Candidatus R. andeanae, respectively, by newly developed genus- and species-specific quantitative real-time polymerase chain reaction assays. In addition Rickettsia felis was found in two A. maculatum nucleic acid preparations.
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Affiliation(s)
- Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland, USA
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58
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Nava S, Mangold AJ, Mastropaolo M, Venzal JM, Fracassi N, Guglielmone AA. Seasonal dynamics and hosts of Amblyomma triste (Acari: Ixodidae) in Argentina. Vet Parasitol 2011; 181:301-8. [DOI: 10.1016/j.vetpar.2011.03.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/26/2011] [Accepted: 03/30/2011] [Indexed: 11/25/2022]
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59
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Tomassone L, Nuñez P, Ceballos LA, Gürtler RE, Kitron U, Farber M. Detection of "Candidatus Rickettsia sp. strain Argentina"and Rickettsia bellii in Amblyomma ticks (Acari: Ixodidae) from Northern Argentina. EXPERIMENTAL & APPLIED ACAROLOGY 2010; 52:93-100. [PMID: 20186466 PMCID: PMC3072707 DOI: 10.1007/s10493-010-9339-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 01/30/2010] [Indexed: 05/28/2023]
Abstract
Ixodid ticks were collected from vegetation and from humans, wild and domestic mammals in a rural area in the semi-arid Argentine Chaco in late spring 2006 to evaluate their potential role as vectors of Spotted Fever Group (SFG) rickettsiae. A total of 233 adult ticks, identified as Amblyomma parvum, Amblyomma tigrinum and Amblyomma pseudoconcolor, was examined for Rickettsia spp. We identified an SFG rickettsia of unknown pathogenicity, "Candidatus Rickettsia sp. strain Argentina", in A. parvum and A. pseudoconcolor by PCR assays targeting gltA, ompA, ompB and 17-kDa outer membrane antigen rickettsial genes. Rickettsia bellii was detected in a host-seeking male of A. tigrinum. Amblyomma parvum is widespread in the study area and is a potential threat to human health.
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Affiliation(s)
- L Tomassone
- Department of Animal Production Epidemiology and Ecology, University of Torino, via L. Da Vinci 44, Grugliasco, Turin, Italy
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60
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Mertins JW, Moorhouse AS, Alfred JT, Hutcheson HJ. Amblyomma triste (Acari: Ixodidae): new North American collection records, including the first from the United States. JOURNAL OF MEDICAL ENTOMOLOGY 2010. [PMID: 20695268 PMCID: PMC7027265 DOI: 10.1093/jmedent/47.4.536] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
New distribution records for the Neotropical tick, Amblyomma triste Koch, are identified from 27 specimens in 18 separate collections. These collections originated from six now recognized geographical foci in two states in the United States (Cochise and Santa Cruz Counties, Arizona, and Brewster and Jeff Davis Counties, Texas) and from import cattle, Bos taurus L., presented for entry at the United States border and originating in three Mexican states (Coahuila, Durango, and Sonora). For at least 67 yr, A. triste has existed in some areas of the United States as a cryptic species, and specimens there have been confused with and identified as Gulf Coast ticks, Amblyomma maculatum Koch, even by noted tick specialists. Most of the records reported in this study were from reidentified, archived specimens of putative A. maculatum.
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Affiliation(s)
- James W Mertins
- United States Department of Agriculture, Animal and Plant Health Inspection Service, Veterinary Services, National Veterinary Services Laboratories, 1800 Dayton Avenue, Ames, IA 50010, USA.
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61
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Mertins JW, Moorhouse AS, Alfred JT, Hutcheson HJ. Amblyomma triste (Acari: Ixodidae): new North American collection records, including the first from the United States. JOURNAL OF MEDICAL ENTOMOLOGY 2010; 47:536-542. [PMID: 20695268 PMCID: PMC7027265 DOI: 10.1603/me09165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 03/19/2010] [Indexed: 05/29/2023]
Abstract
New distribution records for the Neotropical tick, Amblyomma triste Koch, are identified from 27 specimens in 18 separate collections. These collections originated from six now recognized geographical foci in two states in the United States (Cochise and Santa Cruz Counties, Arizona, and Brewster and Jeff Davis Counties, Texas) and from import cattle, Bos taurus L., presented for entry at the United States border and originating in three Mexican states (Coahuila, Durango, and Sonora). For at least 67 yr, A. triste has existed in some areas of the United States as a cryptic species, and specimens there have been confused with and identified as Gulf Coast ticks, Amblyomma maculatum Koch, even by noted tick specialists. Most of the records reported in this study were from reidentified, archived specimens of putative A. maculatum.
