Parkeri Rickettsiosis Research Articles

Establishment of Amblyomma maculatum Ticks and Rickettsia parkeri the Northeastern United States.

We document a case of Rickettsia parkeri rickettsiosis in a patient in Connecticut, USA, who became ill after a bite from a Gulf Coast tick (Amblyomma maculatum). We used PCR to amplify R. parkeri DNA from the detached tick. The patient showed a 4-fold rise in IgG reactive with R. parkeri antigens.

The first record of an established population of Amblyomma maculatum (Acari: Ixodidae) in New Jersey, USA.

Amblyomma maculatum Koch, the Gulf Coast tick, is expanding northward from its original range in the southeastern United States. In 2013, its most northern collection was in Delaware. Amblyomma maculatum has since been found in Connecticut, Illinois, and New York. It is the vector of the human pathogen Rickettsia parkeri, the causative agent of R. parkeri rickettsiosis. We report the first finding of an established population of A. maculatum in Salem County, NJ, with a R. parkeri infection prevalence rate of 23.8%. Our finding of A. maculatum is consistent with other recent findings in the northeastern United States in that specimens were found in open areas devoid of tree canopy. This discovery demonstrates the importance of tick surveillance in order to identify expanding tick populations and the pathogens they may transmit.

'Candidatus Rickettsia andeanae' and Probable Exclusion of Rickettsia parkeri in Ticks from Dogs in a Natural Area of the Pampa Biome in Brazil.

Spotted fever illness caused by the tick-borne pathogen Rickettsia parkeri has emerged in the Pampa biome in southern Brazil, where the tick Amblyomma tigrinum is implicated as the main vector. Because domestic dogs are commonly parasitized by A. tigrinum, this canid is also a suitable sentinel for R. parkeri-associated spotted fever. Herein, we investigate rickettsial infection in ticks, domestic dogs and small mammals in a natural reserve of the Pampa biome in southern Brazil. The ticks A. tigrinum, Amblyomma aureolatum and Rhipicephalus sanguineus were collected from dogs. Molecular analyses of ticks did not detect R. parkeri; however, at least 34% (21/61) of the A. tigrinum ticks were infected by the non-pathogenic agent 'Candidatus Rickettsia andeanae'. Serological analyses revealed that only 14% and 3% of 36 dogs and 34 small mammals, respectively, were exposed to rickettsial antigens. These results indicate that the study area is not endemic for R. parkeri rickettsiosis. We tabulated 10 studies that reported rickettsial infection in A. tigrinum populations from South America. There was a strong negative correlation between the infection rates by R. parkeri and 'Candidatus R. andeanae' in A. tigrinum populations. We propose that high infection rates by 'Candidatus R. andeanae' might promote the exclusion of R. parkeri from A. tigrinum populations. The mechanisms for such exclusion are yet to be elucidated.

Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina

We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

Increasing Incidence of Spotted Fever Group Rickettsioses in the United States, 2010-2018.

Spotted fever group Rickettsia species are intracellular bacteria transmitted by tick or mite vectors and that cause human diseases referred to as spotted fever group rickettsioses, or spotted fevers. In the United States, the most recognized and commonly reported spotted fevers are Rocky Mountain spotted fever (RMSF) (Rickettsia rickettsii), Rickettsia parkeri rickettsiosis, Pacific Coast tick fever (Rickettsia species 364D), and rickettsialpox (Rickettsia akari). In this study, we summarize and evaluate surveillance data on spotted fever cases reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System from 2010 to 2018. During this period, there were 36,632 reported cases of spotted fevers with 95.83% (N = 35,104) reported as meeting the case definition as probable and 4.17% (N = 1528) reported as meeting the case definition as confirmed. The average national incidence of total cases, both probable and confirmed, was 12.77 cases per million persons per year. The highest statewide incidence was in Arkansas, with 256.84 per million per year, whereas the lowest incidence occurred in California, with 0.32 per million per year (note that spotted fevers were not notifiable in Hawaii and Alaska). Cases of spotted fevers were reported more frequently among males by gender, White by race, and non-Hispanic by ethnicity. The incidence of spotted fevers increased significantly from 2010 to 2018, but it is uncertain how many of the reported cases were RMSF and how many developed from more moderate spotted fevers. Improvement of the ability to differentiate between spotted fever group Rickettsia species is needed.

