Ehrlichia and spotted fever group Rickettsiae surveillance in Amblyomma americanum in Virginia through use of a novel six-plex real-time PCR assay

Surveillance of ticks (Acari: Ixodidae) and tick-borne pathogens in Eastern Central Alabama

Similar to other states in the southeastern United States, human cases of tick-borne diseases in Alabama have risen steadily over the last 2 decades. Nevertheless, limited data have been published on ticks or tick-borne pathogen (TBP) distributions since the 1990s. To better understand the risk of tick and TBP exposure in eastern central Alabama, ticks were sampled repeatedly across 8 sites associated with recreational use during May and June of 2015 to characterize tick density and diversity. Although habitats were similar across sites, tick density varied among locations. Seven species were collected, but 97.7% of 1,310 samples were the lone star tick, Amblyomma americanum (L.), the primary vector of ehrlichial agents and the tick species most commonly linked to alpha-gal syndrome and southern tick-associated rash illness. To investigate pathogen prevalence among sites, we tested A. americanum by a multiplex qPCR assay for 5 bacterial species, including 3 Ehrlichia spp. and 2 Rickettsia spp. None of the specimens tested positive for Panola Mountain Ehrlichia or Rickettsia parkeri. However, causative agents of human ehrlichiosis, Ehrlichia chaffeensis and Ehrlichia ewingii, occurred at half of the locations with, respectively, 0.27% and 0.45% of A. americanum infected on average. In contrast, Rickettsia amblyommatis, a tick endosymbiont suspected to be nonpathogenic, was found in 54.5% of the 1119 A. americanum tested. Despite low infection rates of Ehrlichia spp. in A. americanum, high encounter rates with this species in recreational deciduous woodlands suggest a moderate risk of tick bite and a low-to-moderate risk of TBP exposure in late spring.

Changes in the Seroprevalence of Tick-Borne Rickettsia and Ehrlichia Among Soldiers-Fort Liberty, North Carolina, 1991-2019

We obtained samples from the Department of Defense Serum Repository from soldiers who were stationed at Fort Liberty, North Carolina, between 1991 and 2019 to assess temporal trends in tick-borne rickettsiosis and ehrlichiosis. Serological evidence of infection was common, with nearly 1 in 5 (18.9%) demonstrating antibodies. We observed significant decreases in Rickettsia seroprevalence (adjusted odds ratio [aOR], 0.42 [95% CI, .27-.65], P = .0001) while over the same period Ehrlichia seroprevalence, albeit less common, nearly doubled (aOR, 3.61 [95% CI, 1.10-13.99], P = .048). The increase in Ehrlichia seroprevalence likely reflects increased transmission resulting from the expanding geographic range of the lone star tick.

Bayesian group testing regression models for spatial data

Spatial patterns are common in infectious disease epidemiology. Disease mapping is essential to infectious disease surveillance. Under a group testing protocol, biomaterial from multiple individuals is physically combined into a pooled specimen, which is then tested for infection. If the pool tests negative, all contributing individuals are generally assumed to be uninfected. If the pool tests positive, the individuals are usually retested to determine who is infected. When the prevalence of infection is low, group testing provides significant cost savings over traditional individual testing by reducing the number of tests required. However, the lack of statistical methods capable of producing maps from group testing data has limited the use of group testing in disease mapping. We develop a Bayesian methodology that can simultaneously map disease prevalence using group testing data and identify risk factors for infection. We illustrate its real-world utility using two datasets from vector-borne disease surveillance.

Neurological manifestations of ehrlichiosis among a cohort of patients: prevalence and clinical symptoms

BACKGROUND

Ehrlichiosis is a potentially fatal tick-borne disease that can progress to involve the central nervous system (CNS) (i.e., neuro-ehrlichiosis), particularly in cases where diagnosis and treatment are delayed. Despite a six-fold national increase in the incidence of ehrlichiosis over the past 20 years, recent data on the prevalence and manifestations of neuro-ehrlichiosis are lacking.

METHODS

We conducted a retrospective chart review of all patients tested for ehrlichiosis at University of North Carolina Health facilities between 2018 and 2021 and identified patients who met epidemiological criteria for ehrlichiosis as established by the Council of State and Territorial Epidemiologists and employed by the Centers for Disease Control and Prevention. We estimated the prevalence of neurological symptoms and described the spectrum of neurological manifestations in acute ehrlichiosis, documenting select patient cases in more detail in a case series.

RESULTS

Out of 55 patients with confirmed or probable ehrlichiosis, five patients (9.1%) had neurologic symptoms, which is notably lower than previous estimates. Neurological presentations were highly variable and included confusion, amnesia, seizures, focal neurological deficits mimicking ischemic vascular events, and an isolated cranial nerve palsy, though all patients had unremarkable neuroimaging at time of presentation. All but one patient had risk factors for severe ehrlichiosis (i.e., older age, immunosuppression).

CONCLUSIONS

Neuro-ehrlichiosis may lack unifying patterns in clinical presentation that would otherwise aid in diagnosis. Clinicians should maintain a high index of suspicion for neuro-ehrlichiosis in patients with acute febrile illness, diverse neurological symptoms, and negative neuroimaging in lone star tick endemic regions.

Evidence of Incomplete Feeding Behaviors among South Carolina Tick Populations

Dynamic environmental conditions, such as climate change and host availability, have greatly influenced the expansion of medically relevant tick vectors into new regions throughout the southeastern United States of America. As tick populations migrate into new areas, it has been suggested they can exhibit a phenomenon known as incomplete feeding. With this phenomenon, tick vectors feed on more than one host at each life stage, thus increasing the likelihood of pathogen transmission. Although this behavior is not well understood, it presents an important threat to human health. Here we present evidence of incomplete feeding behaviors in multiple tick species in South Carolina. Engorged, blood-fed female ticks were collected from feral dogs at animal shelters across South Carolina in 2022. All ticks were tested for human blood meals using rapid stain identification blood tests. Approximately one third (33.78%) of all ticks tested positive for a human blood meal, with various patterns seen across species, geographic location, and collection month. The results of this pilot study follow the current national trend of increasing rates of tick-borne disease incidence in the southeastern United States of America and warrant further investigation into the relationship between seasonality, geographic distribution, species, and incomplete feeding among tick populations in South Carolina.

Science abhors a surveillance vacuum: Detection of ticks and tick-borne pathogens in southern New Mexico through passive surveillance

Robust tick surveillance enhances diagnosis and prevention of tick-borne pathogens, yet surveillance efforts in the United States are highly uneven, resulting in large surveillance vacuums, one of which spans the state of New Mexico. As part of a larger effort to fill this vacuum, we conducted both active and passive tick sampling in New Mexico, focusing on the southern portion of the state. We conducted active tick sampling using dragging and CO₂ trapping at 45 sites across Hidalgo, Doña Ana, Otero, and Eddy counties between June 2021 to May 2022. Sampling occurred intermittently, with at least one sampling event each month from June to October 2021, pausing in winter and resuming in March through May 2022. We also conducted opportunistic, passive tick sampling in 2021 and 2022 from animals harvested by hunters or captured or collected by researchers and animals housed in animal hospitals, shelters, and farms. All pools of ticks were screened for Rickettsia rickettsii, Rickettsia parkeri, Rickettsia amblyommatis, Ehrlichia ewingii, and Ehrlichia chaffeensis. Active sampling yielded no ticks. Passive sampling yielded 497 ticks comprising Carios kelleyi from pallid bats, Rhipicephalus sanguineus from dogs, mule deer, and Rocky Mountain elk, Otobius megnini from dogs, cats, horses, and Coues deer, Dermacentor parumapertus from dogs and black-tailed jackrabbits, Dermacentor albipictus from domesticated cats, mule deer and Rocky Mountain elk, and Dermacentor spp. from American black bear, Rocky Mountain elk, and mule deer. One pool of D. parumapterus from a black-tailed jackrabbit in Luna County tested positive for R. parkeri, an agent of spotted fever rickettsiosis. Additionally, a spotted fever group Rickettsia was detected in 6 of 7 C. kelleyi pools. Two ticks showed morphological abnormalities; however, these samples did not test positive for any of the target pathogens, and the cause of the abnormalities is unknown. Passive surveillance yielded five identified species of ticks from three domestic and six wild mammal species. Our findings update tick distributions and inform the public, medical, and veterinary communities of the potential tick-borne pathogens present in southern New Mexico.

