Skip to main content

Advertisement

Log in

Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA

Infection Aims and scope Submit manuscript

Abstract

Background

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.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Paddock CD, Sumner JW, Comer JA, Zaki SR, Goldsmith CS, Goddard J, McLellan SLF, Tamminga CL, Ohl CA. Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the United States. Clin Infect Dis. 2004;38:805–11.

    Article  PubMed  Google Scholar 

  2. Paddock CD, Finley RW, Wright CS, Robinson HN, Schrodt BJ, Lane CC, Ekenna O, Blass MA, Tamminga CL, Ohl CA, McLellan SLF, Goddard J, Holman RC, Openshaw JJ, Sumner JW, Zaki SR, Eremeeva ME. Rickettsia parkeri rickettsiosis and its clinical distinction from Rocky Mountain spotted fever. Clin Infect Dis. 2008;47:1188–96.

    Article  PubMed  Google Scholar 

  3. Straily A, Feldpausch A, Ulbrich C, Schell K, Casillas S, Zaki SR, Denison AM, Condit ME, Gabel J, Paddock CD. Notes from the field: Rickettsia parkeri Rickettsiosis—Georgia, 2012–2014. MMWR Morb Mortal Wkly Rep. 2016;65:718–9.

    Article  PubMed  Google Scholar 

  4. Romer Y, Seijo AC, Crudo F, Nicholson WL, Varela-Stokes A, Lash RR, Paddock CD. Rickettsia parkeri Rickettsiosis, Argentina. Emerg Infect Dis. 2011;17:1169–73.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Portillo A, García-García C, Sanz MM, Santibáñez S, Venzal JM, Oteo JA. A confirmed case of Rickettsia parkeri infection in a traveler from Uruguay. Am J Trop M. 2013;89:1203–5.

    Article  PubMed  Google Scholar 

  6. Spolidorio MG, Labruna MB, Mantovani E, Brandão PE, Richtzenhain LJ, Yoshinari NH. Novel spotted fever group rickettsiosis, Brazil. Emerg Infect Dis. 2010;16:521.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Silva N, Eremeeva ME, Rozental T, Ribeiro GS, Paddock CD, Ramos EAG, Ko AI. Eschar-associated spotted fever rickettsiosis, Bahia, Brazil. Emerg Infect Dis. 2011;17:275.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wright CL, Nadolny RM, Jiang J, Richards AL, Sonenshine DE, Gaff HD, Hynes WL. Rickettsia parkeri in Gulf Coast ticks, southeastern Virginia, USA. Emerg Infect Dis. 2011;17:896–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fornadel CM, Zhang X, Smith JD, Paddock CD, Arias JR, Norris DE. High rates of Rickettsia parkeri infection in Gulf Coast ticks (Amblyomma maculatum) and identification of “Candidatus Rickettsia andeanae” from Fairfax County, Virginia. Vector Borne Zoonotic Dis. 2011;11:1535–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Florin DA, Brinkerhoff RJ, Gaff H, Jiang J, Robbins RG, Eickmeyer W, Butler J, Nielsen D, Wright C, White A, Gimpel ME, Richards AL. Additional collections of the Gulf Coast tick, Amblyomma maculatum (Acari: Ixodidae), from the State of Delaware, the first reported field collections of adult specimens from the State of Maryland, and data regarding this tick species from surveillance of migratory songbirds in Maryland. Syst Appl Acarol. 2014;19:257–62.

    Article  Google Scholar 

  11. Nadolny RM, Wright CL, Sonenshine DE, Hynes WL, Gaff HD. Ticks and spotted fever group rickettsiae of southeastern Virginia. Ticks Tick Borne Dis. 2014;5:53–7.

    Article  PubMed  Google Scholar 

  12. Myers T, Lalani T, Dent M, Jiang J, Daly PL, Maguire JD, Richards AL. Detecting Rickettsia parkeri infection from eschar swab specimens. Emerg Infect Dis. 2013;19:778.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Whitman TJ, Richards AL, Paddock CD, Tamminga CL, Sniezek PJ, Jiang J, Byers DK, Sanders JW. Rickettsia parkeri infection after tick bite, Virginia. Emerg Infect Dis. 2007;13:334.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kaskas NM, Ledet JJ, Wong A, Muzny CA, Elopre L, Hughey L. Rickettsia parkeri: Eschar diagnosis. J Am Acad Dermatol. 2014;71:87–9.

    Article  Google Scholar 

  15. Herrick KL, Pena SA, Yaglom HD, Layton BJ, Moors A, Loftis AD, Condit ME, Singleton J, Kato CY, Denison AM, Ng D, Mertins JW, Paddock CD. Rickettsia parkeri Rickettsiosis, Arizona, USA. Emerg Infect Dis. 2016;22:780–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. 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. 2012;12:175–82.

    Article  PubMed  Google Scholar 

  17. Zemtsova GE, Watkins NE, Levin ML. Multiplex qPCR assay for identification and differentiation of Amblyomma americanum, Amblyomma cajennense, and Amblyomma maculatum (Ixodida: Ixodidae) tick species in the Eastern United States. J Med Ent. 2014;51:795–803.

    Article  CAS  Google Scholar 

  18. La Scola B, Raoult D. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol. 1997;35:2715.

    PubMed  PubMed Central  Google Scholar 

  19. Ekenna O, Paddock CD, Goddard J. Gulf coast tick rash illness in Mississippi caused by Rickettsia parkeri. J Miss State Med Assoc. 2014;55:216.

    PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

Authors

Corresponding author

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kelman, P., Thompson, C.W., Hynes, W. et al. Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA. Infection 46, 559–563 (2018). https://doi.org/10.1007/s15010-018-1120-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1120-x

Keywords

Navigation