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For the last decade, the New Jersey (NJ) Department of Health has reported between 42 and 144 new cases each year of "spotted fever group rickettsiosis" (SFGR), a statistic that reflects uncertainty regarding which rickettsial agents (Proteobacteria: Rickettsiaceae: Rickettsia ) are infecting NJ residents. To identify the Rickettsia circulating in NJ ticks, we used a combination of conventional and real time PCR approaches to screen 560 Dermacentor variabilis Say and 245 Amblyomma americanum L. obtained from a 1-day state-wide surveillance in May 2018 and an additional 394 D. variabilis collected across NJ in 2013-2018. We found zero D. variabilis infected with Rickettsia rickettsii, the agent of Rocky Mountain spotted fever and, on average, 1.3% infected with presumed nonpathogenic Rickettsia montanensis . We also found zero A. americanum infected with R. rickettsii, and 20% infected with Rickettsia amblyommatis, a prevalence somewhat lower than in more southern states. Overall, we conclude that it is unlikely that R. rickettsii vectored by D. variabilis is a primary cause of SFGR cases in NJ and discuss our findings in the context of known facts and current limitations. We conclude that understanding the causes of SFGR east of the Mississippi will require collaboration among medical doctors, public health authorities, and medical entomologists to follow up presumptive human cases of SFGR with detailed histories of exposure, species-specific molecular assays, and active surveillance of putative vectors and the pathogens they may carry.

An epidemic of Rocky Mountain spotted fever (RMSF) is ongoing in Mexicali, México. We visited 100 neighborhoods with diagnosed human cases and 100 control neighborhoods to evaluate knowledge of the epidemic; obtain data on the spatial distribution of dogs, canine seroprevalence and active infection, tick infestations, and presence of rickettsial DNA in ticks; and evaluate risk factors for human cases, seropositivity, and tick infestation within an unbiased study design. The majority (80%) of residents had heard of RMSF, but only 48% used acaricides in the home or on dogs. Case neighborhoods and those with high canine seroprevalence tended to be on the city periphery or in the agricultural valley. No dogs were polymerase chain reaction (PCR) positive for Rickettsia rickettsii , and the overall seroprevalence was 65% (titers from 64 to 1,024). PCR prevalence in ticks was 0.70%, confirmed by DNA sequencing as R. rickettsii ; neighborhood prevalence ranged from 0.7% to 6.1%. Twelve percent of dogs had high tick burdens, and all ticks were Rhipicephalus sanguineus . Epidemiologically significant risk factors were ground covering for a neighborhood having a human case; dogs having poor body condition and weighing < 10 kg for canine seropositivity; dogs living at the home for the number of ticks in the environment; and being near canals, having trash on the patio, and a dog being thin for tick burdens on dogs. A One Health approach is crucial to understanding RMSF and brown dog ticks.

Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States., (© The American Society of Tropical Medicine and Hygiene.)

This study reports the first urban human case of Rocky Mountain spotted fever caused by Rickettsia rickettsii, in Costa Rica. An 8-year-old female who died at the National Children's Hospital 4 days after her admission, and an important and significant observation was the presence of an "eschar" (tache noire), which is typical in some rickettsial infections but not frequent in Rocky Mountain spotted fever cases.

This study evaluated the infection caused by Rickettsia and Ehrlichia agents among dogs in southern Brazil. A total of 389 dogs were tested by the indirect immunofluorescence assay (IFA) for Rickettsia rickettsii, Rickettsia parkeri, Rickettsia amblyommii, Rickettsia rhipicephali, Rickettsia bellii, and Ehrlichia canis. Overall, 42.4% (165/389) of the dogs were seroreactive to at least one Rickettsia species, but only 11 canine sera reacted with another Rickettsia species without reacting with R. parkeri. A total of 100 (25.7%) canine sera showed titers to R. parkeri at least 4-fold higher than those to any of the other rickettsial antigens, allowing us to consider that these dogs were infected by R. parkeri. Dogs that had direct contact with pasture or forest areas were > 2 times more likely to be seroreactive to Rickettsia than dogs with no such direct contact. Only 19 (4.8%) of the 389 dogs were seroreactive to E. canis.

