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<h1>RICKETTSIA PARKERI INFECTION</h1>
Rickettsiae are strict intracellular bacteria requiring a host cell to replicate. Within the genus&nbsp;Rickettsia&nbsp;three groups are differentiated, one of which is the spotted fever group (SFG), of which members are associated mainly with ticks, but also with fleas and mites (Raoult and Roux, 1997). Within the SFG,&nbsp;Rickettsia&nbsp;parkeri&nbsp;is an emerging human pathogen, for which the dog has an important sentinel function. It is an agent of tick-borne rickettsiosis in the Americas which has also been named American Boutonneuse fever (Goddard, 2004; Goddard and Varela-Stokes, 2009) or Tidewater spotted fever (Wright et al., 2011).

<h2>PATHOGENS</h2>
The genus&nbsp;Rickettsia&nbsp;is included in the bacterial tribe Rickettsiae, family Rickettsiaceae, order Rickettsiales. The genus Rickettsia includes many species of bacteria associated with important and severe human or animal disease, including those in the spotted fever group (SFG).
Rickettsia parkeri,&nbsp;as one species of this group, has first been isolated in 1937 as a distinct rickettsial strain from Gulf Coast ticks (Amblyomma maculatum), by Ralph Robinson Parker, showing low-grade fever and periorchitis in the animal experiment (here: male guinea pigs). In 1965, the “maculatum agent” was named R. parkeri and described as a small, rod-shaped bacterium, with an average size of 1.6 x 0.5 µm, found in the nucleus and cytoplasm of infected cells (Lackman et al., 1965). Until 2002 the agent most often was relegated to the group of ‘non-pathogenic’ SFG rickettsiae, found in ticks in the United States, when the first confirmed infection with R.&nbsp;parkeri&nbsp;in a human was identified in Virginia (Paddock et al., 2004).

Pathogens

<h2>EPIDEMIOLOGY</h2>
Rickettsia parkeri&nbsp;is an emerging agent of tick-borne rickettsiosis in the Americas. More than 60 years after its initial isolation from tick vectors, it was recognised as a human pathogen.
R. parkeri&nbsp;has been isolated from Gulf Coast ticks (Amblyomma maculatum) in Alabama, Georgia, Mississippi, and Texas (Parker et al., 1939; Parker, 1940; Philip and White, 1955; Philip et al., 1978). It could further be detected in Gulf Coast ticks collected again from Georgia, Florida, Kentucky, Mississippi, Oklahoma and South Carolina (Sumner et al., 2007). While the geographic range of A.&nbsp;maculatum&nbsp;has historically been the southeastern USA, particularly those states bordering the Gulf Coast, established populations of this tick have recently also been found in Virginia (Fornadel et al., 2011; Wright et al., 2011) and Delaware (Florin et al., 2014), suggesting the tick is expanding its range northward.
Apart from the United States,&nbsp;R. parkeri&nbsp;has also been described as an emerging human pathogen in Uruguay (Venzal et al., 2004) and was furthermore detected in ticks and dogs (seroconversion) in Brazil (Labruna et al., 2007; Silveira et al., 2007).
Summarizing the different vector tick species,&nbsp;A. maculatum, Amblyomma triste&nbsp;(Pacheco et al., 2006; Silveira et al., 2007) and&nbsp;Amblyomma tigrinum&nbsp;(Tomassone et al., 2010) have been reported. As these three vector ticks are established in at least 11 other Latin American countries (Guglielmone et al., 2003), the distribution of&nbsp;R. parkeri&nbsp;in the Americas is likely continental (Pacheco et al., 2006; Tomassone et al., 2010). Meanwhile the pathogen has also been detected in&nbsp;Amblyomma ovale&nbsp;(de Oliveira et al., 2019) as well as&nbsp;Amblyomma sculptum&nbsp;(Campos et al., 2020) (both in Brazil) and&nbsp;Amblyomma dubitatum&nbsp;(Lado et al., 2014) (in Uruguay).
Dogs have been characterised as sentinels for human rickettsiosis in rural areas in Brazil, Bolivia and Uruguay, by sharing the same tick species infesting humans and dogs (Labruna et al., 2007; Tomassone et al., 2010; Venzal et al., 2008). But seroconversion has also been reported in cats (Mendes et al., 2019).