Survival of adult Amblyomma americanum, Amblyomma maculatum, and Dermacentor variabilis (Acari: Ixodidae) in four habitats in southeastern Virginia

Adult, unfed Amblyomma americanum (Linnaeus), Amblyomma maculatum Koch, and Dermacentor variabilis (Say) ticks were housed inside environmental containers in situ from May through August 2015. The environmental containers were placed in 4 habitats in southeastern Virginia, United States. Two of the habitats were located in low ground and were prone to flooding; the other two consisted of a drier landscape located in a more upland habitat. A Cox Regression survival analysis indicated there was a significant difference in survival among species across all field sites. There was a 50.5-times higher risk of mortality for A. maculatum compared to A. americanum, a 4.3-times higher risk of mortality for A. maculatum compared to D. variabilis, and an 11.9-times higher risk of mortality for D. variabilis compared to A. americanum. There was also significantly higher mortality in field sites prone to flooding than in drier, upland field sites. We concluded that A. americanum was not negatively affected by increased flooding or the variable environmental conditions in southeastern Virginia. Dermacentor variabilis also was successful at remaining in the environment off-host, although increased flooding reduced survival over time. Amblyomma maculatum was more susceptible to mortality during long periods of time off-host in both environments, with high mortality rates in both dry upland and low-ground, flood-prone habitats.

Understanding Habitats and Environmental Conditions of White-Tailed Deer Population Density and Public Health Data to Aid in Assessing Human Tick-Borne Disease Risk

The extent of tick-borne diseases (TBDs) in the United States is largely unknown and underreported. Equitable diagnostic and treatment options may vary by geographic location. Triangulating multi-modal data sources informed by a One Health approach provides robust proxies for human TBD risk. Using data from the Indiana Department of Natural Resources collected from hunters during the white-tailed deer (Odocoileus virginianus) hunting season and other sources, we employ a mixed-methods approach based on thematic mapping and mixed effects modelling to determine if deer population density aligns with official disease data at the county level from (1) positive canine serological reports for, anaplasmosis, and Lyme Disease (LD); (2) positive human cases of ehrlichiosis, anaplasmosis, LD, and Spotted Fever rickettsioses; and (3) tick infectivity. We propose the need for multimodal data analysis using a variety of potential proxies to better estimate disease risk and inform public health policy and practice. We find similar spatial distributions between deer population density and human and canine TBDs in northeastern and southern Indiana, which are rural and mixed geographic areas. Overall, LD is more prevalent in the northwest, central-western, and southeastern counties, while ehrlichiosis is more common in the southern counties. These findings hold true across humans, canines, and deer.

Ticks and Tick-Borne Pathogens in Recreational Greenspaces in North Central Florida, USA

Tick-borne infections are an increasing medical and veterinary concern in the southeastern United States, but there is limited understanding of how recreational greenspaces influence the hazard of pathogen transmission. This study aimed to estimate the potential human and companion animal encounter risk with different questing tick species, and the bacterial or protozoal agents they carry in recreational greenspaces. We collected ticks bimonthly along trails and designated recreational areas in 17 publicly accessible greenspaces, in and around Gainesville, Florida, USA. We collected Amblyomma americanum, Ixodes scapularis, Amblyomma maculatum, Dermacentor variabilis, Ixodes affinis, and Haemaphysalis leporispalustris. Across the six tick species collected, we detected 18 species of bacteria or protozoa within the Babesia, Borrelia, Cytauxzoon, Cryptoplasma (Allocryptoplasma), Ehrlichia, Hepatozoon, Rickettsia, and Theileria genera, including pathogens of medical or veterinary importance. While tick abundance and associated microorganism prevalence and richness were the greatest in natural habitats surrounded by forests, we found both ticks and pathogenic microorganisms in manicured groundcover. This relationship is important for public health and awareness, because it suggests that the probability of encountering an infected tick is measurable and substantial even on closely manicured turf or gravel, if the surrounding landcover is undeveloped. The presence of medically important ticks and pathogenic microorganisms in recreational greenspaces indicates that public education efforts regarding ticks and tick-borne diseases are warranted in this region of the United States.

Rickettsia amblyommatis in Ticks: A Review of Distribution, Pathogenicity, and Diversity

Rickettsia amblyommatis is a potentially pathogenic species of Rickettsia within the spotted fever group vectored by ticks. While many studies have been published on this species, there is debate over its pathogenicity and the inhibitory role it plays in diagnosing illnesses caused by other spotted fever group Rickettsia species. Many publications have recorded the high infection prevalence of R. amblyommatis in tick populations at a global scale. While this species is rather ubiquitous, questions remain over the epidemiological importance of this possible human pathogen. With tick-borne diseases on the rise, understanding the exact role that R. amblyommatis plays as a pathogen and inhibitor of infection relative to other tick-borne pathogens will help public health efforts. The goal of this review was to compile the known literature on R. amblyommatis, review what we know about its geographic distribution, tick vectors, and pathogenicity, assess relatedness between various international strains from ticks by phylogenetic analysis and draw conclusions regarding future research needed.

County-level surveillance for the lone star tick, Amblyomma americanum, and its associated pathogen, Ehrlichia chaffeensis, in Kentucky

Kentucky experiences some of the highest incidence rates for ehrlichiosis nationwide. Ehrlichiosis is a bacterial infection caused primarily by the pathogen Ehrlichia chaffeensis and can be transmitted to humans through the bite of an infected tick, notably Amblyomma americanum. Amblyomma americanum, the lone star tick, is common to Kentucky and much of the southeast, but has expanded farther north in recent years. As an abundant and aggressive nondiscriminatory biter, this species is of major public health concern for transmission of pathogens to humans. As this vector's range expands, surveillance remains a necessary tool providing data that allows researchers to track this expansion over time. The historical information on tick distribution in Kentucky is variable with very little data on a statewide scale. From January 2019 to December 2020, we conducted surveillance for A. americanum in Kentucky through field collections and the establishment of a statewide tick submission program with the help of the Kentucky Department for Public Health and screened for E. chaffeensis on a county-level throughout the state. We collected 5,726 A. americanum ticks in 77 counties and detected E. chaffeensis in 32 counties. The minimum infection rate was 1.8%. With the expansion of A. americanum and increasing cases of tick-borne diseases, future surveillance is needed to monitor this important tick vector over time.

The Gulf Coast Tick, Amblyomma maculatum (Ixodida: Ixodidae), and Spotted Fever Group Rickettsia in the Highly Urbanized Northeastern United States

We report the multi-year collection of the Gulf Coast tick, Amblyomma maculatum Koch (Acaridae: Ixodida: Ixodidae) in Staten Island, New York City (NYC) as well as their detection in Brooklyn, NYC, and in Atlantic and Cumberland counties in southern New Jersey, USA. The first and most common detections were of adults, however in Freshkills Park on Staten Island larvae were also collected in a following year. The presence of larvae indicates that adults are successfully finding hosts in Staten Island. While it is still unknown how A. americanum reached Staten Island, immatures of this species often parasitize migratory birds, which are now often seen in Freshkills Park. We describe the landscape features of the area in Staten Island where populations were highest and larvae were detected, which could have facilitated the establishment of A. maculatum. Notably, we also report the presence of human pathogens Rickettsia parkeri in 5/10 (50%) of adults tested and R. felis in 1/24 (4.17%) of larvae tested. In addition to established populations in Staten Island we found evidence of A. maculatum in NJ and other NYC boroughs, suggesting current or future establishment is possible. The failure thus far to detect established populations in these areas may be due to inherent difficulties in detecting low density, spatially heterogeneous incipient populations, which could require targeted surveillance efforts for this species. We discuss the consequences to public health of the establishment of A. maculatum and detection of two additional rickettsial pathogens in the densely populated northeastern United States.

