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The family comprises two genera of small, obligately intracellular bacteria that reside free within the host cell’s cytosol, namely, and . The genus is divided by the phylogenetic clustering of species into the typhus group (TG) and spotted fever group (SFG), defined originally by their distinctive lipopolysaccharide antigens, and the transitional and other basal groups that are widely distributed in arthropods. Among SFG and TG rickettsiae the genomes have remarkable synteny. resides free in the cytosol and is maintained in nature by transovarian transmission in trombiculid mites, which transmit the infection to humans during feeding at the larval stage. For immunohistologic detection of rickettsiae, the specimen can be snap-frozen for frozen sectioning or fixed in formaldehyde for the preparation of paraffin-embedded sections. Autopsy tissues can also be examined for rickettsiae by immunohistochemistry or polymerase chain reaction (PCR). The technique of in situ hybridization has been developed but has not been reported for the detection of rickettsiae in clinical samples. Antimicrobial susceptibility studies of rickettsiae are not routinely performed clinical laboratory tests. Detection of three or more rickettsiae in vascular endothelium in biopsy specimens or four or more rickettsiae in captured circulating endothelial cells is diagnostic of rickettsial infection.

Citation: Walker D, Bouyer D. 2011. and , p 1001-1012. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch61

Key Concept Ranking

Rocky Mountain Spotted Fever
Antimicrobial Susceptibility Testing
Outer Membrane Protein B
Outer Membrane Protein A
Outer Membrane Protein B
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Image of FIGURE 1

Phylogeny of and as determined by unweighted maximum-parsimony analyses of gene sequences prepared by PAUP 4.0 software with as the outgroup. Numerical values on the branches represent the quantity of genetic divergence from the nearest node. (T) indicates type strain.

Citation: Walker D, Bouyer D. 2011. and , p 1001-1012. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch61
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Image of FIGURE 2

(Left) Direct immunofluorescence staining of skin biopsy specimens with anti-SFG antibodies facilitates rapid diagnosis. Rickettsiae are present in the vessel wall. (Right) Demonstration of rickettsial organisms in the microvasculature of the dermis in a patient with a history of RMSF. Rickettsiae are seen in the vessel wall. An immunoperoxidase stain, using monoclonal antibodies directed against SFG lipopolysaccharide, was used. Skin biopsy magnification, ×800.

Citation: Walker D, Bouyer D. 2011. and , p 1001-1012. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch61
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1. Animut, A.,, Y. Mekonnen,, D. Shimelis,, and E. Ephraim. 2009. Febrile illnesses of different etiology among outpatients in four health centers in northwestern Ethiopia. Jpn. J. Infect. Dis. 62:104110.
2. Bella, F.,, B. Font,, S. Uriz,, T. Munoz,, E. Espejo,, J. Traveria,, J. A. Serrano,, and F. Segura. 1990. Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever. Antimicrob. Agents Chemother. 34:937938.
3. Birg, M. L.,, B. La Scola,, V. Roux,, P. Brouqui,, and D. Raoult. 1999. Isolation of Rickettsia prowazekii from blood by shell vial cell culture. J. Clin. Microbiol. 37:37223724.
4. Blacksell, S. D.,, N. J. Bryant,, D. H. Paris,, J. A. Doust,, Y. Sakoda,, and N. P. J. Day. 2007. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to lots of confusion. Clin. Infect. Dis. 44:391401.
5. Boudebouch, N.,, M. Sarih,, C. Socolovschi,, T. Fatihi,, A. Chakib,, H. Amarouch,, M. Hassar,, J.-M. Rolain,, P. Parola,, and D. Raoult. 2008. Spotted fever group rickettsioses documented in Morocco. Clin. Microbiol. Infect. 15:257258.
6. Bouyer, D. H.,, J. Stenos,, P. Crocquet-Valdes,, C. G. Moron,, V. L. Popov,, J. E. Zavala-Velazquez,, L. D. Foil,, D. R. Stothard,, A. F. Azad,, and D. H. Walker. 2001. Rickettsia felis: molecular characterization of a new member of the spotted fever group. Int. J. Syst. Evol. Microbiol. 51:339347.
7. Brouqui, P.,, P. Parola,, P. E. Fournier,, and D. Raoult. 2007. Spotted fever rickettsioses in southern and eastern Europe. FEMS Immunol. Med. Microbiol. 49:212.
8. Brown, G. W.,, A. Shirai,, C. Rogers,, and M. G. Groves. 1983. Diagnostic criteria for scrub typhus: probability values for immunofluorescent antibody and Proteus OXK agglutinin titers. Am. J. Trop. Med. Hyg. 32:11011107.