Epidemiology

<h2>TRANSMISSION</h2>
Rickettsia parkeri&nbsp;was first isolated from the Gulf Coast tick&nbsp;Amblyomma maculatum&nbsp;in 1937 (Parker et al., 1939). Meanwhile it has been isolated from several other&nbsp;Amblyomma&nbsp;species (see under Epidemiology). Experimental infection of&nbsp;Amblyomma cajennense&nbsp;ticks with&nbsp;R. parkeri&nbsp;(Sangioni et al., 2005) and transstadial and transovarial transmission of R. parkeri in Amblyomma americanum, the Lone Star tick, could also be proven in the lab (Goddard, 2003), so that the distribution of&nbsp;R. parkeri&nbsp;might even be larger than the documented distribution so far.
The agent is transmitted via the infected tick during feeding. Confirmed infections have resulted from bites of nymphal and adult stage Gulf Coast ticks (Paddock et al., 2008; Whitman et al., 2007), but the preponderance of mid-to-late summer occurrences of this disease, when coupled with the phenology of&nbsp;A. maculatum&nbsp;in the southeastern United States (Cilek and Olson, 2000; Gleim et al., 2013; Hixson, 1940; Teel et al., 2010), suggest that most cases of R.&nbsp;parkeri&nbsp;rickettsiosis result from bites of adult rather than immature ticks (Paddock and Goddard, 2015).

Amblyomma americanum - 2018 update - GBLCACPAR00023.png

Transmission

<h2>PATHOGENESIS</h2>
Rickettsia parkeri&nbsp;is an obligate intracellular bacterium in the order Rickettsiales, belonging to the spotted fever group (SFG) of&nbsp;Rickettsia. Generally, SFG rickettsiae can grow in the nucleus or in the cytoplasm of the host cell. Once inside the host, the rickettsiae multiply, resulting in damage and death of these cells.
Information on the pathogenesis regarding&nbsp;R. parkeri&nbsp;is scarce and manifestation in humans is often with non-specific clinical signs and symptoms.

Pathogenesis

<h2>DIAGNOSIS</h2>
Serological assays as the indirect immunofluorescence assay (IFA) are used for the detection of antibodies in humans as well as in dogs. Generally, for rickettsial diseases one limitation of serology is the cross-reactivity that might occur between the antigens of organisms within the same genus and in different genera (Parola and Raoult, 2001), so that serology is often only considered as the first step towards diagnosing a rickettsial disease (Parola et al., 2005). In order to differentiate infections within rickettsial antigens, difference in dilution as well as cross-absorption of sera and Western-blotting can be done when cross reaction is suspected (La Scola and Raoult, 1997; Parola et al., 2003; Raoult and Paddock, 2005).
Rickettsia&nbsp;isolation in cell culture can also be used as direct evidence of the pathogen, but is usually not used in routine diagnosis due to high laboratory standard and time needed.
Additionally polymerase chain reaction (PCR) and sequencing methods are also used to detect and identify rickettsiae in blood and skin biopsies (particularly the eschar), as well as in ticks. Various generic or species-specific PCRs are available to detect rickettsial DNA in those specimens (Wölfel et al., 2008).