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Affiliation(s)
- James W Mertins
- United States Department of Agriculture, Animal and Plant Health Inspection Service, Veterinary Services, National Veterinary Services Laboratories, 1800 Dayton Avenue, Ames, IA 50010, USA.
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62
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Paddock CD, Fournier PE, Sumner JW, Goddard J, Elshenawy Y, Metcalfe MG, Loftis AD, Varela-Stokes A. Isolation of Rickettsia parkeri and identification of a novel spotted fever group Rickettsia sp. from Gulf Coast ticks (Amblyomma maculatum) in the United States. Appl Environ Microbiol 2010. [PMID: 20208020 DOI: 10.1128/aem] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Until recently, Amblyomma maculatum (the Gulf Coast tick) had garnered little attention compared to other species of human-biting ticks in the United States. A. maculatum is now recognized as the principal vector of Rickettsia parkeri, a pathogenic spotted fever group rickettsia (SFGR) that causes an eschar-associated illness in humans that resembles Rocky Mountain spotted fever. A novel SFGR, distinct from other recognized Rickettsia spp., has also been detected recently in A. maculatum specimens collected in several regions of the southeastern United States. In this study, 198 questing adult Gulf Coast ticks were collected at 4 locations in Florida and Mississippi; 28% of these ticks were infected with R. parkeri, and 2% of these were infected with a novel SFGR. Seventeen isolates of R. parkeri from individual specimens of A. maculatum were cultivated in Vero E6 cells; however, all attempts to isolate the novel SFGR were unsuccessful. Partial genetic characterization of the novel SFGR revealed identity with several recently described, incompletely characterized, and noncultivated SFGR, including "Candidatus Rickettsia andeanae" and Rickettsia sp. Argentina detected in several species of Neotropical ticks from Argentina and Peru. These findings suggest that each of these "novel" rickettsiae represent the same species. This study considerably expanded the number of low-passage, A. maculatum-derived isolates of R. parkeri and characterized a second, sympatric Rickettsia sp. found in Gulf Coast ticks.
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Affiliation(s)
- Christopher D Paddock
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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63
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Tomassone L, Conte V, Parrilla G, De Meneghi D. Rickettsia infection in dogs and Rickettsia parkeri in Amblyomma tigrinum ticks, Cochabamba Department, Bolivia. Vector Borne Zoonotic Dis 2010; 10:953-8. [PMID: 20426684 DOI: 10.1089/vbz.2009.0126] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Only few published data are available on ticks and tick-borne zoonotic pathogens in Bolivia. To evaluate rickettsial seroprevalence and infection in dogs and ticks, during February-April 2007, we collected whole blood, sera, and ticks from dogs living in the rural, peri-urban, and urban areas of Cochabamba, Bolivia. Dog sera were subjected to enzyme-linked immunosorbent assay test to detect IgG antibodies against Rickettsia rickettsii and 68.2% of samples were found to be positive (n = 30; 95% confidence interval [CI]: 52.4-81.4). Blood samples and ticks were tested using polymerase chain reaction to detect spotted fever group (SFG) rickettsiae. One blood sample was positive for Rickettsia parkeri (2.3%; 95% CI: 0.06-12.3). Ticks were collected from 10 dogs and were identified as Amblyomma tigrinum (n = 44) and Rhipicephalus sanguineus (n = 1). All A. tigrinum ticks were collected from resident dogs from the rural areas of Cochabamba, whereas R. sanguineus was from a dog originating from Santa Cruz. Of 42 DNA samples extracted from ticks, 23 (54.8%; 95% CI: 38.7-70.1) were polymerase chain reaction positive for Rickettsia spp. Sequencing analysis identified 22 samples as R. parkeri and one as Rickettsia aeschlimannii. Positive ticks (all A. tigrinum) were collected from six dogs, all of which were seropositive. This is the first report of SFG rickettsiae in A. tigrinum, suggesting that this tick-like others species in the Amblyomma maculatum group--may play a role in the biological cycle of Ri. parkeri. The high infection prevalence of SFG rickettsiae in ticks and the even higher seroprevalence in dogs suggest an active circulation of agents of rickettsiosis in the study area, although there are no confirmed cases of infection in humans. Our study supports the use of canine serology as risk indicator for SF rickettsioses.