9. Cascio, A.,, C. Colomba,, D. Di Rosa,, L. Salsa,, L. di Martino,, and L. Titone. 2001. Efficacy and safety of clarithromycin as treatment for Mediterranean spotted fever in children: a randomized controlled trial. Clin. Infect. Dis. 33:409411.
10. Chapman, A. S., in collaboration with the Tickborne Rickettsial Diseases Working Group. 2006. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States. MMWR Recommend. Rep. 55 (RR-4):127.
11. Charoensak, A.,, O. Charwalparit,, C. Suttinont,, K. Niwattayakul,, K. Losuwanaluk,, S. Silpasakor,, and Y. Suputtamongkol. 2006. Scrub typhus: chest radiographic and clinical findings in 130 Thai patients. J. Med. Assoc. Thai. 89:600606.
12. Ching, W. M.,, D. Rowland,, Z. Zhang,, A. L. Bourgeois,, D. Kelly,, G. A. Dasch,, and P. L. Devine. 2001. Early diagnosis of scrub typhus with a rapid flow assay using recombinant major outer membrane protein antigen (r56) of Orientia tsutsugamushi. Clin. Diagn. Lab. Immunol. 8:409414.
13. Cho, N.-H.,, H.-R. Kim,, J.-H. Lee,, S.-Y. K. J. Kim,, S. Cha,, S.-Y. Kim,, A. C. Darby,, H.-H. Fuxelius,, J. Yin,, J. H. Kim,, H. Kim,, S. J. Lee,, Y.-S. Koh,, W.-J. Jang,, K.-H. Park,, S. G. E. Andersson,, M.-S. Choi,, and K.-S. Kim. 2007. The Orientia tsutsugamushi genome reveals massive proliferation of conjugative type IV secretion system and host-cell interaction genes. Proc. Natl. Acad. Sci. USA 104:79817986.
14. Choi, Y.-J.,, W.-J. Jang,, J.-H. Kim,, J.-S. Ryu,, S.-H. Lee,, K.-H. Park,, H.-S. Paik,, Y.-S. Koh,, M.-S. Choi,, and I.-S. Kim. 2005. Spotted fever group and typhus group rickettsioses in humans, South Korea. Emerg. Infect. Dis. 11:237244.
15. Coleman, R. E.,, V. Sangkasuwan,, N. Suwanabun,, C. Eamsila,, S. Mungviriya,, P. Devine,, A. L. Richards,, D. Rowland,, W.-M. Ching,, J. Sattabongkot,, and K. Lerdthusnee. 2002. Comparative evaluation of selected diagnostic assays for the detection of IgG and IgM antibody to Orientia tsutsugamushi in Thailand. Am. J. Trop. Med. Hyg. 67:497503.
16. de Sousa, R.,, A. Franca,, S. D. Nobrega,, A. Belo,, M. Amaro,, T. Abreu,, J. Pocas,, P. Proenca,, J. Vaz,, J. Torgal,, F. Bacellar,, N. Ismail,, and D. H. Walker. 2008. Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients. J. Infect. Dis. 198:576585.
17. Dobler, G.,, and R. Wolfel. 2009. Typhus and other rickettsioses. Dtsch. Arztebl. Int. 106:348354.
18. Dumler, J.,, J. P. Taylor,, and D. H. Walker. 1991. Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987. JAMA 266:13651370.
19. Eremeeva, M. E.,, N. M. Balayeva,, and D. Raoult. 1994. Serological response of patients suffering from primary and recrudescent typhus: comparison of complement fixation reaction, Weil-Felix test, microimmunofluorescence, and immunoblotting. Clin. Diagn. Lab. Immunol. 1:318324.
20. Fenollar, F.,, and D. Raoult. 1999. Diagnosis of rickettsial diseases using samples dried on blotting paper. Clin. Diagn. Lab. Immunol. 6:483488.
21. Fournier, P. E.,, J. S. Dumler,, G. Greub,, J. Zhang,, Y. Wu,, and D. Raoult. 2003. Gene sequence-based criteria for identification of new Rickettsia isolates and description of Rickettsia heilongjiangensis sp. nov. J. Clin. Microbiol. 41:54565465.
22. Fournier, P. E.,, and D. Raoult. 2004. Suicide PCR on skin biopsy specimens for diagnosis of rickettsioses. J. Clin. Microbiol. 42:34283434.
23. Furuya, Y.,, T. Katayama,, Y. Yoshida,, and I. Kaiho. 1995. Specific amplification of Rickettsia japonica DNA from clinical specimens by PCR. J. Clin. Microbiol. 33:487489.
24. Gevers, D.,, F. M. Cohan,, J. G. Lawrence,, B. G. Spratt,, T. Coenye,, E. J. Feil,, E. Stackebrandt,, Y. Van de Peer,, P. Vandamme,, F. L. Thompson,, and J. Swings. 2005. Re-evaluating prokaryotic species. Nat. Rev. Microbiol. 3:733739.