Diagnosis

<h2>CLINICAL SIGNS</h2>
Clinical signs of&nbsp;Rickettsia parkeri&nbsp;infection in&nbsp;humans&nbsp;have been described with a febrile illness associated with headache, myalgia, a maculopapular rash, and multiple eschars (Paddock et al., 2004). The agent produces a spotted fever-like illness similar to that of Boutonneuse fever in the Old World with areas of necrosis (eschars) at the sites of tick bites (Paddock et al., 2004; Paddock, 2005). For this reason,&nbsp;R. parkeri&nbsp;rickettsiosis in humans is sometimes referred to as American Boutonneuse fever or ABF (Goddard, 2004). It is assumed that the infection with&nbsp;R. parkeri&nbsp;has often been misdiagnosed as <a href="/en-us/diseases/tick-borne-diseases/rocky-mountain-spotted-fever/">Rocky Mountain Spotted Fever</a> (RMSF) in the United States. Several compelling lines of evidence suggest that infections with&nbsp;R. parkeri, and probably one or more other tick-borne spotted fever group (SFG) rickettsiae, are responsible for at least some of the yearly reported cases of RMSF in the US (Paddock, 2005).
In&nbsp;dogs&nbsp;seroreactivity to&nbsp;R. parkeri&nbsp;has been reported in serosurveys in several Southamerican countries (e.g., Brazil, Bolivia, Uruguay) with very different prevalences (Labruna et al., 2007; Lado et al., 2015; Saito et al., 2008; Tomassone et al., 2010). However, clinical signs in dogs correlating with a&nbsp;R. parkeri&nbsp;infection have not been described yet. Seropositivity has also been reported in surveys with&nbsp;cats&nbsp;(Mendes et al., 2019).
For special areas, where the transmitting tick species is found to infest dogs as well as humans (e.g., rural areas in Monte Negro region, Brazil), dogs have been described as sentinels (Labruna et al., 2007) and canine serology is suggested as risk indicator for spotted fever rickettsioses (Tomassone et al., 2010).

Clinical Signs

<h2>TREATMENT &amp; PREVENTION</h2>
Treatment&nbsp;with antibiotics can control the disease, and generally doxycycline is the drug of choice for treatment of all tick-borne rickettsial diseases in&nbsp;humans. For more detailed information see Biggs et al. (2016).
As with other diseases transmitted by fleas or ticks, ectoparasite control is the basis of&nbsp;prevention. Products which repel and kill ticks and fleas are the appropriate means of choice in order to protect&nbsp;dogs&nbsp;and&nbsp;cats&nbsp;from becoming infected. The sentinel position which has been attributed to dogs in the context of&nbsp;Rickettsia parkeri&nbsp;infection makes an ectoparasite control even more important.