Rickettsia parkeri.

Rickettsia parkeri is an obligate intracellular bacterial pathogen that primarily targets vascular endothelial cells, but also infects macrophages and epithelial cells. Infection of the endothelium leads to leakage of vascular fluid, causing a characteristic eschar and rash, along with fever, headache, and myalgia. Tick vectors transmit this bacterium from infected mammals (e.g., rodents) to humans. The disease caused by R. parkeri (Rickettsia parkeri rickettsiosis) is generally milder than those caused by other spotted fever group (SFG) Rickettsia spp., such as Rickettsia rickettsii (Rocky Mountain spotted fever) and Rickettsia conorii (Mediterranean spotted fever).

Established Populations of Rickettsia parkeri-Infected Amblyomma maculatum Ticks in New York City, New York, USA.

Objectives: We sought to determine the habitat associations and pathogen status of Amblyomma maculatum ticks in New York City (NYC), New York, USA, a newly expanded portion of their range. Methods: We collected 88 ticks from two NYC parks on Staten Island, one of the five boroughs of NYC, and compared our findings with similar habitat in Brooklyn, New York during the same time period (April 30-September 1). We tested 76 for pathogens. Results: We found adult and immature ticks in native and invasive grasses at Freshkills and Brookfield parks on Staten Island. No A. maculatum ticks were found in Brooklyn. 52.6% of ticks tested were infected with Rickettsia parkeri-the etiological agent of R. parkeri rickettsiosis. Conclusions: This high rate of R. parkeri in a dense urban center is of concern to the medical community, who should be aware of this species' presence and the symptoms of R. parkeri rickettsiosis.

Significant Growth by Rickettsia Species within Human Macrophage-Like Cells Is a Phenotype Correlated with the Ability to Cause Disease in Mammals.

Rickettsia are significant sources of tick-borne diseases in humans worldwide. In North America, two species in the spotted fever group of Rickettsia have been conclusively associated with disease of humans: Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever, and Rickettsia parkeri, the cause of R. parkeri rickettsiosis. Previous work in our lab demonstrated non-endothelial parasitism by another pathogenic SFG Rickettsia species, Rickettsia conorii, within THP-1-derived macrophages, and we have hypothesized that this growth characteristic may be an underappreciated aspect of rickettsial pathogenesis in mammalian hosts. In this work, we demonstrated that multiple other recognized human pathogenic species of Rickettsia, including R. rickettsii, R. parkeri, Rickettsia africae, and Rickettsia akari can grow within target endothelial cells as well as within PMA-differentiated THP-1 cells. In contrast, Rickettsia bellii, a Rickettsia species not associated with disease of humans, and R. rickettsii strain Iowa, an avirulent derivative of pathogenic R. rickettsii, could invade both cell types but proliferate only within endothelial cells. Further analysis revealed that similar to previous studies on R. conorii, other recognized pathogenic Rickettsia species could grow within the cytosol of THP-1-derived macrophages and avoided localization with two different markers of lysosomal compartments; LAMP-2 and cathepsin D. R. bellii, on the other hand, demonstrated significant co-localization with lysosomal compartments. Collectively, these findings suggest that the ability of pathogenic rickettsial species to establish a niche within macrophage-like cells could be an important factor in their ability to cause disease in mammals. These findings also suggest that analysis of growth within mammalian phagocytic cells may be useful to predict the pathogenic potential of newly isolated and identified Rickettsia species.