Relevance of Spatial and Temporal Trends in Nymphal Tick Density and Infection Prevalence for Public Health and Surveillance Practice in Long-Term Endemic Areas: A Case Study in Monmouth County, NJ

Tick-borne diseases are a growing public health problem in the United States, and the US northeast has reported consistently high case rates for decades. Monmouth County, New Jersey, was one of the earliest jurisdictions to report Lyme disease cases in 1979 and reports several hundred cases per year nearly 40 yr later. In the time since, however, tick-borne health risks have expanded far beyond Lyme disease to include a variety of other bacterial pathogens and viruses, and additional vectors, necessitating a continually evolving approach to tick surveillance. In 2017, Monmouth County initiated an active surveillance program targeting sites across three ecological regions for collection of Ixodes scapularis Say (Acari: Ixodidae) and Amblyomma americanum L. (Acari: Ixodidae) as well as testing via qPCR for associated bacterial pathogens. During the first five years of this program (2017-2021), we report high levels of spatiotemporal variability in nymphal density and infection prevalence in both species, limiting the granularity with which human risk can be predicted from acarological data. Nonetheless, broader patterns emerged, including an ongoing trend of A. americanum dominance, risks posed by Borrelia miyamotoi, and the frequency of coinfected ticks. We present some of the first county-level, systematic surveillance of nymphal A. americanum density and infection prevalence in the northeastern US. We also documented a temporary decline in Borrelia burgdorferi that could relate to unmeasured trends in reservoir host populations. We discuss the implications of our findings for tick-borne disease ecology, public health communication, and tick surveillance strategies in endemic areas.

Pathogen prevalence in Amblyomma americanum and Ixodes scapularis ticks from central Appalachian Virginia, U.S.A

Ticks are known vectors of several viral, bacterial, and protozoal pathogens that cause disease in both humans and animals. While pathogen prevalence has been studied extensively in other portions of the United States, pathogen surveillance studies within tick populations in the central Appalachian region of Virginia is almost nonexistent. Two prominent species in this region are Ixodes scapularis (the blacklegged tick) and Amblyomma americanum (the lone star tick). In this study, we collected ticks biweekly from three habitat types (forest, urban, and pasture) across eight counties in southwest Virginia from June, 2019-November, 2020. Ixodes scapularis and A. americanum captures were screened for evidence of associated tick-borne pathogens. In this region, Borrelia burgdorferi sensu stricto (15.3% in nymphs and 37.6% in adults), Anaplasma phagocytophilum (1.9% in nymphs and 12.2% in adults), and Borrelia miyamotoi (2.97% in nymphs and 2.33% in adults) were detected in I. scapularis ticks. Aside from two previously reported Powassan-positive I. scapularis ticks from Floyd County, VA, no additional Powassan-positive ticks are reported here. No evidence of Ehrlichia chaffeensis, Heartland virus (HRTV), or Bourbon virus (BRBV) was detected in collected A. americanum. Detection and confirmation of multiple emerging tick-borne pathogens in this region raises an increased concern for public health risk, calling for heightened awareness of tick-borne pathogen transmission and increased tick surveillance in understudied areas.

Established Populations of Rickettsia parkeri-Infected Amblyomma maculatum Ticks in New York City, New York, USA

Objectives: We sought to determine the habitat associations and pathogen status of Amblyomma maculatum ticks in New York City (NYC), New York, USA, a newly expanded portion of their range. Methods: We collected 88 ticks from two NYC parks on Staten Island, one of the five boroughs of NYC, and compared our findings with similar habitat in Brooklyn, New York during the same time period (April 30-September 1). We tested 76 for pathogens. Results: We found adult and immature ticks in native and invasive grasses at Freshkills and Brookfield parks on Staten Island. No A. maculatum ticks were found in Brooklyn. 52.6% of ticks tested were infected with Rickettsia parkeri-the etiological agent of R. parkeri rickettsiosis. Conclusions: This high rate of R. parkeri in a dense urban center is of concern to the medical community, who should be aware of this species' presence and the symptoms of R. parkeri rickettsiosis.

Rickettsiosis subcommittee report to the tick-borne disease working group

Tick-borne rickettsial infections are serious, common, and difficult to diagnose. Among the most important factors leading to failure to diagnose and treat tick-borne rickettsioses effectively is a lack of consideration of the potential diagnosis by primary caregivers and emergency department physicians in patients presenting with undifferentiated acute febrile illness during tick season. This situation exists because of insufficient primary and continuing medical education of medical students, primary care and emergency medicine residents, and practicing physicians regarding tick-borne rickettsioses specific to the region where they practice. Delayed initiation of treatment with an appropriate antibiotic is associated with adverse outcomes including increased rates of hospitalization, admission to an intensive care unit, and mortality. The earliest symptoms are nonspecific, consisting of fever, headache, myalgias, and nausea and/or vomiting. Laboratory abnormalities are typically absent at this time when the therapeutic response to an appropriate antibiotic would be optimal. There is a mistaken idea among a substantial portion of physicians that the best antibiotic available, doxycycline, should not be administered to children 8 years of age or younger or during pregnancy. For all of the above reasons, there is unnecessary morbidity and mortality caused by tick-borne rickettsioses. This report proposes measures to address these critical issues regarding tick-borne rickettsioses.

Ehrlichiosis and anaplasmosis subcommittee report to the Tick-borne Disease Working Group

Ehrlichioses and anaplasmosis have undergone dramatic increases in incidence, and the geographic ranges of their occurrence and vectors have also expanded. There is marked underreporting of these diseases owing to deficient physician awareness and knowledge of the illnesses as well as limited access to appropriate diagnostic tests. Human monocytic ehrlichiosis and anaplasmosis are life threatening diseases with estimated case fatality rates of 2.7 and 0.3%, respectively. However, knowledge of their full range of signs and symptoms is incomplete, and the incidence of subclinical infections is unknown. Currently available laboratory diagnostic methods are poorly utilized, and with the exception of nucleic acid amplification tests are not useful for diagnosis during the acute stage of illness when timely treatment is needed. The Ehrlichiosis and Anaplasmosis Subcommittee of the Tick-Borne Disease Working Group recommended active clinical surveillance to determine the true incidence, full clinical spectrum, and risk factors for severe illness, as well as standardized surveillance of ticks for these pathogens, and enhanced education of primary medical caregivers and the public regarding these diseases. The subcommittee identified the needs to develop sensitive, specific acute stage diagnostic tests for local clinical laboratories and point-of-care testing, to develop approaches for utilizing electronic medical records, data mining, and artificial intelligence for assisting early diagnosis and treatment, and to develop adjunctive therapies for severe disease.

Discovery and Surveillance of Tick-Borne Pathogens

Within the past 30 yr molecular assays have largely supplanted classical methods for detection of tick-borne agents. Enhancements provided by molecular assays, including speed, throughput, sensitivity, and specificity, have resulted in a rapid increase in the number of newly characterized tick-borne agents. The use of unbiased high throughput sequencing has enabled the prompt identification of new pathogens and the examination of tick microbiomes. These efforts have led to the identification of hundreds of new tick-borne agents in the last decade alone. However, little is currently known about the majority of these agents beyond their phylogenetic classification. Our article outlines the primary methods involved in tick-borne agent discovery and the current status of our understanding of tick-borne agent diversity.