Treatment and Prevention

<h2>REFERENCES</h2>
<h4>Introduction</h4>
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<h4>Pathogens</h4>
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<h4>Epidemiology</h4>
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<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372349/pdf/06-0577.pdf" data-new-window="true" target="_blank" rel="noopener noreferrer">Pacheco RC, Venzal JM, Richtzenhain LJ, et al.: Rickettsia parkeri in Uruguay. Emerg Infect Dis. 2006, 12, 1804-5</a>
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Tomassone L, Conte V, Parrilla G, et al.: Rickettsia infection in dogs and Rickettsia parkeri in Amblyomma tigrinum ticks, Cochabamba department, Bolivia. Vector Borne Zoonotic Dis. 2010, 10, 953-8
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<h4>Transmission</h4>
<a href="https://scholar.google.com/scholar_url?url=https://academic.oup.com/jme/article-pdf/37/3/439/18273742/jmedent37-0439.pdf%3Fcasa_token%3D77_wmS6_VE8AAAAA:HD9onaClKc7pBPIbz1y-RI2mNWnoPsiEJZeUXk1d7_6lzrcO0UwDfpe3xzotdnqFZW0vBU-vkSf4Og&amp;hl=de&amp;sa=T&amp;oi=ucasa&amp;ct=ucasa&amp;ei=_FLsXsPcGcqymAHXrojYDg&amp;scisig=AAGBfm1O1xSbxAo2odsZYBYRo5gVnEABAg" data-new-window="true" target="_blank" rel="noopener noreferrer">Cilek JE, Olson MA: Seasonal distribution of ticks (Acari: Ixodidae) in northwestern Florida. J Med Entomol. 2000, 37, 439-44</a>
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<h4>Diagnosis</h4>
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<h4>Clinical Signs</h4>
Goddard J: American Boutonneuse fever – a new spotted fever rickettsiosis. Infect Med. 2004, 21, 207-10
Labruna MB, Horta MC, Aguiar DM, et al.: Prevalence of Rickettsia infection in dogs from the urban and rural areas of Monte Negro municipality, western Amazon, Brazil. Vector Borne Zoonotic Dis. 2007, 7, 249-55
Lado P, Costa FB, Verdes JM, et al.: Seroepidemiological survey of Rickettsia spp. in dogs from the endemic area of Rickettsia parkeri rickettsiosis in Uruguay. Acta Trop. 2015, 146, 7‐10
<a href="https://www.scielo.br/pdf/rbpv/v28n4/1984-2961-rbpv-S1984-29612019092.pdf" data-new-window="true" target="_blank" rel="noopener noreferrer">Mendes JCR, Kmetiuk LB, Martins CM, et al.: Serosurvey of Rickettsia spp. in cats from a Brazilian spotted fever-endemic area. Rev Bras Parasitol Vet. 2019, 28, 713-21</a>
<a href="https://scholar.google.com/scholar_url?url=https://academic.oup.com/cid/article-pdf/38/6/805/910058/38-6-805.pdf&amp;hl=de&amp;sa=T&amp;oi=ucasa&amp;ct=ufr&amp;ei=g1YNX5qjM6iBy9YPyZKI0AY&amp;scisig=AAGBfm1uPo9DWm0Au2JfLJY79ShQ63exDA" data-new-window="true" target="_blank" rel="noopener noreferrer">Paddock CD, Sumner JW, Comer JA, et al.: Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the United States. Clin Infect Dis. 2004, 38, 805-11</a>
Paddock CD: Rickettsia parkeri as a paradigm for multiple causes of tick-borne spotted fever in the western hemisphere. Ann N Y Acad Sci. 2005, 1063, 315-26
<a href="https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.543.4621&amp;rep=rep1&amp;type=pdf" data-new-window="true" target="_blank" rel="noopener noreferrer">Saito TB, Cunha-Filho NA, Pacheco RC, et al.: Canine infection by rickettsiae and ehrlichiae in southern Brazil. Am J Trop Med Hyg. 2008, 79, 102-8</a>
Tomassone L, Conte V, Parrilla G, et al.: Rickettsia infection in dogs and Rickettsia parkeri in Amblyomma tigrinum ticks, Cochabamba Department, Bolivia. Vector Borne Zoonotic Dis. 2010, 10, 953‐8
<h4>Treatment &amp; Prevention</h4>
<a href="https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6502.pdf" data-new-window="true" target="_blank" rel="noopener noreferrer">Biggs HM, Behravesh CB, Bradley KK, et al.: Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016, 65, 1-44</a>

References

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 <tr><td><a href="/en-us/cvbd-maps">CVBD MAPS</a>
<figure data-asset-id="f9b4837d-05e5-4003-98c9-2b8f0b838a52" data-image-id="f9b4837d-05e5-4003-98c9-2b8f0b838a52"><img src="https://assets-eu-01.kc-usercontent.com:443/43db687c-fb47-015f-c990-00802940e2bc/87cc8f9d-5925-4551-ab81-30c41ab67e7a/adolfo-felix-4JL_VAgxwcU-unsplash%20%281%29.jpg" data-asset-id="f9b4837d-05e5-4003-98c9-2b8f0b838a52" data-image-id="f9b4837d-05e5-4003-98c9-2b8f0b838a52" alt=""></figure>
<h4>CVBD Maps</h4>
The CVBD Occurence World Map presents country-specific situations based on current scientific knowledge and feed-back from experts around the world in an easy-to-grasped way.
 
 
 
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<h4>Resources</h4>
Elanco Animal Health supports education in parasitology and especially in the field of vector-borne diseases.&nbsp;Access image collections, discover the World Forum calendar, interesting links and our glossary.
 
 
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<h4>CVBD World Forum</h4>
The CVBD World Forum is a working group of leading international experts with the mission to enhance knowledge and communication on companion animal vector-borne diseases for the improvement of animal, human, and environmental health.
 
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