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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
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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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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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