We describe the first molecular confirmation of Rickettsia rickettsii, the cause of Rocky Mountain spotted fever (RMSF), from a tick vector, Amblyomma cajennense, and from a cluster of fatal spotted fever cases in Argentina. Questing A. cajennense ticks were collected at or near sites of presumed or confirmed cases of spotted fever rickettsiosis in Jujuy Province and evaluated by polymerase chain reaction assays for spotted fever group rickettsiae. DNA of R. rickettsii was amplified from a pool of A. cajennense ticks and from tissues of one of four patients who died during 2003-2004 after illnesses characterized by high fever, severe headache, myalgias, and petechial rash. The diagnosis of spotted fever rickettsiosis was confirmed in the other patients by indirect immunofluorescence antibody and immunohistochemical staining techniques. These findings show the existence of RMSF in Argentina and emphasize the need for clinicians throughout the Americas to consider RMSF in patients with febrile rash illnesses.

We recently rediscovered Rocky Mountain spotted fever in Villeta, Colombia, near the same locality (Tobia) where it was first recognized in 1937. To have a better idea of the magnitude of this problem, sera from 392 randomly recruited healthy adults from Villeta were analyzed by indirect immunofluorescent antibody assay to detect IgG against Rickettsia rickettsii as antigen. The seropositivity rate for spotted fever group rickettsiae was 40.3%. We did not find any association between the presence of antibodies to spotted fever group rickettsiae and several demographic and epidemiologic variables, which could be a reflection of unique features of this area.

A sequential occurrence of Rocky Mountain spotted fever (RMSF) in a dog and its owner is described. Diagnosis of RMSF in the animal guided subsequent testing for and diagnosis of the same disease in the human patient. Previous reports of concurrent RMSF in dogs and their owners are reviewed, and the epidemiologic significance of this occurrence is discussed.

During 1985-1995, illnesses clinically and epidemiologically compatible with Brazilian spotted fever were identified in 17 patients in the county of Pedreira, in the state of São Paulo, Brazil. Spotted-fever group rickettsial infection was confirmed by serology and/or immunostaining of tissues in 10 of these patients. Immunostaining confirmed infection in a 37-year-old pregnant patient, although rickettsial antigens were not demonstrable in the tissues of the fetus. A serosurvey was conducted in four localities in the county to determine the prevalence of subclinical or asymptomatic infections with spotted fever group rickettsiae. Five hundred and twenty-five blood samples were tested by an indirect immunofluorescence assay for antibodies reactive with Rickettsia rickettsii. Twenty-two (4.2%) of these samples demonstrated titers > or = 1:64. The results indicate that Brazilian spotted fever is endemic within this region of Brazil.

Between November 1993 and March 1994, a cluster 6 pediatric patients with acute febrile illnesses associated with rashes was identified in Jujuy Province, Argentina. Immunohistochemical staining of tissues confirmed spotted fever group rickettsial infection in a patient with fatal disease, and testing of serum of a patient convalescing from the illness by using an indirect immunofluorescence assay (IFA) demonstrated antibodies reactive with spotted fever group rickettsiae. A serosurvey was conducted among 16 households in proximity to the index case. Of 105 healthy subjects evaluated by IFA, 19 (18%) demonstrated antibodies reactive with rickettsiae or ehrlichiae: 4 had antibodies reactive with Rickettsia rickettsii, 15 with Ehrlichia chaffeensis, and 1 with R. typhi. Amblyomma cajennense, a known vector of R. rickettsii in South America, was collected from pets and horses in the area. These results are the first to document rickettsial spotted fever and ehrlichial infections in Argentina.

