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We report a case of rickettsiosis caused by Rickettsia monacensis in an immunocompetent 67-year-old man in Portugal who had eschar, erythematous rash, and an attached Ixodes ricinus tick. Seroconversion and eschar biopsy led to confirmed diagnosis by PCR. Physicians should be aware of this rare rickettsiosis, especially in geographic regions with the vector.

Rickettsia lanei is a newly recognized spotted fever group rickettsial species that causes severe Rocky Mountain spotted fever-like illness. We used genome sequencing, enabled by hybridization capture-based target enrichment, to establish Dermacentor occidentalis ticks as the likely source of a human infection with R. lanei in California, USA.

Since the beginning of the 1980s, 33 emerging tick-borne agents have been identified in mainland China, including eight species of spotted fever group rickettsiae, seven species in the family Anaplasmataceae, six genospecies in the complex Borrelia burgdorferi sensu lato, 11 species of Babesia, and the virus causing severe fever with thrombocytopenia syndrome. In this Review we have mapped the geographical distributions of human cases of infection. 15 of the 33 emerging tick-borne agents have been reported to cause human disease, and their clinical characteristics have been described. The non-specific clinical manifestations caused by tick-borne pathogens present a major diagnostic challenge and most physicians are unfamiliar with the many tick-borne diseases that present with non-specific symptoms in the early stages of the illness. Advances in and application of modern molecular techniques should help with identification of emerging tick-borne pathogens and improve laboratory diagnosis of human infections. We expect that more novel tick-borne infections in ticks and animals will be identified and additional emerging tick-borne diseases in human beings will be discovered.

As a result of migrations and globalization, people may face a possible increase in the incidence of central nervous system rickettsial infections (CNS R). These diseases, caused by Rickettsia species and transmitted to humans by arthropod bites, are putatively lethal. However, the diagnosis of CNS R is challenging and often delayed due to their nonspecific clinical presentation and the strict intracellular nature of rickettsiae. Furthermore, transfer of rickettsiae to the brain parenchyma is not yet understood. The aim of this review is to analyze and summarize the features and correlated findings of CNS R in order to focus attention on these intriguing but frequently neglected illnesses. We also incorporated data on CNS infections caused by Rickettsia-related microorganisms.

Vector-borne diseases account for nearly 20% of all globally recognised infectious diseases. Within the spectrum of flea-borne pathogens, Bartonella and Rickettsia bacteria are prominent, contributing to the emergence and resurgence of diseases on a global scale. This study investigates the presence of species of Bartonella and Rickettsia harboured by fleas collected from wild rodents in northwestern Argentina (NWA). A total of 28 fleas from three genera and seven species were assessed. DNA of Bartonella and Rickettsia spp. was found in 12 fleas (42.8%). Phylogenetic analysis of concatenated sequences of gltA and rpoB genes showed the presence of Bartonella quintana in eight fleas of two species, Craneopsylla minerva minerva and Polygenis acodontis . Phylogenetic analysis of concatenated sequences of gltA , ompA and ompB genes identified Rickettsia felis in ten fleas of five species, C. m. minerva , P. acodontis , Polygenis bohlsi bohlsi , Polygenis byturus and Tiamastus palpalis . These bacterial species mark the first report in all flea species studied. This study represents the first survey of flea-borne bacteria for NWA. The results provide information to address strategies for the control and prevention of bartonellosis and rickettsiosis that could have an impact on public health in one of the geographical areas of Argentina with the highest incidence of infections transmitted to humans by ectoparasites.

ABSTRACT Bacterial infection is a highly complex biological process involving a dynamic interaction between the invading microorganism and the host. Specifically, intracellular pathogens seize control over the host cellular processes including membrane dynamics, actin cytoskeleton, phosphoinositide metabolism, intracellular trafficking and immune defense mechanisms to promote their host colonization. To accomplish such challenging tasks, virulent bacteria deploy unique species-specific secreted effectors to evade and/or subvert cellular defense surveillance mechanisms to establish a replication niche. However, despite superficially similar infection strategies, diverse Rickettsia species utilize different effector repertoires to promote host colonization. This review will discuss our current understandings on how different Rickettsia species deploy their effector arsenal to manipulate host cellular processes to promote their intracytosolic life within the mammalian host. Rickettsiae deploy their effector arsenal to manipulate membrane dynamics, actin cytoskeleton, phosphoinositide metabolism, intracellular trafficking and immune defense mechanisms; to gain access, and promote their intracytosolic lifespan to ultimately expedite transmission.

We document a case of Rickettsia parkeri rickettsiosis in a patient in Connecticut, USA, who became ill after a bite from a Gulf Coast tick (Amblyomma maculatum). We used PCR to amplify R. parkeri DNA from the detached tick. The patient showed a 4-fold rise in IgG reactive with R. parkeri antigens.

We report a case-series study of 5 patients with Japanese spotted fever from the Three Gorges Area in China, including 1 fatal case. Seroprevalence of Rickettsia japonica was ≈21% among the local population. Our report highlights the emerging potential threat to human health of Japanese spotted fever in the area.

New tick-borne pathogens are being discovered worldwide, and recognized tick-borne diseases are becoming increasingly diverse. Candidatus R. jingxinensis is endemic in Asia, but its potential to cause clinical infection in humans remains unclear. This study was designed to elucidate the prevalence and delineate the clinical profile of Candidatus Rickettsia jingxinensis infection in Liaoning Province, China. The subjects of this study were suspected cases of tick-borne infectious diseases admitted to the First Affiliated Hospital of China Medical University or reported to the Liaoning Provincial Center for Disease Control and Prevention in 2018-2022. Epidemiological and clinical data were collected. Tick-borne pathogens were detected with a microfluidic chip detection system, and specific gene fragments of the screened pathogens were amplified, sequenced, and compared. Evolutionary and phylogenetic trees were constructed and analyzed. In total, 398 infected subjects from 14 cities were included in the study, and 255 tick-borne pathogens were detected. Among these, 11 subjects were found to be infected with Candidatus Rickettsia jingxinensis. This is the first time this strain has been shown to cause infection and illness in humans. The main clinical features of subjects infected with Candidatus R. jingxinensis included fever, fatigue, dizziness, headache, nausea, diarrhea, general pain or muscle and joint pain, reduced leukocytes and platelets, abnormal coagulation function and liver function. This study documents the first human infections with Candidatus R. jingxinensis, confirms its prevalence in Liaoning Province, and delineates the primary clinical manifestations of the disease.

The complexity of rickettsial serodiagnostics during acute illness has limited clinical characterization in Africa. We used archived samples from sepsis (n = 259) and acute febrile illness (n = 70) cohorts in Uganda to identify spotted fever and typhus group rickettsiae by using immunofluorescence assay and clinically validated rRNA reverse transcription PCR (RT-PCR). Among 329 participants, 10.0% had rickettsial infections (n = 33; n = 20 identified with immunofluorescence assay and n = 13 by RT-PCR). Serum rRNA RT-PCR was 75.0% (95% CI 42.8-94.5%) sensitive and 91.2% (95% CI 85.8-95.1%) specific. Thrombocytopenia was more common among patients with rickettsial infections than with other nonmalarial infections (adjusted odds ratio 3.7; p = 0.003). No participants were on a tetracycline antimicrobial drug at admission. rRNA RT-PCR is a promising diagnostic strategy for identifying acute rickettsial infections. Doxycycline should be included in empiric antimicrobial drug regimens for nonmalarial febrile illness in this region.