Detection of Rickettsia Species, and Coxiella-Like and Francisella-Like Endosymbionts in Amblyomma americanum and Amblyomma maculatum from a Shared Field Site in Georgia, United States of America

Two abundant species of aggressive ticks commonly feed on humans in Georgia: the Gulf Coast tick (Amblyomma maculatum) and the Lone Star tick (A. americanum). A. maculatum is the primary host of Rickettsia parkeri, "Candidatus Rickettsia andeanae," and a Francisella-like endosymbiont (AmacFLE), whereas A. americanum is the primary host for R. amblyommatis, Ehrlichia chaffeensis, E. ewingii, and a Coxiella-like endosymbiont (AamCLE). Horizontal transmission of R. parkeri from A. maculatum to A. americanum by co-feeding has been described, and R. amblyommatis has been found infrequently in A. maculatum ticks. We assessed the prevalence of these agents and whether exchange of tick-associated bacteria is common between A. maculatum and A. americanum collected from the same field site. Unengorged ticks were collected May-August 2014 in west-central Georgia from a 4.14 acre site by flagging and from humans and canines traversing that site. All DNA samples were screened with quantitative PCR assays for the bacteria found in both ticks, and the species of any Rickettsia detected was identified by species-specific TaqMan assays or sequencing of the rickettsial ompA gene. Only R. amblyommatis (15) and AamCLE (39) were detected in 40 A. americanum, while the 74 A. maculatum only contained R. parkeri (30), "Candidatus Rickettsia andeanae" (3), and AmacFLE (74). Neither tick species had either Ehrlichia species. Consequently, we obtained no evidence for the frequent exchange of these tick-borne agents in a natural setting despite high levels of carriage of each agent and the common observance of infestation of both ticks on both dogs and humans at this site. Based on these data, exchange of these Rickettsia, Coxiella, and Francisella agents between A. maculatum and A. americanum appears to be an infrequent event.

Detection of Rickettsia amblyommatis and Ehrlichia chaffeensis in Amblyomma americanum Inhabiting Two Urban Parks in Oklahoma

For the past 30 years, the number of people infected with causative agents of ehrlichiosis, Rocky Mountain spotted fever, and spotted fever group rickettiosis (SFGR) has increased in Oklahoma. However, there is a lack of data on pathogen prevalence within urban environments. To assess the prevalence of tick-borne pathogens in different environments, 434 Amblyomma americanum (lone star) ticks were collected from the environment in two parks in Edmond, Oklahoma. The presence of Ehrlichia spp. and spotted fever group (SFG) Rickettsia spp. was determined using quantitative real-time polymerase chain reaction (qPCR). 33.6% (146/434) of the A. americanum ticks were positive for Rickettsia amblyommatis and 15.2% (66/434) were positive for Ehrlichia chaffeensis. No ticks were positive for other SFG Rickettsiae (R. rickettsii, R. parkeri) or other Ehrlichiae (E. ewingii, and Panola Mountain Ehrlichia). These studies provide increased understanding of the potential risk for encountering tick-borne pathogens in urban environments.

Meningoencephalitis due to Spotted Fever Rickettsioses, Including Rocky Mountain Spotted Fever

BACKGROUND

The spotted fever rickettsioses (SFR), including Rocky Mountain spotted fever, are tick-borne infections with frequent neurologic involvement. High morbidity and mortality make early recognition and empiric treatment critical. Most literature on SFR meningoencephalitis predates widespread magnetic resonance imaging (MRI) utilization. To better understand the contemporary presentation and outcomes of this disease, we analyzed clinical and radiographic features of patients with SFR meningoencephalitis.

METHODS

Patients were identified through hospital laboratory-based surveillance or through the Tennessee Unexplained Encephalitis Study. Cases meeting inclusion criteria underwent medical records review and, when available, independent review of the neuroimaging.

RESULTS

Nineteen cases (11 children, 8 adults) met criteria for SFR meningoencephalitis. Rash was significantly more common in children than adults (100% vs 50%, respectively), but other clinical features were similar between the 2 groups. Cerebrospinal fluid pleocytosis and protein elevation were each seen in 87.5% of cases, and hypoglycorrhachia was present in 18.8% of cases. The "starry sky" sign (multifocal, punctate diffusion restricting or T2 hyperintense lesions) was seen on MRI in all children, but no adults. Ninety percent of patients required intensive care unit admission and 39% were intubated. Outcomes were similar between adults and children, with only 46% making a complete recovery by the time of discharge.

CONCLUSIONS

SFR meningoencephalitis is a life-threatening infection. The clinical presentation varies between adults and children based on the presence of rash and brain MRI findings. The starry sky sign was ubiquitous in children and should prompt consideration of empiric treatment for SFR when present.

Ticks infesting dogs and cats in North America: Biology, geographic distribution, and pathogen transmission

A diverse array of ixodid and argasid ticks infest dogs and cats in North America, resulting in skin lesions, blood loss, and disease. The ticks most commonly found on pets in this region are hard ticks of the genera Amblyomma, Dermacentor, Ixodes, and Rhipicephalus, as well as the more recently established Haemaphysalis longicornis. Soft tick genera, especially Otobius and Ornithodoros, are also reported from pets in some regions. In this review, we provide a summary of the complex and diverse life histories, distinct morphologies, and questing and feeding behaviors of the more common ticks of dogs and cats in North America with a focus on recent changes in geographic distribution. We also review pathogens of dogs and cats associated with the different tick species, some of which can cause serious, potentially fatal disease, and describe the zoonotic risk posed by ticks of pets. Understanding the natural history of ticks and the maintenance cycles responsible for providing an ongoing source of tick-borne infections is critical to effectively combatting the challenges ticks pose to the health of pets and people.

New Jersey-Wide Survey of Spotted Fever Group Rickettsia (Proteobacteria: Rickettsiaceae) in Dermacentor variabilis and Amblyomma americanum (Acari: Ixodida: Ixodidae)

For the last decade, the New Jersey (NJ) Department of Health has reported between 42 and 144 new cases each year of "spotted fever group rickettsiosis" (SFGR), a statistic that reflects uncertainty regarding which rickettsial agents (Proteobacteria: Rickettsiaceae: Rickettsia) are infecting NJ residents. To identify the Rickettsia circulating in NJ ticks, we used a combination of conventional and real time PCR approaches to screen 560 Dermacentor variabilis Say and 245 Amblyomma americanum L. obtained from a 1-day state-wide surveillance in May 2018 and an additional 394 D. variabilis collected across NJ in 2013-2018. We found zero D. variabilis infected with Rickettsia rickettsii, the agent of Rocky Mountain spotted fever and, on average, 1.3% infected with presumed nonpathogenic Rickettsia montanensis. We also found zero A. americanum infected with R. rickettsii, and 20% infected with Rickettsia amblyommatis, a prevalence somewhat lower than in more southern states. Overall, we conclude that it is unlikely that R. rickettsii vectored by D. variabilis is a primary cause of SFGR cases in NJ and discuss our findings in the context of known facts and current limitations. We conclude that understanding the causes of SFGR east of the Mississippi will require collaboration among medical doctors, public health authorities, and medical entomologists to follow up presumptive human cases of SFGR with detailed histories of exposure, species-specific molecular assays, and active surveillance of putative vectors and the pathogens they may carry.

A dynamic relationship between two regional causes of IgE-mediated anaphylaxis: α-Gal syndrome and imported fire ant

BACKGROUND

A syndrome of mammalian meat allergy relating to IgE specific for galactose-α-1,3-galactose (α-Gal) was first reported 10 years ago in the southeastern United States and has been related to bites of the lone star tick (Amblyomma americanum).

OBJECTIVE

Here we investigated the epidemiology of the "α-Gal syndrome" in the United States and sought additional evidence for the connection to tick bites.

METHODS

A survey of allergists was conducted by using a snowball approach. A second tier of the survey included questions about anaphylaxis to imported fire ants (IFAs). History of tick bites and tick-related febrile illness were assessed as part of a case-control study in Virginia. Antibody assays were conducted on sera from subjects reporting allergic reactions to mammalian meat or IFA.