Survey of Rickettsia parkeri and Amblyomma maculatum associated with small mammals in southeastern Virginia

Small mammals are often parasitized by the immature stages of hard-bodied ticks (family Ixodidae) and may serve as reservoir hosts of tick-borne pathogens. Amblyomma maculatum, the Gulf Coast tick, is the primary vector of Rickettsia parkeri, the causative agent of R. parkeri rickettsiosis. This hard-bodied tick species is expanding its historical range from the Gulf Coast of the U.S. up the Mid-Atlantic coast. In Mid-Atlantic states, such as Virginia, R. parkeri prevalence is higher in these ticks than those found in its historical range. This high prevalence may be explained in part by small mammal populations. In this study, small mammals were trapped and checked for the presence of immature A. maculatum. The ticks as well as tissue samples from these mammals were tested for the presence of R. parkeri. This study found six rodent species acting as hosts to immature A. maculatum and three species that may play a role in the enzootic cycle of R. parkeri in Virginia.

Distribution and Occurrence of Amblyomma maculatum sensu lato (Acari: Ixodidae) and Rickettsia parkeri (Rickettsiales: Rickettsiaceae), Arizona and New Mexico, 2017-2019.

Amblyomma maculatum Koch sensu lato (s.l.) ticks are the vector of Rickettsia parkeri in Arizona, where nine cases of R. parkeri rickettsiosis have been identified since the initial case in 2014. The current study sought to better define the geographic ranges of the vector and pathogen and to assess the potential public health risk posed by R. parkeri in this region of the southwestern United States. A total of 275 A. maculatum s.l. ticks were collected from 34 locations in four counties in Arizona and one county in New Mexico and screened for DNA of Rickettsia species. Rickettsia parkeri was detected in 20.4% of the ticks, including one specimen collected from New Mexico, the first report of R. parkeri in A. maculatum s.l. from this state. This work demonstrates a broader distribution of A. maculatum s.l. ticks and R. parkeri in the southwestern United States than appreciated previously to suggest that R. parkeri rickettsiosis is underrecognized in this region.

Clinical and epidemiological comparison of Rickettsia parkeri rickettsiosis, related to Amblyomma triste and Amblyomma tigrinum, in Argentina

The aim of this work was to compare the epidemiological and clinical characteristics of Rickettsia parkeri rickettsiosis related to Amblyomma triste and Amblyomma tigrinum ecological regions in Argentina. We reviewed cases of R. parkeri rickettsiosis from 2007 to 2017 evaluated at Muñiz Hospital, directly or through referral. Univariate analysis was used to examine the association between different variables and the disease related by each vector species. The eighteen cases of R. parkeri rickettsiosis included had fever, inoculation eschar and all except one had rash. Regional differences in epidemiological variables were identified, depending on the vector. There was a significantly increased risk of exposure to A. tigrinum in peri-domestic areas (odd ratio 12, p = 0.02), whereas an increased risk of exposure to A. triste was evident in wildlife areas (odd ratio 12, p = 0.02). Seasonality of R. parkeri rickettsiosis differed based on its vector. Cases associated with A. triste occurred predominantly during spring and summer, whereas those associated with A. tigrinum occurred during fall, winter, and springtime. Exanthema was maculopapular (13/18), maculo-vesicular (3/18) or petechial (1/18). No clinical differences were identified depending on the vector.

Rickettsia parkeri (Rickettsiales: Rickettsiaceae) in the Sky Islands of West Texas.

Rickettsia parkeri, a tick-borne pathogen distributed throughout several countries of the Americas, causes a mild to moderately severe, eschar-associated spotted fever rickettsiosis. Although most U.S. cases of R. parkeri rickettsiosis are reported from southeastern states, some have been reported recently from remote regions of southern Arizona. These cases are linked to R. parkeri-infected ticks of the Amblyomma maculatum (Acari: Ixodidae) group found in several isolated mountain ranges of southern Arizona and New Mexico, referred to as 'sky islands'. Archival records also document ticks of the A. maculatum group collected from domestic and wild animals in West Texas. We surveyed sites in two sky island chains of Jeff Davis and Brewster counties to document the off-host occurrence of these ticks and identify the presence of R. parkeri in the Trans-Pecos region of Texas. During August 2019, 43 adult A. maculatum group ticks were flagged from vegetation or removed from a road-killed, female mule deer. Of 39 samples evaluated by PCR, eight contained a partial sca0 sequence with complete identity to R. parkeri and two with complete identity to 'Candidatus Rickettsia andeanae', a species of undetermined pathogenicity. Four isolates of R. parkeri were obtained using cell culture. Persons at risk for R. parkeri rickettsiosis include those who work or recreate in these mountains, such as hikers, backpackers, research scientists, foresters, and border enforcement personnel. Additional investigations are needed to define the distribution of these medically important arthropods in other parts of the southwestern United States and northern Mexico.

