Rickettsia parkeri rickettsiosis and its clinical distinction from Rocky Mountain spotted fever
Rickettsia parkeri rickettsiosis and its clinical distinction from Rocky Mountain spotted fever
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DOI：
10.1086/592254
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发表时间：
2008-11-01
影响因子：
11.8
通讯作者：
Eremeeva, Marina E.
中科院分区：
文献类型：
--
作者：
Paddock, Christopher D.;Finley, Richard W.;Eremeeva, Marina E.
背景。帕克里立克次体病是一种最近发现的由墨西哥湾沿岸蜱（Amblyomma maculatum）传播的斑疹热，于 2004 年首次被描述。我们总结了美国 12 名确诊或疑似由帕克里立克次体感染的患者的临床和流行病学特征，并对帕克里立克次体病与美国其他地区的区别进行了评论 立克次体病。方法。美国疾病控制和预防中心（佐治亚州亚特兰大）对居住在斑 A. maculatum 范围内且描述有焦痂或水疱性皮疹的患者的临床标本进行了 1 次以上实验室检测评估，以确定可能或确诊的 R. Parkeri 感染。结果。 1998年至2007年期间，提交了来自12名流行病学和临床上与帕克里立克次体病相符的疾病的患者的临床样本进行诊断评估。使用间接免疫荧光抗体测定、免疫组织化学、聚合酶链反应测定和细胞培养物分离，我们鉴定了 6 例确诊病例和 6 例疑似感染帕克里氏菌感染病例。这些患者的总体临床特征揭示了一种与经典描述的落基山斑疹热相似但较轻的疾病。结论。更密切地关注美国和西半球其他国家存在的各种斑疹热综合征的独特临床特征，再加上更频繁地使用特定的验证性检测，可能会揭示上个世纪被统称为落基山斑疹热的几种独特疾病。对这些不同感染的准确评估最终将为目前公认的落基山斑疹热的分布、发病率和病死率提供更有效的描述。
Background. Rickettsia parkeri rickettsiosis, a recently identified spotted fever transmitted by the Gulf Coast tick (Amblyomma maculatum), was first described in 2004. We summarize the clinical and epidemiological features of 12 patients in the United States with confirmed or probable disease attributable to R. parkeri and comment on distinctions between R. parkeri rickettsiosis and other United States rickettsioses.Methods. Clinical specimens from patients in the United States who reside within the range of A. maculatum for whom an eschar or vesicular rash was described were evaluated by >= 1 laboratory assays at the Centers for Disease Control and Prevention (Atlanta, GA) to identify probable or confirmed infection with R. parkeri.Results. During 1998-2007, clinical samples from 12 patients with illnesses epidemiologically and clinically compatible with R. parkeri rickettsiosis were submitted for diagnostic evaluation. Using indirect immunofluorescence antibody assays, immunohistochemistry, polymerase chain reaction assays, and cell culture isolation, we identified 6 confirmed and 6 probable cases of infection with R. parkeri. The aggregate clinical characteristics of these patients revealed a disease similar to but less severe than classically described Rocky Mountain spotted fever.Conclusions. Closer attention to the distinct clinical features of the various spotted fever syndromes that exist in the United States and other countries of the Western hemisphere, coupled with more frequent use of specific confirmatory assays, may unveil several unique diseases that have been identified collectively as Rocky Mountain spotted fever during the past century. Accurate assessments of these distinct infections will ultimately provide a more valid description of the currently recognized distribution, incidence, and case-fatality rate of Rocky Mountain spotted fever.