RESULTS

In North America the α-Gal syndrome is recognized across the Southeast, Midwest, and Atlantic Coast, with many providers in this area managing more than 100 patients each. The distribution of cases generally conformed to the reported range of A americanum, although within this range there was an inverse relationship between α-Gal cases and cases of IFA anaphylaxis that were closely related to the territory of IFA. The connection between tick bites and α-Gal sensitization was further supported by patients' responses to a questionnaire and the results of serologic tests.

CONCLUSIONS

The α-Gal syndrome is commonly acquired in adulthood as a consequence of tick bites and has a regional distribution that largely conforms to the territory of the lone star tick. The epidemiology of the syndrome is expected to be dynamic and shifting north because of climate change and ecologic competition from IFA.

Rickettsia spp. Infecting Lone Star Ticks (Amblyomma americanum) (Acari: Ixodidae) in Monmouth County, New Jersey

Tick-borne rickettsiae are undergoing epidemiological changes in the eastern United States while human encounters with lone star ticks (Amblyomma americanum L.) have increased substantially. We used real-time polymerase chain reaction assays to test for three species of spotted fever group rickettsiae (SFGR) (Rickettsiales: Rickettsiaceae) in 1,858 nymphal A. americanum collected from Monmouth County, New Jersey, a coastal county with endemic Lyme disease and established tick surveillance. Out of the 1,858 tested, 465 (25.0%) were infected with Rickettsia amblyommatis Karpathy, a species of undetermined pathogenicity found frequently in A. americanum, while 1/1,858 (0.05%) contained Rickettsia rickettsii Brumpt, the agent of Rocky Mountain spotted fever. No ticks tested positive for mildly pathogenic Rickettsia parkeri Lackman, and no ticks were co-infected with multiple Rickettsia spp. Our results indicate that A. americanum could be involved in transmission of R. rickettsii to humans in New Jersey, albeit rarely. The much higher rates of R. amblyommatis infection are consistent with hypotheses that human sera reacting to this species could contribute to reports of mild SFGR cases.

Novel PCR exclusion assay to detect spotted fever group rickettsiae in the lone star tick (Amblyomma americanum)

The lone star tick (Amblyomma americanum) is the most common and abundant human-biting tick in the southeastern United States where spotted fever rickettsioses frequently occur. However, the role of this tick in transmitting and maintaining pathogenic and non-pathogenic spotted fever group rickettsiae (SFGR) remains poorly defined. This is partially due to the high prevalence and abundance of Rickettsia amblyommatis in most populations of A. americanum. Many molecular assays commonly employed to detect rickettsiae use PCR primers that target highly conserved regions in the SFGR so low abundance rickettsia may not be detected when R. amblyommatis is present. It is costly and inefficient to test for low abundance rickettsial agents with multiple individual specific assays even when they are multiplexed, as most samples will be negative. Real time PCR assays may also be hampered by inadequate limits of detection (LODs) for low abundance agents. We exploited the absence of an otherwise relatively SFGR-conserved genome region in R. amblyommatis to design a hemi-nested PCR-assay which has a sensitivity of 10 copies in detecting the presence of most SFGR, but not R. amblyommatis in DNA of infected lone star ticks. This deletion is conserved in 21 isolates of R. amblyommatis obtained from multiple states. We demonstrated the assay's utility by detecting a pathogenic SFGR, Rickettsia parkeri, in 15/50 (30 %) of field collected A. americanum ticks that were previously screened with conventional assays and found to be positive for R. amblyommatis. These co-infected ticks included 1 questing female, 6 questing nymphs, and 8 attached males. The high prevalence of R. parkeri among host-attached ticks may be due to several variables and does not necessarily reflect the risk of disease transmission from attached ticks to vertebrate hosts. This novel assay can provide accurate estimates of the prevalence of less common SFGR in A. americanum and thus improve our understanding of the role of this tick in the maintenance and transmission of the SFGR commonly responsible for human rickettsioses.

On the cause and consequences of IgE to galactose-α-1,3-galactose: A report from the National Institute of Allergy and Infectious Diseases Workshop on Understanding IgE-Mediated Mammalian Meat Allergy

The mammalian meat allergy known as the "α-Gal syndrome" relates to IgE specific for galactose-α-1,3-galactose (α-Gal), an oligosaccharide that is present in cells and tissues of nonprimate mammals. The recognition of delayed reactions to food derived from mammals in patients with IgE to α-Gal and also the association with tick bites have been increasing worldwide. In 2018, the National Institute of Allergy and Infectious Diseases, Division of Allergy, Immunology and Transplantation, sponsored a workshop on this emerging tick-related disease. International experts from the fields of tick biology, allergy, immunology, infectious disease, and dermatology discussed the current state of our understanding of this emerging medical condition. The participants provided suggestions for specific research priorities and for the development of resources to advance our knowledge of the mechanisms, diagnosis, management, and prevention of this allergic disease. This publication is a summary of the workshop and the panel's recommendations are presented herein.

Presence of diverse Rickettsia spp. and absence of Borrelia burgdorferi sensu lato in ticks in an East Texas forest with reduced tick density associated with controlled burns

As tick-borne diseases continue to emerge across the United States, there is need for a better understanding of the tick and pathogen communities in the southern states and of habitat features that influence transmission risk. We surveyed questing and on-host ticks in pine-dominated forests with various fire management regimes in the Sam Houston National Forest, a popular recreation area near Houston, Texas. Four linear transects were established- two with a history of controlled burns, and two unburned. Systematic drag sampling yielded 112 ticks from two species, Ixodes scapularis (n=73) and Amblyomma americanum (n=39), with an additional 106 questing ticks collected opportunistically from drag cloth operators. There was a significant difference in systematically-collected questing tick density between unburned (15 and 18 ticks/1000 m²) and burned (2 and 4 ticks/1000 m²) transects. We captured 106 rodents and found 74 ticks on the rodents, predominantly Dermacentor variabilis. One unburned transect had significantly more ticks per mammal than any of the other three transects. DNA of Rickettsia species was detected in 146/292 on and off-host ticks, including the 'Rickettsial endosymbiont of I. scapularis' and Rickettsia amblyommatis, which are of uncertain pathogenicity to humans. Borrelia lonestari was detected in one A. americanum, while Borrelia burgdorferi sensu stricto, the agent of Lyme disease, was not detected in any tick samples. Neither Borrelia nor Rickettsia spp. were detected in any of the mammal ear biopsies (n=64) or blood samples (n=100) tested via PCR. This study documents a high prevalence in ticks of Rickettsia spp. thought to be endosymbionts, a low prevalence of relapsing fever group Borrelia in ticks, and a lack of detection of Lyme disease-group Borrelia in both ticks and mammals in an east Texas forested recreation area. Additionally, we observed low questing tick density in areas with a history of controlled burns. These results expand knowledge of tick-borne disease ecology in east Texas which can aid in directing future investigative, modeling, and management efforts.

Diagnosis and Management of Patients with the α-Gal Syndrome

The galactose-α-1,3-galactose (α-Gal) syndrome has many novel features that are relevant to diagnosis and management. In most cases, the diagnosis can be made on a history of delayed allergic reactions to mammalian meat and the blood test for IgE to the oligosaccharide α-Gal. In general, the diagnosis also dictates the primary treatment, that is, avoiding mammalian meat and also dairy in some cases. In the United States, the lone star tick is the primary cause of this disease, but different ticks are responsible in other countries. Blood levels of IgE to α-Gal often drop in patients who avoid recurrent tick bites, but the rate of decline is variable. Similarly, the delay before reactions is variable and the severity of the allergic reactions is not predicted by the delay or the titer of specific IgE. Some mammalian-derived products such as heart valves, gelatin-based plasma expanders, and pancreatic enzymes are relevant to only select patient groups. A minority of cases may benefit from avoiding a wide range of products that are prepared with mammalian-derived constituents, such as gelatin. This review focuses on the nature of the syndrome, common challenges in diagnosis and management, and also gaps in our current knowledge that would benefit from additional investigation.