Expanding Recognition of Rickettsia parkeri Rickettsiosis in Southern Arizona, 2016-2017.

Rickettsia parkeri rickettsiosis is an emerging, tick-borne disease in the United States (US), transmitted by the bite of Amblyomma maculatum group ticks. Clinical manifestations include fever, headache, myalgia, maculopapular rash, and a characteristic eschar that forms at the site of the tick bite. Arizona's index case of R. parkeri rickettsiosis was reported in 2014. Seven additional confirmed and probable cases were identified during 2016-2017 through routine investigation of electronic laboratory reports and by self-reporting to public health authorities. Serum samples were evaluated for immunoglobulin G antibodies reactive with antigens of Rickettsia rickettsii (the agent of Rocky Mountain spotted fever [RMSF]) and R. parkeri using indirect immunofluorescence antibody tests. Eschar swab specimens were evaluated using Rickettsia genus-specific and R. parkeri-specific real-time PCR assays. Patients (six male, one female) ranged in age from 29 to 69 years (median of 41 years), and became ill between July 2016 and September 2017. Fever (6/7), myalgia (5/7), and arthralgia (5/7) were most commonly reported and 5/7 patients had a documented eschar. All patients reported a tick bite acquired in southern Arizona within 2-8 days before illness onset. Four patients worked as U.S. Border Patrol agents. Antibodies reactive to R. rickettsii, R. parkeri, or to both antigens were detected in all patients. Seroconversions between acute and convalescent-phase samples were identified for two patients and DNA of R. parkeri was identified in eschar swab samples from two patients. R. parkeri rickettsiosis is endemic to a region of the southwestern United States and presents an occupational risk that could be lessened by prevention messaging to Border Patrol agents. RMSF, a closely related and more severe spotted fever rickettsiosis, is also endemic to Arizona. Public health agencies can assist clinicians in distinguishing these two infections clinically through education and accessing species-specific diagnostic assays that can improve surveillance efforts for both diseases.

Rickettsia parkeri and “Candidatus Rickettsia andeanae” in Amblyomma maculatum (Acari: Ixodidae) collected from the Atlanta metropolitan area, Georgia, United States

Rickettsia parkeri is a recently recognized human pathogen transmitted in the southeastern United States by Amblyomma maculatum, the Gulf Coast tick. Since R. parkeri was conclusively identified as a human pathogen in 2004, over 40 cases of R. parkeri rickettsiosis have been identified in the United States, most of which occur in the southeastern states. During 2012–2014, five of these cases were identified by a single urgent care practice in Coweta County, a Georgia county within the Atlanta metropolitan area. To investigate the occurrence of R. parkeri-infected A. maculatum in the Atlanta metropolitan area, ticks were collected from 6 counties around the city of Atlanta and evaluated for infection with a Rickettsia species. A total of 263 questing adult A. maculatum were collected during 2015 and 2016. Of these, 93 (35%) were PCR-positive for DNA of R. parkeri and an additional 46 (17%) were PCR-positive for DNA of “Candidatus Rickettsia andeanae,” a spotted fever group Rickettsia species of unknown pathogenicity. No co-infections of these two rickettsiae were detected; however four of the six counties sampled showed presence of both rickettsial organisms. The high frequency of R. parkeri in these tick populations indicates a potential risk for those living, working, or recreating in A. maculatum-infested habitats within these six counties in the Atlanta metropolitan area.

