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Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA

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Infection with Rickettsia parkeri is an emerging tick-borne illness, often accompanied by fever and an eschar at the site of tick attachment. We present three cases of R. parkeri in Virginia residents.

Case presentations

Case 1 presented initially afebrile, failed to seroconvert to rickettsial antigens, and was diagnosed by DNA testing of the eschar. Case 2 presented febrile with eschar, no serologies were performed, and was diagnosed by DNA testing of the eschar. Case 3 presented febrile with eschar, serologies were negative for rickettsial antigens, and was diagnosed by DNA testing of the eschar.


DNA testing of eschars represents an under-utilized diagnostic test and may aid in cases where the diagnosis is not made clinically.

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CWT was supported by a P.E.O. Scholar Award and by the Jayne Koskinas and Ted Giovanis Foundation for Health and Policy.

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Correspondence to Holly Gaff.

Ethics declarations

The patient data described for Cases #2 and 3 in this report have been de-identified by their respective physicians who are co-authors, and further, Case #1 is a co-author and provided his own data and the photograph used. Thus, the case report was declared to be exempt by the Old Dominion University Institutional Review Board, so no informed consent was required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Kelman, P., Thompson, C.W., Hynes, W. et al. Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA. Infection 46, 559–563 (2018).

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