25. Gikas, A.,, S. Doukakis,, J. Pediaditis,, S. Kastanakis,, A. Psaroulaki,, and Y. Tselentis. 2002. Murine typhus in Greece: epidemiological, clinical, and therapeutic data from 83 cases. Trans. R. Soc. Trop. Med. Hyg. 96:250253.
26. Gillespie, J. J.,, K. Williams,, M. Shukla,, E. E. Snyder,, E. K. Norkberg,, S. M. Ceraul,, C. Dharmanolla,, D. Rainery,, J. Soneja,, J. M. Shallom,, N. Dongre Vishnubhat,, R. Wattam,, A. Purkayastha,, M. Czar,, O. Crasta,, J. C. Setubal,, A. F. Azad,, and B. S. Sobral. 2008. Rickettsia phylogenomics: unwinding the intricacies of obligate intracellular life. PLoS One 3:e2018.
27. Gilmore, R. D., Jr. 1993. Comparison of the rompA gene repeat regions of Rickettsiae reveals species-specific arrangements of individual repeating units. Gene 125:97102.
28. Hechemy, K. E.,, R. L. Anacker,, R. N. Philip,, K. T. Kleeman,, J. N. MacCormack,, S. J. Sasowski,, and E. E. Michaelson. 1980. Detection of Rocky Mountain spotted fever antibodies by a latex agglutination test. J. Clin. Microbiol. 12:144150.
29. Holman, R. C.,, C. D. Paddock,, A. T. Curns,, J. W. Krebs,, J. H. McQuiston,, and J. E. Childs. 2001. Analysis of risk factors for fatal Rocky Mountain spotted fever: evidence for superiority of tetracyclines for therapy. J. Infect. Dis. 184:14371444.
30. Horney, L. F.,, and D. H. Walker. 1988. Meningoencephalitis as a major manifestation of Rocky Mountain spotted fever. South. Med. J. 81:915918.
31. Horta, M. C.,, J. Moraes-Filho,, R. A. Casagrande,, T. B. Saito,, S. C. Rosa,, M. Ogrzewalska,, E. R. Matushima,, and M. B. Labruna. 2009. Experimental infection of opossums Didelphis aurita by Rickettsia rickettsii and evaluation of the transmission of the infection to ticks Amblyomma cajennense. Vector Borne Zoonotic Dis. 9:109118.
32. Jado, I.,, J. A. Oteo,, M. Aldamiz,, H. Gil,, R. Escudero,, V. Ibarra,, J. Portu,, A. Portillo,, M. J. Lezaun,, C. Garcia-Amil,, I. Rodríguez-Moreno,, and P. Anda. 2007. Rickettsia monacensis and human disease, Spain. Emerg. Infect. Dis. 13:14051407.
33. Jang, W. J.,, M. S. Huh,, K. H. Park,, M. S. Choi,, and I. S. Kim. 2003. Evaluation of an immunoglobulin M capture enzyme- linked immunosorbent assay for diagnosis of Orientia tsutsugamushi infection. Clin. Diagn. Lab. Immunol. 10:394398.
34. Jensenius, M.,, P. E. Fournier,, S. Vene,, S. H. Ringertz,, B. Myrvang,, and D. Raoult. 2004. Comparison of immunofluorescence, Western blotting, and cross-adsorption assays for diagnosis of African tick bite fever. Clin. Diagn. Lab. Immunol. 11:786788.
35. Jiang, J.,, T. C. Chan,, J. J. Temenak,, G. A. Dasch,, W. M. Ching,, and A. L. Richards. 2004. Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi. Am. J. Trop. Med. Hyg. 70:351356.
36. Jiang, J.,, K. J. Marienau,, L. A. May,, H. J. Beecham III,, R. Wilkinson,, W.-M. Ching,, and A. L. Richards. 2003. Laboratory diagnosis of two scrub typhus outbreaks at Camp Fuji, Japan in 2000 and 2001 by enzyme-linked immunosorbent assay, rapid flow assay, and Western blot assay using outer membrane 56-kD recombinant proteins. Am. J. Trop. Med. Hyg. 69:6066.
37. Kaplan, J. E.,, and L. B. Schonberger. 1986. The sensitivity of various serologic tests in the diagnosis of Rocky Mountain spotted fever. Am. J. Trop. Med. Hyg. 35:840844.
38. Kaplowitz, L. G.,, J. V. Lange,, J. J. Fischer,, and D. H. Walker. 1983. Correlation of rickettsial titers, circulating endotoxin, and clinical features in Rocky Mountain spotted fever. Arch. Intern. Med. 143:11491151.