Polymicrobial Nature of Tick-Borne Diseases

Tick-borne diseases have doubled in the last 12 years, and their geographic distribution has spread as well. The clinical spectrum of tick-borne diseases can range from asymptomatic to fatal infections, with a disproportionate incidence in children and the elderly. In the last few years, new agents have been discovered, and genetic changes have helped in the spread of pathogens and ticks. Polymicrobial infections, mostly in Ixodes scapularis, can complicate diagnostics and augment disease severity. Amblyomma americanum ticks have expanded their range, resulting in a dynamic and complex situation, possibly fueled by climate change. To document these changes, using molecular biology strategies for pathogen detection, an assessment of 12 microbes (9 pathogens and 3 symbionts) in three species of ticks was done in Suffolk County, New York. At least one agent was detected in 63% of I. scapularis ticksBorrelia burgdorferi was the most prevalent pathogen (57% in adults; 27% in nymphs), followed by Babesia microti (14% in adults; 15% in nymphs), Anaplasma phagocytophilum (14% in adults; 2% in nymphs), Borrelia miyamotoi (3% in adults), and Powassan virus (2% in adults). Polymicrobial infections were detected in 22% of I. scapularis ticks, with coinfections of B. burgdorferi and B. microti (9%) and of B. burgdorferi and A. phagocytophilum (7%). Three Ehrlichia species were detected in 4% of A. americanum ticks. The rickettsiae constituted the largest prokaryotic biomass of all the ticks tested and included Rickettsia amblyommatis, Rickettsia buchneri, and Rickettsia montanensis The high rates of polymicrobial infection in ticks present an opportunity to study the biological interrelationships of pathogens and their vectors.IMPORTANCE Tick-borne diseases have increased in prevalence in the United States and abroad. The reasons for these increases are multifactorial, but climate change is likely to be a major factor. One of the main features of the increase is the geographic expansion of tick vectors, notably Amblyomma americanum, which has brought new pathogens to new areas. The clinical spectrum of tick-borne diseases can range from asymptomatic to fatal infections, with a disproportionate incidence in children and the elderly. In addition, new pathogens that are cotransmitted by Ixodes scapularis have been discovered and have led to difficult diagnoses and to disease severity. Of these, Borrelia burgdorferi, the agent of Lyme disease, continues to be the most frequently transmitted pathogen. However, Babesia microti, Borrelia miyamotoi (another spirochete), Anaplasma phagocytophilum, and Powassan virus are frequent cotransmitted agents. Polymicrobial infection has important consequences for the diagnosis and management of tick-borne diseases.

Collaborative-Tick Surveillance Works: An Academic and Government Partnership for Tick Surveillance in the Southeastern United States (Acari: Ixodidae)

Tick surveillance provides essential information on distributions and encounter frequencies; it is a component of operational activities in public health practice. Our research objectives were a proof-of-concept for collaborative surveillance, which involved establishing an academic and government partnership to enhance tick surveillance efforts. The University of Tennessee (UT) collaborated with United States Department of Agriculture Forest Service, Southern Research Station Forest Inventory Analysis (FIA) in an Occupational Health and Safety partnership. UT provided FIA crews in the southeastern United States with vials containing 80% ethanol (July 2014-November 2017). Crew members were instructed to put all encountered ticks into the vials and return them to FIA headquarters. UT identified all submitted ticks to species and life stage, and screened Amblyomma americanum (L.) for Ehrlichia bacteria using a nested-PCR assay. From the 198 returned vials, 1,180 ticks were submitted, including A. americanum (90.51%; 202 larvae, 503 nymphs, and 363 adults), Dermacentor variabilis Say (7.12%; 1 nymph, 83 adults), Ixodes scapularis (Say) (1.61%; 19 adults), Amblyomma maculatum Koch (0.59%; 1 nymph, 6 adults), and Amblyomma cajennense (Fabricius) (0.17%; 1 nymph, 1 adult). FIA crews encountered A. americanum with Ehrlichia and collection information was used to generate baseline occurrence data of tick encounters. Results indicate that this collaborative-tick surveillance can be improved and used to generate useful data including pathogen detection, and because crews revisit these sites, changes in tick encounters can be monitored.

A review on the occurrence of companion vector-borne diseases in pet animals in Latin America

Companion vector-borne diseases (CVBDs) are an important threat for pet life, but may also have an impact on human health, due to their often zoonotic character. The importance and awareness of CVBDs continuously increased during the last years. However, information on their occurrence is often limited in several parts of the world, which are often especially affected. Latin America (LATAM), a region with large biodiversity, is one of these regions, where information on CVBDs for pet owners, veterinarians, medical doctors and health workers is often obsolete, limited or non-existent. In the present review, a comprehensive literature search for CVBDs in companion animals (dogs and cats) was performed for several countries in Central America (Belize, Caribbean Islands, Costa Rica, Cuba, Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Puerto Rico) as well as in South America (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, French Guiana, Guyana (British Guyana), Paraguay, Peru, Suriname, Uruguay, Venezuela) regarding the occurrence of the following parasitic and bacterial diseases: babesiosis, heartworm disease, subcutaneous dirofilariosis, hepatozoonosis, leishmaniosis, trypanosomosis, anaplasmosis, bartonellosis, borreliosis, ehrlichiosis, mycoplasmosis and rickettsiosis. An overview on the specific diseases, followed by a short summary on their occurrence per country is given. Additionally, a tabular listing on positive or non-reported occurrence is presented. None of the countries is completely free from CVBDs. The data presented in the review confirm a wide distribution of the CVBDs in focus in LATAM. This wide occurrence and the fact that most of the CVBDs can have a quite severe clinical outcome and their diagnostic as well as therapeutic options in the region are often difficult to access and to afford, demands a strong call for the prevention of pathogen transmission by the use of ectoparasiticidal and anti-feeding products as well as by performing behavioural changes.

Dynamics of two pathogens in a single tick population

A mathematical model for a two-pathogen, one-tick, one-host system is presented and explored. The model system is based on the dynamics of Amblyomma americanum, Rickettsia parkeri, and Rickettsia amblyommatis. The goal of this model is to determine how long an invading pathogen, R. parkeri, persists within a tick population, A. americanum, in which a resident pathogen, R. amblyommatis, is already established. The numerical simulations of the model demonstrate the parameter ranges that allow for coexistence of the two pathogens. Sensitivity analysis highlights the importance of vector-borne, tick-to-host, transmission rates on the invasion reproductive number and persistence of the pathogens over time. The model is then applied to a case study based on a reclaimed swampland field site in south-eastern Virginia using field and laboratory data. The results pinpoint the thresholds required for persistence of both pathogens in the local tick population. However, R. parkeri, is not predicted to persist beyond 3 years. Understanding the persistence and coexistence of tick-borne pathogens will allow public health officials increased insight into tick-borne disease dynamics.

Exposure to Ticks and their Pathogens in Northeast Missouri

While the prevalence of human pathogens has been quantified in ticks in Adair County, Missouri, the prevalence of residents acquiring tick-borne diseases and seeking medical treatment has not. A public survey (n=109) revealed that 96% of respondents reported finding attached ticks on their person; of these, 38% developed symptoms post tick bite; of these, 55% reported consultation with a health care provider. Overall, 89% of practitioners surveyed had treated at least one patient for tick-borne disease. Rocky Mountain spotted fever and Lyme disease were the most common illnesses diagnosed, however, the only confirmed cases reported by Missouri Department of Health and Senior Services from 2013-2017 were ehrlichiosis. Results from these surveys indicate that exposure to ticks is common and ehrlichiosis infections are likely underdiagnosed while Rocky Mountain spotted fever and Lyme disease are likely overdiagnosed.

Natural history of Amblyomma maculatum in Virginia

The Gulf Coast tick Amblyomma maculatum Koch is increasingly relevant to medical and veterinary communities as human infection rates of Rickettsia parkeri rise, the risk of introduction of Ehrlichia ruminantium increases, and the range of this tick expands into the densely populated Mid-Atlantic region of the United States. We report on the results of five years of field surveillance to better describe the ecology of A. maculatum in newly established populations in southeastern Virginia. We document habitat preferences, host preferences, and the phenology of the adult human-biting life stage. We discuss key ecological factors needed for A. maculatum establishment and the influence of the successional process and anthropogenic activities on the persistence of A. maculatum populations in Virginia.