An autochthonous confirmed case of Rickettsia parkeri rickettsiosis in Uruguay

Rickettsia parkeri, a member of the spotted fever group (SFG) rickettsiae, was first confirmed as an etiological agent of human rickettsiosis in 2004. Nearly all cases are characterized by an inoculation eschar, and no fatalities have been reported. In Uruguay, probable human cases of R. parkeri infection (confused initially with R. conorii infection) have been described since 1990 using the clinical name “cutaneous-ganglionar” rickettsiosis. This is the only tick-borne rickettsiosis reported in the country. A single case of R. parkeri rickettsiosis has been confirmed by molecular and serological testing in a Spanish traveler returning from Uruguay. We report the first autochthonous human R. parkeri infection, confirmed by molecular testing in Uruguay.

Rickettsia parkeri (Rickettsiales: Rickettsiaceae) Detected in Ticks of the Amblyomma maculatum (Acari: Ixodidae) Group Collected from Multiple Locations in Southern Arizona.

Rickettsia parkeri is an emerging human pathogen transmitted by Amblyomma ticks in predominately tropical and subtropical regions of the western hemisphere. In 2014 and 2015, one confirmed case and one probable case of R. parkeri rickettsiosis were reported from the Pajarita Wilderness Area, a semi-arid mountainous region in southern Arizona. To examine more closely the potential public health risk of R. parkeri in this region, a study was initiated to investigate the pervasiveness of Amblyomma maculatum Koch group ticks in mountainous areas of southern Arizona and to ascertain the infection frequencies of R. parkeri in these ticks. During July 2016, a total of 182 adult ticks were collected and evaluated from the Pajarita Wilderness Area in Santa Cruz County and two additional sites in Cochise and Santa Cruz counties in southern Arizona. DNA of R. parkeri was detected in a total of 44 (24%) of these ticks. DNA of "Candidatus Rickettsia andeanae" and Rickettsia rhipicephali was detected in three (2%) and one (0.5%) of the samples, respectively. These observations corroborate previous collection records and indicate that established populations of A. maculatum group ticks exist in multiple foci in southern Arizona. The high frequency of R. parkeri in these tick populations suggests a public health risk as well as the need to increase education of R. parkeri rickettsiosis for those residing, working in, or visiting this area.

Amblyomma maculatum Feeding Augments Rickettsia parkeri Infection in a Rhesus Macaque Model: A Pilot Study

Rickettsia parkeri is an emerging eschar-causing human pathogen in the spotted fever group of Rickettsia and is transmitted by the Gulf coast tick, Amblyomma maculatum. Tick saliva has been shown to alter both the cellular and humoral components of the innate and adaptive immune systems. However, the effect of this immunomodulation on Rickettsia transmission and pathology in an immunocompetent vertebrate host has not been fully examined. We hypothesize that, by modifying the host immune response, tick feeding enhances infection and pathology of pathogenic spotted fever group Rickettsia sp. In order to assess this interaction in vivo, a pilot study was conducted using five rhesus macaques that were divided into three groups. One group was intradermally inoculated with low passage R. parkeri (Portsmouth strain) alone (n = 2) and another group was inoculated during infestation by adult, R. parkeri-free A. maculatum (n = 2). The final macaque was infested with ticks alone (tick feeding control group). Blood, lymph node and skin biopsies were collected at several time points post-inoculation/infestation to assess pathology and quantify rickettsial DNA. As opposed to the tick-only animal, all Rickettsia-inoculated macaques developed inflammatory leukograms, elevated C-reactive protein concentrations, and elevated TH1 (interferon-γ, interleukin-15) and acute phase inflammatory cytokines (interleukin-6) post-inoculation, with greater neutrophilia and interleukin-6 concentrations in the tick plus R. parkeri group. While eschars formed at all R. parkeri inoculation sites, larger and slower healing eschars were observed in the tick feeding plus R. parkeri group. Furthermore, dissemination of R. parkeri to draining lymph nodes early in infection and increased persistence at the inoculation site were observed in the tick plus R. parkeri group. This study indicates that rhesus macaques can be used to model R. parkeri rickettsiosis, and suggests that immunomodulatory factors introduced during tick feeding may enhance the pathogenicity of spotted fever group Rickettsia.