39. Kass, E. M.,, W. K. Szaniawski,, H. Levy,, J. Leach,, K. Srinivasan,, and C. Rives. 1994. Rickettsialpox in a New York City hospital, 1980 to 1989 N. Engl. J. Med. 331:16121617.
40. Kelly, D. J.,, P. A. Fuerst,, W-M. Ching,, and A. L. Richards. 2009. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin. Infect. Dis. 48:S203S230.
41. Kelly, D. J.,, C. T. Chan,, H. Paxton,, K. Thompson,, R. Howard,, and G. A. Dasch. 1995. Comparative evaluation of a commercial enzyme immunoassay for the detection of human antibody to Rickettsia typhi. Clin. Diagn. Lab. Immunol. 2:356360.
42. Kelly, D. J.,, P. W. Wong,, E. Gan,, and G. E. Lewis, Jr. 1988. Comparative evaluation of the indirect immunoperoxidase test for the serodiagnosis of rickettsial disease. Am. J. Trop. Med. Hyg. 38:400406.
43. Kidd, L.,, R. Maggi,, P. P. V. P. Diniz,, B. Hegarty,, M. Tucker,, and E. Breitschwerdt. 2008. Evaluation of conventional and real-time PCR assays for detection and differentiation of spotted fever group Rickettsia in dog blood. Vet. Microbiol. 129:294303.
44. Kim, D.-M.,, H. L. Kim,, C. Y. Park,, T. Y. Yang,, J. H. Lee,, J. T. Yang,, S.-K. Shim,, and S.-H. Lee. 2006. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin. Infect. Dis. 43:12961300.
45. Kim, Y.-S.,, H.-J. Yun,, S. K. Shim,, S. H. Koo,, S. Y. Kim,, and S. Kim. 2004. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin. Infect. Dis. 39:13291335.
46. Labruna, M. B.,, M. Ogrzewalska,, T. F. Martins,, A. Pinter,, and M. C. Horta. 2008. Comparative susceptibility of larval stages of Amblyomma aureolatum, Amblyomma cajennense, and Rhipicephalus sanguineus to infection by Rickettsia rickettsii. J. Med. Microbiol. 45:11561159.
47. Labruna, M. B.,, T. Whitworth,, M. C. Horta,, D. H. Bouyer,, J. W. McBride,, A. Pinter,, V. Popov,, S. M. Gennari,, and D. H. Walker. 2004. Rickettsia species infecting Amblyomma cooperi ticks from an area in the state of São Paulo, Brazil, where Brazilian spotted fever is endemic. J. Clin. Microbiol. 42:9098.
48. La Scola, B.,, and D. Raoult. 1996. Diagnosis of Mediterranean spotted fever by cultivation of Rickettsia conorii from blood and skin samples using the centrifugation-shell vial technique and by detection of R. conorii in circulating endothelial cells: a 6-year follow-up. J. Clin. Microbiol. 34:27222727.
49. La Scola, B.,, L. Rydkina,, J. B. Ndihokubwayo,, S. Vene,, and D. Raoult. 2000. Serological differentiation of murine typhus and epidemic typhus using cross-adsorption and Western blotting. Clin. Diagn. Lab. Immunol. 7:612616.
50. Lee, J.-H.,, H.-S. Park,, W.-J. Jang,, S.-E. Koh,, J.-M. Kim,, S.-K. Shim,, M.-Y. Park,, Y.-W. Kim,, B.-J. Kim,, Y.-H. Kook,, K.-H. Park,, and S.-H. Lee. 2003. Differentiation of rickettsiae by groEL gene analysis. J. Clin. Microbiol. 41:29522960.
51. Lee, N.,, M. Ip,, B. Wong,, G. Lui,, W. T. Y. Tsang,, J. Y. Lai,, K. W. Choi,, R. Lam,, T. K. Ng,, J. Ho,, Y. Y. Chan,, C. S. Cockram,, and S. T. Lai. 2008. Risk factors associated with life-threatening rickettsial infections. Am. J. Trop. Med. Hyg. 78:973978.
52. Leitner, M.,, S. Yitzhaki,, S. Rzotkiewicz,, and A. Keysary. 2002. Polymerase chain reaction-based diagnosis of Mediterranean spotted fever in serum and tissue samples. Am. J. Trop. Med. Hyg. 67:166169.
53. Liu, Y.-X.,, W.-C. Cao,, Y. Gao,, J.-L. Zhang,, Z.-Q. Yang,, Z.-T. Zhao,, and J. E. Foley. 2006. Orientia tsutsugamushi in eschars from scrub typhus patients. Emerg. Infect. Dis. 12:11091112.
54. Martinez, J. J.,, S. Seveau,, E. Veiga,, S. Matsuyama,, and P. Cossart. 2005. Ku70, a component of DNA-dependent protein kinase, is a mammalian receptor for Rickettsia conorii. Cell 123:10131023.