Investigating the Adult Ixodid Tick Populations and Their Associated Anaplasma, Ehrlichia, and Rickettsia Bacteria at a Rocky Mountain Spotted Fever Hotspot in Western Tennessee

Ehrlichiosis and rickettsiosis are two common bacterial tick-borne diseases in the southeastern United States. Ehrlichiosis is caused by ehrlichiae transmitted by Amblyomma americanum and rickettsiosis is caused by rickettsiae transmitted by Amblyomma maculatum and Dermacentor variabilis. These ticks are common and have overlapping distributions in the region. The objective of this study was to identify Anaplasma, Ehrlichia, and Rickettsia species associated with questing ticks in a Rocky Mountain spotted fever (RMSF) hotspot, and identify habitats, time periods, and collection methods for collecting questing-infected ticks. Using vegetation drags and CO₂-baited traps, ticks were collected six times (May-September 2012) from 100 sites (upland deciduous, bottomland deciduous, grassland, and coniferous habitats) in western Tennessee. Adult collections were screened for Anaplasma and Ehrlichia (simultaneous polymerase chain reaction [PCR]) and Rickettsia using genus-specific PCRs, and resulting positive amplicons were sequenced. Anaplasma and Ehrlichia were only identified within A. americanum (Ehrlichia ewingii, Ehrlichia chaffeensis, Panola Mountain Ehrlichia, and Anaplasma odocoilei sp. nov.); more Ehrlichia-infected A. americanum were collected at the end of June regardless of habitat and collection method. Rickettsia was identified in three tick species; "Candidatus Rickettsia amblyommii" from A. americanum, R. parkeri and R. andeanae from A. maculatum, and R. montanensis ( = montana) from D. variabilis. Overall, significantly more Rickettsia-infected ticks were identified as A. americanum and A. maculatum compared to D. variabilis; more infected-ticks were collected from sites May-July and with dragging. In this study, we report in the Tennessee RMSF hotspot the following: (1) Anaplasma and Ehrlichia are only found in A. americanum, (2) each tick species has its own Rickettsia species, (3) a majority of questing-infected ticks are collected May-July, (4) A. americanum and A. maculatum harbor pathogenic bacteria in western Tennessee, and (5) R. rickettsii remains unidentified.

Genetic profiling for Anaplasma and Ehrlichia species in ticks collected in the Eastern Cape Province of South Africa

Background

Anaplasma and Ehrlichia are emerging tick-borne pathogens that cause anaplasmosis and ehrlichiosis in humans and other animals worldwide. Infections caused by these pathogens are deadly if left untreated. There has been relatively no systematic survey of these pathogens among ticks in South Africa, thus necessitating this study. The presence of Anaplasma and Ehrlichia species were demonstrated by PCR in ticks collected from domestic ruminants at some selected communities in the Eastern Cape of South Africa. The ticks were identified by morphological characteristics and thereafter processed to extract bacterial DNA, which was analyzed for the presence of genetic materials of Anaplasma and Ehrlichia.

Results

Three genera of ticks comprising five species were identified. The screening yielded 16 positive genetic materials that were phylogenetically related to Ehrlichia sequences obtained from GenBank, while no positive result was obtained for Anaplasma. The obtained Ehrlichia sequences were closely related to E. chaffeensis, E. canis, E. muris and the incompletely described Ehrlichia sp. UFMG-EV and Ehrlichia sp. UFMT.

Conclusion

The findings showed that ticks in the studied areas were infected with Ehrlichia spp. and that the possibility of transmission to humans who might be tick infested is high.

Borrelia burgdorferi DNA absent, multiple Rickettsia spp. DNA present in ticks collected from a teaching forest in North Central Florida

Tick-borne diseases are an emerging public health threat in the United States. In Florida, there has been public attention directed towards the possibility of locally acquired Borrelia burgdorferi sensu stricto, the causative agent of Lyme disease, in association with the lone star tick. The aim of this study was to determine the prevalence of ticks and the pathogens they carry and potentially transmit, such as B. burgdorferi, in a highly utilized teaching and research forest in North Central Florida. Ticks were collected by dragging and flagging methods over a four month period in early 2014, identified, and tested by PCR for multiple pathogens including Anaplasma, Borrelia, Rickettsia, and Ehrlichia species. During the study period the following ticks were collected: 2506 (96.5%) Amblyomma americanum L., 64 (2.5%) Ixodes scapularis Say, 19 (0.7%) Dermacentor variabilis Say, and 5 (0.2%) Ixodes affinis Neuman. Neither Borrelia spp. (0/846) nor Anaplasma spp. (0/69; Ixodes spp. only) were detected by PCR in any of the ticks tested. However, Rickettsia DNA was present in 53.7% (86/160), 62.5% (40/64), 60.0% (3/5) and 31.6% (6/19) of A. americanum, I. scapularis, I. affinis and D. variabilis, respectively. Furthermore, E. chaffeensis and E. ewingii DNA were detected in 1.3% and 4.4% of adult A. americanum specimens tested, respectively. Although receiving an A. americanum bite is likely in wooded areas in North Central Florida due to the abundance of this tick, the risk of contracting a tick-borne pathogen in this specific area during the spring season appears to be low. The potential for pathogen prevalence to be highly variable exists, even within a single geographical site and longitudinal studies are needed to assess how tick-borne pathogen prevalence is changing over time in North Central Florida.

Rickettsia amblyommatis sp. nov., a spotted fever group Rickettsia associated with multiple species of Amblyomma ticks in North, Central and South America

In 1973, investigators isolated a rickettsial organism, designated strain WB-8-2T, from an adult Amblyomma americanum tick collected at Land Between the Lakes National Recreation Area, TN, USA. This organism is now recognized as highly prevalent in A. americanum, as well as several other Amblyomma species found throughout the Western hemisphere. It has been suggested that cross-reactivity to WB-8-2T and similar strains contributes to the increasing number of spotted fever cases reported in the USA. In 1995, investigators provided preliminary evidence that this strain, as well as another strain from Missouri, represented a distinct taxonomic unit within the genus Rickettsia by evaluating sequences of the 16S rRNA and 17 kDa protein genes. However, the bacterium was never formally named, despite the use of the designation 'Rickettsia amblyommii' and later 'Candidatus Rickettsia amblyommii', for more than 20 years in the scientific literature. Herein, we provide additional molecular evidence to identify strain WB-8-2T as a representative strain of a unique rickettsial species and present a formal description for the species, with the proposed name modified to Rickettsia amblyommatis sp. nov. to conform to the International Code of Nomenclature of Prokaryotes. We also establish a pure culture of strain WB-8-2T and designate it as the type strain for the species. The type strain is WB-8-2T (=CRIRC RAM004T=CSURP2882T).

First report of "Candidatus Rickettsia amblyommii" in west coast of Mexico

We report the first case of "Candidatus Rickettsia amblyommii" detected in Amblyomma mixtum ticks on humans on the west coast of Mexico. This is the most western record of "Ca. R. amblyommii" in the Western Hemisphere, representing the first record for the western coast of the Americas. Even if the record is far from the previously known locations for the species it does not represent a new record regarding temperature, precipitation and topographic parameters. Since "Ca. R. amblyommii" antibodies have been detected in patients suspected of Rocky Mountain spotted fever, and the tick A. mixtum has been associated with humans, it is important to consider "Ca. R. amblyommii" as a potential risk for the human population that has not been considered at risk before.