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Affiliation(s)
- Laura Tomassone
- Department of Animal Production, Epidemiology & Ecology, University of Turin, Grugliasco, Torin, Italy
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64
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Isolation of Rickettsia parkeri and identification of a novel spotted fever group Rickettsia sp. from Gulf Coast ticks (Amblyomma maculatum) in the United States. Appl Environ Microbiol 2010; 76:2689-96. [PMID: 20208020 DOI: 10.1128/aem.02737-09] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Until recently, Amblyomma maculatum (the Gulf Coast tick) had garnered little attention compared to other species of human-biting ticks in the United States. A. maculatum is now recognized as the principal vector of Rickettsia parkeri, a pathogenic spotted fever group rickettsia (SFGR) that causes an eschar-associated illness in humans that resembles Rocky Mountain spotted fever. A novel SFGR, distinct from other recognized Rickettsia spp., has also been detected recently in A. maculatum specimens collected in several regions of the southeastern United States. In this study, 198 questing adult Gulf Coast ticks were collected at 4 locations in Florida and Mississippi; 28% of these ticks were infected with R. parkeri, and 2% of these were infected with a novel SFGR. Seventeen isolates of R. parkeri from individual specimens of A. maculatum were cultivated in Vero E6 cells; however, all attempts to isolate the novel SFGR were unsuccessful. Partial genetic characterization of the novel SFGR revealed identity with several recently described, incompletely characterized, and noncultivated SFGR, including "Candidatus Rickettsia andeanae" and Rickettsia sp. Argentina detected in several species of Neotropical ticks from Argentina and Peru. These findings suggest that each of these "novel" rickettsiae represent the same species. This study considerably expanded the number of low-passage, A. maculatum-derived isolates of R. parkeri and characterized a second, sympatric Rickettsia sp. found in Gulf Coast ticks.
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65
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Zavala-Castro JE, Zavala-Velázquez JE, Peniche-Lara GF, Sulú Uicab JE. Human rickettsialpox, southeastern Mexico. Emerg Infect Dis 2010; 15:1665-7. [PMID: 19861070 PMCID: PMC2866381 DOI: 10.3201/eid1510.081507] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The detection of Rickettsia akari in 2 human patients increased the diversity of rickettsioses affecting the public health in the southeast of Mexico. Rickettsialpox should be considered in the differential diagnosis with other febrile illnesses for the correct diagnosis and accurate treatment of this potential threat to human health.
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Affiliation(s)
- Jorge E Zavala-Castro
- Facultad de Medicina, Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Universidad Autónoma de Yucatán, Mérida, México.
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66
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Conti-Díaz IA, Moraes-Filho J, Pacheco RC, Labruna MB. Serological evidence of Rickettsia parkeri as the etiological agent of rickettsiosis in Uruguay. Rev Inst Med Trop Sao Paulo 2009; 51:337-9. [DOI: 10.1590/s0036-46652009000600005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/27/2009] [Indexed: 11/21/2022] Open
Abstract
We report three new rickettsiosis human cases in Uruguay. The three clinical cases presented clinical manifestations similar to previous reported cases of Rickettsia parkeri in the United States; that is mild fever (< 40 ºC), malaise, headache, rash, inoculation eschar at the tick bite site, regional lymphadenopathy, and no lethality. Serological antibody-absorption tests with purified antigens of R. parkeri and Rickettsia rickettsii, associated with immunofluorescence assay indicated that the patients in two cases were infected by R. parkeri. Epidemiological and clinical evidences, coupled with our serological analysis, suggest that R. parkeri is the etiological agent of human cases of spotted fever in Uruguay, a disease that has been recognized in that country as cutaneous-ganglionar rickettsiosis.
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67
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Abstract
As newly recognized rickettsial diseases and rickettsial pathogens increase in scope and magnitude, several elements related to the concept of emerging rickettsioses deserve consideration. Newly identified rickettsiae may be mildly pathogenic, or perhaps even nonpathogenic, and have little direct impact on human or animal health, yet nonetheless wield considerable influence on the epidemiology and ecology of historically recognized diseases. In this context "new" rickettsioses provide a lens through which "old" rickettsioses are more accurately represented. Predicting pathogen from nonpathogen is not an exact science, particularly as so few rickettsiae have been broadly accepted as nonpathogenic by contemporary rickettsiologists. However, various factors relating to specific physiologic requirements and molecular machinery of the particular rickettsia, as well as characteristics of its invertebrate host that either position or exclude the rickettsia from infecting a human host, must be considered. Close inspection of mild or atypical forms of historically recognized rickettsioses and a greater emphasis on culture- and molecular-based diagnostic techniques are the keys to identifying future rickettsial agents of disease.
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Affiliation(s)
- Christopher D Paddock
- Infectious Disease Pathology Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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