55. Martinez, J. J.,, and P. Cossart. 2004. Early signaling events involved in the entry of Rickettsia conorii into mammalian cells. J. Cell Sci. 117:50975106.
56. McDade, J. E.,, C. C. Shepard,, M. A. Redus,, V. F. Newhouse,, and J. D. Smith. 1980. Evidence of Rickettsia prowazekii infections in the United States. Am. J. Trop. Med. Hyg. 29:277284.
57. McLeod, M. P.,, X. Qin,, S. E. Karpathy,, J. Gioia,, S. K. Highlander,, G. E. Fox,, T. Z. McNeill,, J. Jiang,, D. Muzny,, L. S. Jacob,, A. C. Hawes,, E. Sodergren,, R. Gill,, J. Hume,, M. Morgan,, G. Fan,, A. A. Amin,, R. A. Gibbs,, C. Hong,, X-Y. Yu,, D. H. Walker,, and G. M. Weinstock. 2004. Complete genome sequence of Rickettsia typhi and comparison with sequences of other rickettsiae. J. Bacteriol. 186:58425855.
58. Meloni, G.,, and T. Meloni. 1996. Azithromycin vs. doxycycline for Mediterranean spotted fever. Pediatr. Infect. Dis. J. 15:10421044.
59. Montenegro, M. R.,, S. Mansueto,, B. C. Hegarty,, and D. H. Walker. 1983. The histology of “taches noires” of boutonneuse fever and demonstration of Rickettsia conorii in them by immunofluorescence. Virchows Arch. 400:309317.
60. Moron, C. L.,, H.-M. Feng,, D. J. Wear,, and D. H. Walker. 2000. Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus. Mod. Pathol. 14:752759.
61. Mouffok, N.,, P. Parola,, H. Lepidi,, and D. Raoult. 2009. Mediterranean spotted fever in Algeria—new trends. Int. J. Infect. Dis. 13:227235.
62. Nascimento, E. M. M.,, S. Colombo,, T. K. Nagasse-Sugahara,, R. N. Angerami,, M. R. Resende,, L. J. da Silva,, G. Katz,, and F. C. P. dos Santos. 2009. Evaluation of PCR-based assay in human serum samples for diagnosis of fatal cases of spotted fever group rickettsiosis. Clin. Microbiol. Infect. 15:232234.
63. Ndip, L. M.,, E. B. Fokam,, D. H. Bouyer,, R. N. Ndip,, V. P. Titanji,, D. H. Walker,, and J. W. McBride. 2004. Detection of Rickettsia africae in patients and ticks along the coastal region of Cameroon. Am. J. Trop. Med. Hyg. 71:363366.
64. Nilsson, K. 2009. Septicaemia with Rickettsia helvetica in a patient with acute febrile illness, rash and myasthenia. J. Infect. 58:7982.
65. Ono, A.,, K. Nakamura,, S. Higuchi,, Y. Miwa,, K. Nakamura,, T. Tsunoda,, H. Kuwabara,, Y. Furuya,, K. Dobashi,, and M. Mori. 2002. Successful diagnosis using scab for PCR specimen in tsutsugamushi disease. Intern. Med. 41:408411.
66. Paddock, C. D.,, R. W. Finley,, C. S. Wright,, H. N. Robinson,, B. J. Schrodt,, C. C. Lane,, O. Ekenna,, M. A. Blass,, C. L. Tamminga,, C. A. Ohl,, S. L. F. McLellan,, J. Goddard,, R. C. Holman,, J. J. Openshaw,, J. W. Sumner,, S. R. Zaki,, and M. E. Ermeeva. 2008. Rickettsia parkeri rickettsiosis and its clinical distinction from Rocky Mountain spotted fever. Clin. Infect. Dis. 47:11881196.
67. Paris, D. H.,, N. Aukkanit,, K. Jenjaroen,, S. D. Blacksell,, and N. P. J. Day. 2009. A highly sensitive quantitative real-time PCR assay based on the groEL gene of contemporary Thai strains of Orientia tsutsugamushi. Clin. Microbiol. Infect. 15:488495.
68. Paris, D. H.,, S. D. Blacksell,, P. N. Newton,, and N. P. J. Day. 2008. Simple, rapid and sensitive detection of Orientia tsutsugamushi by loop-isothermal DNA amplification. Trans. R. Soc. Trop. Med. Hyg. 102:12391246.
69. Parola, P.,, R. S. Miller,, P. McDaniel,, S. R. Telford III,, J.-M. Rolain,, C. Wongsrichanalai,, and D. Raoult. 2003. Emerging rickettsioses of the Thai-Myanmar border. Emerg. Infect. Dis. 9:592595.
70. Parola, P.,, C. D. Paddock,, and D. Raoult. 2005. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin. Microbiol. Rev. 18:719756.