Immunoproteomic profiling of Rickettsia parkeri and Rickettsia amblyommii

Rickettsia parkeri is an Amblyomma-associated, spotted fever group Rickettsia species that causes an eschar-associated, febrile illness in multiple countries throughout the Western Hemisphere. Many other rickettsial species of known or uncertain pathogenicity have been detected in Amblyomma spp. ticks in the Americas, including Rickettsia amblyommii, “Candidatus Rickettsia andeanae” and Rickettsia rickettsii. In this study, we utilized an immunoproteomic approach to compare antigenic profiles of low-passage isolates of R. parkeri and R. amblyommii with serum specimens from patients with PCR- and culture-confirmed infections with R. parkeri. Five immunoreactive proteins of R. amblyommii and nine immunoreactive proteins of R. parkeri were identified by matrix-assisted laser desorption ionization tandem time-of-flight mass spectrometry. Four of these, including the outer membrane protein (Omp) A, OmpB, translation initiation factor IF-2, and cell division protein FtsZ, were antigens common to both rickettsiae. Serum specimens from patients with R. parkeri rickettsiosis reacted specifically with cysteinyl–tRNA synthetase, DNA-directed RNA polymerase subunit alpha, putative sigma (54) modulation protein, chaperonin GroEL, and elongation factor Tu of R. parkeri which have been reported as virulence factors in other bacterial species. Unique antigens identified in this study may be useful for further development of the better serological assays for diagnosing infection caused by R. parkeri.

Rickettsia parkeri Transmission to Amblyomma americanum by Cofeeding with Amblyomma maculatum (Acari: Ixodidae) and Potential for Spillover.

Amblyomma americanum (L.) is a human-biting ixodid tick distributed throughout much of the southeastern United States. Rickettsia parkeri is a member of the spotted fever group rickettsiae and causes a febrile illness in humans commonly referred to as "Tidewater spotted fever" or "R. parkeri rickettsiosis." Although the Gulf Coast tick, Amblyomma maculatum Koch, is the primary vector of R. parkeri, a small proportion of A. americanum have also been shown to harbor R. parkeri. The purpose of this investigation was to determine whether R. parkeri is spilling over into A. americanum in eastern Virginia and also to determine through laboratory experiments, whether A. americanum can acquire R. parkeri by cofeeding alongside infected ticks. Of 317 wild-caught, flat adult A. americanum tested from 29 counties and independent cities in coastal Virginia, a single female A. americanum was positive for R. parkeri, suggesting that R. parkeri is spilling over into this species, but at very low rates (<1.0%). Laboratory studies using guinea pigs indicated that nymphal A. americanum were able to acquire R. parkeri while feeding alongside infected A. maculatum and then transstadially maintain the infection. Nymphal A. americanum infected with Rickettsia amblyommii, however, were less likely to acquire R. parkeri, suggesting that infection with R. amblyommii may prevent R. parkeri from establishing infection in A. americanum.

High prevalence of “Candidatus Rickettsia andeanae” and apparent exclusion of Rickettsia parkeri in adult Amblyomma maculatum (Acari: Ixodidae) from Kansas and Oklahoma

Amblyomma maculatum (the Gulf Coast tick), an aggressive, human-biting, Nearctic and Neotropical tick, is the principal vector of Rickettsia parkeri in the United States. This pathogenic spotted fever group Rickettsia species has been identified in 8–52% of questing adult Gulf Coast ticks in the southeastern United States. To our knowledge, R. parkeri has not been reported previously from adult specimens of A. maculatum collected in Kansas or Oklahoma. A total of 216 adult A. maculatum ticks were collected from 18 counties in Kansas and Oklahoma during 2011–2014 and evaluated by molecular methods for evidence of infection with R. parkeri. No infections with this agent were identified; however, 47% of 94 ticks collected from Kansas and 73% of 122 ticks from Oklahoma were infected with “Candidatus Rickettsia andeanae” a spotted fever group Rickettsia species of undetermined pathogenicity. These preliminary data suggest that “Ca. R. andeanae” is well-adapted to survival in populations of A. maculatum in Kansas and Oklahoma, and that its ubiquity in Gulf Coast ticks in these states may effectively exclude R. parkeri from their shared arthropod host, which could diminish markedly or preclude entirely the occurrence of R. parkeri rickettsiosis in this region of the United States.