A polymerase chain reaction (PCR) for amplifying ribosomal DNA of Rickettsia rickettsii was performed on blood clots and urine samples from 10 patients with suspected Rocky Mountain spotted fever (RMSF) and five controls with nonrickettsial diseases. The results of this PCR-based procedure were positive in four of the five patients with probable RMSF, but reamplification was required in three patients. Rickettsia rickettsii was grown from the blood of two of these four patients. The urine from one patient was also PCR-positive. These results confirm earlier findings that the PCR can detect R. rickettsii, but the need for reamplification indicates that the lack of sensitivity is a serious limitation in the usefulness of the PCR as a clinical diagnostic test.

A field study was initiated in 1988 to investigate whether spotted fever group rickettsiae occur in geographic areas in Egypt that are adjacent to an area in the southern Israeli Negev that has a defined focus of spotted fever disease. Ticks were collected from dogs, sheep, and camels at four study sites in the northern Sinai. Tick hemolymph was processed for rickettsial detection by staining with fluorescein isothiocyanate-conjugated antibody to Rickettsia rickettsii. Of the 442 hemolymphs examined, 15 contained immunofluorescent rickettsiae. Eight hemolymph test-positive (HT+) ticks were Rhipicephalus sanguineus removed from dogs; the other HT+ ticks comprised three Hyalomma species, H. anatolicum, H. impeltatum, and H. dromedarii. Both HT+ and HT- ticks were tested for rickettsial DNA using the polymerase chain reaction (PCR). Eight of 10 HT+ field-collected ticks were PCR positive (PCR+). All laboratory colony R. rickettsii-infected ticks were PCR+. No HT- ticks from field or laboratory isolates were PCR+.

Adult Dermacentor andersoni ticks were collected by flagging vegetation in 18 canyons bordering the Bitterroot Valley, Montana, an area where nearly 400 cases of Rocky Mountain spotted fever (RMSF) have occurred since 1900. Three hundred and nine (8.3%) of the 3,705 ticks collected contained hemocyte-associated rickettsia-like organisms of three morphologic types, coccobacillary, fine bacillary, and coarse bacillary (long forms). Only the coccobacillary and fine bacillary organisms stained with fluorescein-conjugated antibody specific for the spotted fever group. One hundred and six isolates of spotted fever-group rickettsiae obtained by inoculation of Vero cells with suspensions of hemolymph test-positive ticks were serologically typed by microimmunofluorescence. Four sharply distinct serotypes were obtained, including Rickettsia rickettsii (10 strains), R. montana (8 strains), R. rhipicephali (47 strains), and a hitherto undescribed serotype referred to as 369-C (41 strains). All but two isolates were obtained from west-side canyons where virtually all cases of RMSF had been acquired. The four serotypes were widely distributed on the west side as evidenced by their presence in 5-11 of the 13 collecting sites. Each serotype induced distinctive plaques and cytopathogenicity in Vero cell culture.

A rickettsial survey of ixodid ticks known to bite man was conducted in 1979 in four coastal counties of California to obtain isolates from tick species that might be involved in the transmission of spotted fever-like illnesses, and to examine serologic characteristics of the rickettsiae relative to defined members of the spotted fever group (SFG). One hundred and seventy (19.4%) of 877 ticks comprising three species were shown by hemolymph test to harbor rickettsia-like organisms. A total of 85 SFG rickettsia isolates was obtained by Vero-cell culture; 82 were from Dermacentor occidentalis, two were from D. variabilis, and one was from Ixodes pacificus. As determined by microimmunofluorescence, the isolates comprised four distinct serotypes. Two serotypes were obtained only from D. occidentalis, and one each only from D. variabilis and I. pacificus, respectively. Most D. occidentalis isolates possessed the serologic characteristics of Rickettsia rhipicephali, but there were similar to yet distinguishable from, R. rickettsii and are members of an unclassified serotype referred to as 364D. The two isolates from D. variabilis resembled the unclassified 369C serotype previously shown to be associated with this species and D. andersoni elsewhere in the United States. The I. pacificus isolate was similar to strains of the unclassified Tillamook serotype isolated from this tick in several localities in western Oregon. Representative strains of the four serotypes could also be distinguished on the basis of pathogenicity for Vero cells, chick embryos, guinea pigs, and/or meadow voles. The significance of these findings relative to occurrence of tick-associated illnesses in western California is briefly discussed.