71. Parola, P.,, D. Vogelaers,, C. Roure,, F. Janbon,, and D. Raoult. 1998. Murine typhus in travelers returning from Indonesia. Emerg. Infect. Dis. 4:677680.
72. Phetsouvanh, R.,, S. D. Blacksell,, K. Jenjaroen,, N. P. J. Day,, and P. N. Newton. 2009. Comparison of indirect immunofluorescence assays for diagnosis of scrub typhus and murine typhus using venous blood and finger prick filter paper blood spots. Am. J. Trop. Med. Hyg. 80:837840.
73. Prakash, J. A. J.,, M. E. Reller,, N. Barat,, and J. S. Dumler. 2009. Assessment of a quantitative multiplex 59 nuclease realtime PCR for spotted fever and typhus group rickettsioses and Orientia tsutsugamushi. Clin. Microbiol. Infect. 15:292293.
74. Premaratna, R.,, T. G. A. N. Chandrasena,, A. S. Dassayake,, A. D. Loftis,, G. A. Dasch,, and H. D. de Silva. 2006. Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin. Infect. Dis. 42:e6e8.
75. Premaratna, R.,, A. D. Loftis,, T. G. A. N. Chandrasena,, G. A. Dasch,, and J. J. de Silva. 2008. Rickettsial infections and their clinical presentations in the western province of Sri Lanka: a hospital-based study. Int. J. Infect. Dis. 12:198202.
76. Pretorius, A.-M.,, and R. J. Birtles. 2002. Rickettsia aeschlimannii: a new pathogenic spotted fever group rickettsia, South Africa. Emerg. Infect. Dis. 8:874.
77. Raoult, D.,, P.-E. Fournier,, F. Fenollar,, M. Jensenius,, T. Prioe,, J. J. De Pina,, G. Caruso,, N. Jones,, H. Laferl,, J. E. Rosenblatt,, and T. J. Marrie. 2001. Rickettsia africae, a tickborne pathogen in travelers to sub-Saharan Africa. N. Engl. J. Med. 344:15011510.
78. Raoult, D.,, A. Lakos,, F. Fenollar,, J. Beytout,, P. Brouqui,, and P.-E. Fournier. 2002. Spotless rickettsiosis caused by Rickettsia slovaca and associated with Dermacentor ticks. Clin. Infect. Dis. 34:13311336.
79. Raoult, D.,, and M. Maurin,. 2002. Rickettsia species, p. 913921. In V. L. Yu,, R. Webber,, and D. Raoult (ed.), Antimicrobial Therapy and Vaccines, 2nd ed. Apple Trees Production, LLC, New York, NY.
80. Regnery, R. L.,, C. L. Spruill,, and B. D. Plikaytis. 1991. Genotypic identification of rickettsiae and estimation of intraspecies sequence divergence for portions of two rickettsial genes. J. Bacteriol. 173:15761589.
81. Rolain, J. M.,, L. Stuhl,, M. Maurin,, and D. Raoult. 2002. Evaluation of antibiotic susceptibilities of three rickettsial species including Rickettsia felis by a quantitative PCR DNA assay. Antimicrob. Agents Chemother. 46:27472751.
82. Roux, V.,, and D. Raoult. 1999. Body lice as tools for diagnosis and surveillance of reemerging diseases. J. Clin. Microbiol. 37:596599.
83. Ruiz-Beltrán, R.,, and J. I. Herrero-Herrero. 1992. Evaluation of ciprofloxacin and doxycycline in the treatment of Mediterranean spotted fever. Eur. J. Clin. Microbiol. Infect. Dis. 11:427431.
84. Saisongkorh, W.,, M. Chenchittikul,, and K. Silpapojakul. 2004. Evaluation of nested PCR for the diagnosis of scrub typhus among patients with acute pyrexia of unknown origin. Trans. R. Soc. Trop. Med. Hyg. 98:360366.
85. Sangkasuwan, V.,, T. Chatyingmongkol,, S. Sukwit,, C. Eamsila,, T. Chuenchitra,, W. Rodkvamtook,, J. Jiang,, A. L. Richards,, K. Lerdthusnee,, and J. W. Jones. 2007. Description of the first reported human case of spotted fever group rickettsiosis in urban Bangkok. Am. J. Trop. Med. Hyg. 77:891892.
86. Schriefer, M. E.,, J. B. Sacci, Jr.,, J. S. Dumler,, M. G. Bullen,, and A. F. Azad. 1994. Identification of a novel rickettsial infection in a patient diagnosed with murine typhus. J. Clin. Microbiol. 32:949954.
87. Shpynov, S.,, P. E. Fournier,, N. Rudakov,, I. Arsen’eva,, M. Granitov,, I. Tarasevich,, and D. Raoult. 2009. Tick-borne rickettsiosis in the Altay region of Russia. Clin. Microbiol. Infect. 15:313314.
88. Silpapojakul, K. 1997. Scrub typhus in the Western Pacific region. Ann. Acad. Med. Singapore 26:794800.
89. Singhsilarak, T.,, W. Leowattana,, S. Looareesuwan,, V. Wongchotigul,, J. Jiang,, A. L. Richards,, and G. Watt. 2005. Short report: detection of Orientia tsutsugamushi in clinical samples by quantitative real-time polymerase chain reaction. Am. J. Trop. Med. Hyg. 72:640641.
90. Sirisanthana, V.,, T. Puthanakit,, and T. Sirisanthana. 2003. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr. Infect. Dis. 22:341345.
91. Sonthayanon, P.,, W. Chierakul,, V. Wuthiekanun,, K. Phimda,, S. Pukrittayakamee,, N. P. Day,, and S. J. Peacock. 2009. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J. Clin. Microbiol. 47:430434.
92. Souza, C. E.,, J. Moraes-Filho,, M. Ogrzewalska,, F. C. Uchoa,, M. C. Horta,, S. S. L. Souza,, R. C. M. Borba,, and M. B. Labruna. 2009. Experimental infection of capybaras Hydrochoerus hydrochaeris by Rickettsia rickettsii and evaluation of the transmission of the infection to ticks Amblyomma cajennense. Vet. Parasitol. 161:116121.
93. Stenos, J.,, S. R. Graves,, and N. B. Unsworth. 2005. A highly sensitive and specific real-time PCR assay for the detection of spotted fever and typhus group rickettsiae. Am. J. Trop. Med. Hyg. 73:10831085.
94. Strickman, D.,, T. Sheer,, K. Salata,, J. Hershey,, G. Dasch,, D. Kelly,, and R. Kuschner. 1995. In vitro effectiveness of azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus. Antmicrob. Agents Chemother. 39:24062410.
95. Suputtamongkol, Y.,, C. Suttinont,, K. Niwatayakul,, S. Hoontrakul,, R. Limpaiboon,, W. Chierakul,, K. Losuwanaluk,, and W. Saisongkork. 2009. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann. N. Y. Acad. Sci. 1166:172179.
96. Tsai, K.-H.,, H. Y. Lu,, J. J. Tsai,, S. K. Yu,, J. H. Huang,, and P. Y. Shu. 2008. Human case of Rickettsia felis infection, Taiwan. Emerg. Infect. Dis. 14:19701972.
97. Valbuena, G.,, W. Bradford,, and D. H. Walker. 2003. Expression analysis of the T-cell-targeting chemokines CXCL9 and CXCL10 in mice and humans with endothelial infections caused by rickettsiae of the spotted fever group. Am. J. Pathol. 163:13571369.
98. Vishwanath, S. 1991. Antigenic relationships among the rickettsiae of the spotted fever and typhus groups. FEMS Microbiol. Lett. 81:341344.
99. Vitorino, L.,, S.-M. Chen,, F. Bacellar,, and L. Ze-Ze. 2007. Rickettsiae phylogeny: a multigenic approach. Microbiology 153:160168.
100. Walker, D. H. 2003. Principles of the malicious use of infectious agents to create terror: reasons for concern for organisms of the genus Rickettsia. Ann. N. Y. Acad. Sci. 990:739742.
101. Walker, D. H.,, M. S. Burday,, and J. D. Folds. 1980. Laboratory diagnosis of Rocky Mountain spotted fever. South. Med. J. 73:14431447.
102. Walker, D. H.,, C. G. Crawford,, and B. G. Cain. 1980. Rickettsial infection of pulmonary microcirculation: the basis for interstitial pneumonitis in Rocky Mountain spotted fever. Hum. Pathol. 11:263272.
103. Walker, D. H.,, H-M. Feng,, S. Ladner,, A. N. Billings,, S. R. Zaki,, D. J. Wear,, and B. Hightower. 1997. Immunohistochemical diagnosis of typhus rickettsioses using an anti-lipopolysaccharide monoclonal antibody. Mod. Pathol. 10:10381042.
104. Walker, D. H.,, S. D. Hudnall,, W. K. Szaniawski,, and H.-M. Feng. 1999. Monoclonal antibody-based immunohistochemical diagnosis of rickettsialpox: the macrophage is the principal target. Mod. Pathol. 12:529533.
105. Walker, D. H.,, F. M. Parks,, T. G. Betz,, J. P. Taylor,, and J. W. Muehlberger. 1989. Histopathology and immunohistologic demonstration of the distribution of Rickettsia typhi in fatal murine typhus. Am. J. Clin. Pathol. 91:720724.