A survey for the prevalence of Rocky Mountain spotted fever (RMSF) antibodies in dogs associated with confirmed human cases in Ohio was conducted during 1981. Twelve of 14 confirmed cases (85%) had a history of dog association prior to onset of RMSF. A total of 29 dogs were included in the study, with 16 dogs providing serum samples for antibody testing and the remainder providing tick samples. Serum samples tested by indirect microimmunofluorescence techniques revealed 12/16 dogs (75%) to be seropositive for Rickettsia rickettsii. A total of 310 ticks were collected from study dogs and the vegetation surrounding RMSF case exposure sites. Twenty-two (7.1%) of these ticks (all Dermacentor variabilis) were found to be infected with spotted fever group rickettsiae. Four ticks (1.3%) were infected with R. rickettsii, 13 (4.2%) with Rickettsia montana, and four (1.3%) with Rickettsia bellii. R. montana, a nonpathogen, was the only rickettsia found in dogs (antibodies) and ticks (isolation) associated with human cases in Southern Ohio.

Since Rocky Mountain spotted fever (RMSF) was recognized in Costa Rica, ecological studies have been undertaken to discern its distribution and the natural cycle of Rickettsia rickettsii. The population of ticks parasitizing animals and vegetation was scarce. Rickettsiae were not isolated from pools of ticks nor from spleens of the animals studied. However, the active circulation of rickettsiae was evidenced through the demonstration of spotted fever group antibodies in humans, dogs, and wild rabbits. These findings concur with those in a number of fatal human cases as well as with the isolation of R. rickettsii from wild rabbit ticks.

During the ecological studies done in Costa Rica on Rocky Mountain spotted fever, we have been able to isolate 2 strains of rickettsiae from the rabbit tick Haemaphysalis leporispalustris, indistinguishable from R. rickettsii isolated from humans in our country. Moreover, serological evidence of this agent was demonstrated in convalescent guinea pigs and in the sera of the wild rabbit (Sylvilagus braziliensis).

Because the incidence of spotted fever is increasing in South Carolina, campaigns were carried out in 1973 and 1974 to provide the public and medical practitioners, through pamphlets and news media, with information about spotted fever and the ticks which transmit the causative agent, Rickettsia rickettsii. People were also invited to save and submit live ticks removed from vegetation, animals and humans, for examination by the hemolymph test. A total of 1,186 ticks consisting of 987 Dermacentor variabilis, 103 Rhipicephalus sanguineus, and 96 Amblyomma americanum were examined. Rickettsiae identified by direct immunofluorescence as members of the spotted fever group were detected in 49 (4.9%) of the D. variabilis, and 16 (16.6%) of the A. americanum ticks. Two hundred and twenty (199 D. variabilis, 17 A. americanum, and 4 R. sanguineus) were recorded as having been attached to 199 persons. Nine of these ticks (8 D. variabilis, and 1 A. americanum) were hemolymph test-positive for spotted fever-group rickettsiae. Infected ticks originated from each of the three major South Carolina biogeographic regions, namely Piedmont, Sandhill, and Coastal Plain. Since education is the first and most important step in preventing spotted fever, educational programs and tick examination services similar to those decribed, are suggested for other states with high spotted fever incidence.

Live ticks removed from human hosts were tested for the presence of spotted fever group rickettsiae from 1974 through 1976. Spotted fever group rickettsiae were detected in Dermacentor variabilis, Amblyomma americanum, Amblyomma maculatum, and Ixodes scapularis. Persons from whom positive ticks were removed in 1974 and 1975 were questioned about ensuing illness. Eleven of 51 persons from whom rickettsia-positive D. variabilis were removed reported some unexplained combination of symptoms compatible with Rocky Mountain spotted fever. Persons with positive ticks other than D. variabilis reported no illness in the 2 weeks following exposure. D. variabilis from the Coastal Plain of South Carolina have a higher percentage of infection than those from the Piedmont region. Conversely, most reported human cases of spotted fever are from the Piedmont.