106. Wang, C.-C.,, S.-F. Liu,, J.-W. Liu,, Y.-H. Chung,, M.-C. Su,, and M.-C. Lin. 2007. Acute respiratory distress syndrome in scrub typhus. Am. J. Trop. Med. Hyg. 76:11481152.
107. Watt, G.,, C. Chouriyagune,, R. Ruangweerayud,, P. Watcharapichat,, D. Phulsuksombati,, K. Jongsakul,, P. Teja-Isavadharm,, D. Bhodhidatta,, K. D. Corcoran,, G. A. Dasch,, and D. Strickman. 1996. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet 348:8689.
108. Watt, G.,, K. Jongsakul,, R. Ruangvirayuth,, P. Kantipong,, and K. Silpapojakul. 2005. Short report: prospective evaluation of a multi-test strip for the diagnoses of scrub and murine typhus, leptospirosis, dengue fever, and Salmonella typhi infection. Am. J. Trop. Med. Hyg. 72:1012.
109. Watt, G.,, and D. Strickman. 1994. Life-threatening scrub typhus in a traveler returning from Thailand. Clin. Infect. Dis. 18:624626.
110. Weddle, J. R.,, T.-C. Chan,, K. Thompson,, H. Paxton,, D. J. Kelly,, G. Dasch,, and D. Strickman. 1995. Effectiveness of a dot-blot immunoassay of anti-Rickettsia tsutsugamushi antibodies for serologic analysis of scrub typhus. Am. J. Trop. Med. Hyg. 53:4346.
111. Weinert, L. A.,, J. H. Werren,, A. Aebi,, G. N. Stone,, and F. M. Jiggins. 2009. Evolution and diversity of Rickettsia bacteria. BMC Biol. 7:6. http://www.biomedcentral.com/1741-7007/7/6..
112. Whitworth, T.,, V. L. Popov,, X. J. Yu,, D. H. Walker,, and D. H. Bouyer. 2005. Expression of Rickettsia prowazekii pld or tlyC gene in Salmonella enterica serovar Typhimurium mediates phagosomal escape. Infect. Immun. 73:66686673.
113. Wilkinson, R.,, D. Rowland,, and W. M. Ching. 2003. Development of an improved rapid lateral flow assay for the detection of Orientia tsutsugamushi-specific IgG/IgM antibodies. Ann. N. Y. Acad. Sci. 990:386390.
114. Wolfel, R.,, S. Essbauer,, and G. Gobler. 2008. Concepts of modern rickettsial diagnosis. Int. J. Med. Microbiol. 298: 368374.
115. Yu, X. J.,, and D. H. Walker,. 2005. Family I. Rickettsiaceae, p. 96116. In G. M. Garrity et al. (ed.), Bergey’s Manual of Systematic Bacteriology, 2nd ed., vol. 2. Williams & Wilkins, Baltimore, MD.
116. Zavala-Castro, J.,, J. Zavala-Velazquez,, D. H. Walker,, J. Perez-Osorio,, and G. Peniche-Lara. 2009. Severe human infection with Rickettsia felis associated with hepatitis in Yucatan, Mexico. Int. J. Med. Microbiol. 299:529533.
117. Zavala-Castro, J. E.,, K. R. Dzul-Rosado,, J. J. A. Leon,, D. H. Walker,, and J. E. Zavala-Velazquez. 2008. Short report: Rickettsia felis outer membrane protein A: a potential tool for diagnosis of patients with flea-borne spotted fever. Am. J. Trop. Med. Hyg. 79:903906.
118. Zavala-Castro, J. E.,, K. R. Dzul-Rosado,, J. J. A. Leon,, D. H. Walker,, and J. E. Zavala-Velazquez. 2008. An increase in human cases of spotted fever rickettsiosis in Yucatan, Mexico, involving children. Am. J. Trop. Med. Hyg. 79:907910.
119. Zavala-Velazquez, J. E.,, J. A. Ruiz-Sosa,, R. A. Sanchez- Elias,, G. Becerra-Carmona,, and D. H. Walker. 2000. Rickettsia felis rickettsiosis in Yucatan. Lancet 356:10791080.
120. Znazen, A.,, J.-M. Rolain,, N. Hammami,, A. Hammami,, M. B. Jemaa,, and D. Raoult. 2006. Rickettsia felis infection, Tunisia. Emerg. Infect. Dis. 12:138140.


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Characteristics of and

LPS, lipopolysaccharide; S, SFG LPS present; T, TG LPS present; B, -type LPS present. Symbols: 1, present; 0, absent.

Citation: Walker D, Bouyer D. 2011. and , p 1001-1012. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch61
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Etiology, epidemiology, and ecology of rickettsial diseases

Citation: Walker D, Bouyer D. 2011. and , p 1001-1012. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch61

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