Human Infections by Multiple Spotted Fever Group Rickettsiae in Tennessee

Rocky Mountain spotted fever is the most common tick-borne disease in Tennessee. However, Rickettsia rickettsii has rarely been isolated from endemic ticks, suggesting rickettsioses may be caused by other species. A total of 56 human serum samples that were serologically positive for exposure to Rickettsia were obtained from commercial laboratories in 2010 and 2011. In addition, 20 paired sera from patients with encephalitis and positive Rickettsia serology were obtained from the Tennessee Unexplained Encephalitis Surveillance (TUES) study. Using an immunofluorescence assay, reactivity of the sera to R. rickettsii, Rickettsia montanensis, Rickettsia parkeri, and Rickettsia amblyommii was tested, and a comparison of endpoint titers was used to determine the probable antigen that stimulated the antibody response. Cross-absorption was conducted for 94.8% (N = 91) of the samples due to serologic cross-reactivity. Of the commercial laboratory samples, 55.4% (N = 31) had specific reactivity to R. amblyommii and 44.6% (N = 25) were indeterminate. Of the paired TUES samples, 20% (N = 4) had specific reactivity to R. amblyommii, 5% (N = 1) to R. montanensis, and 5% (N = 1) to R. parkeri Patients with specific reactivity to R. amblyommii experienced fever (75%), headache (68%) and myalgia (58%). Rash (36%) and thrombocytopenia (40%) were less common. To our knowledge, this is the first time R. amblyommii has been reported as a possible causative agent of rickettsioses in Tennessee.

Prevalence, Distribution, and Development of an Ecological Niche Model of Dermacentor variabilis Ticks Positive for Rickettsia montanensis

Rickettsia montanensis has long been considered a nonpathogenic member of the spotted fever group rickettsiae. However, the infection potential of R. montanensis is being revisited in light of its recent association with a case of human infection in the United States and the possibility that additional cases may have been misdiagnosed as Rocky Mountain spotted fever. To this end, DNA was extracted from American dog ticks (Dermacentor variabilis) removed from Department of Defense (DoD) personnel and their dependents at DoD medical treatment facilities (MTFs) during 2002-2012 (n = 4792). These 4792 samples were analyzed for the presence of R. montanensis (n =  36; 2.84%) and all vector DNA was confirmed to be of D. variabilis origin using a novel Dermacentor genus-specific quantitative real-time polymerase chain reaction procedure, Derm, and a novel Dermacentor species multilocus sequence typing assay. To assess the risk of R. montanensis infection, the positive and negative samples were geographically mapped utilizing MTF site locations. Tick localities were imported into a geographical information systems (GIS) program, ArcGIS, for mapping and analysis. The ecological niche modeling (ENM) program, Maxent, was used to estimate the probability of tick presence in eastern United States using locations of both R. montanensis-positive and -negative ticks, climate, and elevation data. The ENM for R. montanensis-positive D. variabilis estimated high probabilities of the positive ticks occurring in two main areas, including the northern Midwest and mid-Atlantic portions of the northeastern regions of United States, whereas the R. montanensis-negative D. variabilis tick model showed a wider estimated range. The results suggest that R. montanensis-positive and -negative D. variabilis have different ranges where humans may be at risk and are influenced by similar and different factors.

Comparison of synganglion neuropeptides, neuropeptide receptors and neurotransmitter receptors and their gene expression in response to feeding in Ixodes scapularis (Ixodidae) vs. Ornithodoros turicata (Argasidae)

Illumina GAII high-throughput sequencing was used to compare expressed genes for female synganglion neuropeptides, neuropeptide receptors and neurotransmitter receptors of the soft tick Ornithodoros turicata with the hard tick Ixodes scapularis. Gene ontology molecular level three mapping revealed no significant differences amongst the same categories represented in O. turicata and I. scapularis. Transcripts predicting 22 neuropeptides or their receptors in the O. turicata synganglion were similar to annotations for 23 neuropeptides or receptors previously identified from I scapularis, with minor exceptions. A transcript predicting ecdysis triggering hormone receptor was identified in O. turicata; transcripts encoding for proprotein convertase and glycoprotein B were identified in both species. Transcripts predicting the same neurotransmitter receptors were found in the synganglion of both species. Gene expression of the transcripts showed numerous differences in response to feeding. Major differences were observed in expression of genes believed important in regulating slow vs. rapid feeding, blood water elimination, cuticle synthesis plasticity and in signalling reproductive activity. Although the glutamate receptor was strongly upregulated in both species, the gamma aminobutyric acid receptor, which inhibits glutamate, was upregulated significantly only in I. scapularis. These differences are consistent with the slow vs. rapid action of the pharyngeal pump in the two species.

Expanding Range of Amblyomma americanum and Simultaneous Changes in the Epidemiology of Spotted Fever Group Rickettsiosis in the United States

Spotted fever group (SFG) Rickettsia species are etiologic agents of a wide range of human infections from asymptomatic or mild infections to severe, life-threatening disease. In the United States, recent passive surveillance for SFG rickettsiosis shows an increased incidence and decreased severity of reported cases. The reasons for this are not well understood; however, we hypothesize that less pathogenic rickettsiae are causing more human infections, while the incidence of disease caused by more pathogenic rickettsiae, particularly Rickettsia rickettsii, is relatively stable. During the same period, the range of Amblyomma americanum has expanded. Amblyomma americanum is frequently infected with "Candidatus Rickettsia amblyommii", a SFG Rickettsia of unknown pathogenicity. We tested our hypothesis by modeling incidence rates from 1993 to 2013, hospitalization rates from 1981 to 2013, and case fatality rates from 1981 to 2013 regressed against the presence of A. americanum, the decade of onset of symptoms, and the county of residence. Our results support the hypothesis, and we show that the expanding range of A. americanum is associated with changes in epidemiology reported through passive surveillance. We believe epidemiological and acarological data collected on individual cases from enhanced surveillance may further elucidate the reasons for the changing epidemiology of SFG rickettsiosis.

Rickettsia parkeri Transmission to Amblyomma americanum by Cofeeding with Amblyomma maculatum (Acari: Ixodidae) and Potential for Spillover

Amblyomma americanum (L.) is a human-biting ixodid tick distributed throughout much of the southeastern United States. Rickettsia parkeri is a member of the spotted fever group rickettsiae and causes a febrile illness in humans commonly referred to as "Tidewater spotted fever" or "R. parkeri rickettsiosis." Although the Gulf Coast tick, Amblyomma maculatum Koch, is the primary vector of R. parkeri, a small proportion of A. americanum have also been shown to harbor R. parkeri. The purpose of this investigation was to determine whether R. parkeri is spilling over into A. americanum in eastern Virginia and also to determine through laboratory experiments, whether A. americanum can acquire R. parkeri by cofeeding alongside infected ticks. Of 317 wild-caught, flat adult A. americanum tested from 29 counties and independent cities in coastal Virginia, a single female A. americanum was positive for R. parkeri, suggesting that R. parkeri is spilling over into this species, but at very low rates (<1.0%). Laboratory studies using guinea pigs indicated that nymphal A. americanum were able to acquire R. parkeri while feeding alongside infected A. maculatum and then transstadially maintain the infection. Nymphal A. americanum infected with Rickettsia amblyommii, however, were less likely to acquire R. parkeri, suggesting that infection with R. amblyommii may prevent R. parkeri from establishing infection in A. americanum.

Review of the Mid-Atlantic Tick Summit III: A model for regional information sharing

Ticks are the most significant vectors of infectious diseases in the United States, inspiring many researchers to study aspects of their biology, ecology, and their effects on public health. However, regional differences in tick abundance and pathogen infection prevalence result in the inability to assume results from one area are relevant in another. Current local information on tick ranges, infection rates, and human cases is needed to assess tick-borne disease risk in any given region. The Mid-Atlantic Tick Summit III brought together over 100 area experts and researchers to share regional updates on ticks and their associated pathogens. We report some meeting highlights here. Regional meetings foster cross-disciplinary collaborations that benefit the community, and open novel lines of inquiry so that tick-bite risk can be reduced and tick-borne diseases can be treated effectively.

Development of a Quantitative PCR Assay for Differentiating the Agent of Heartwater Disease, Ehrlichia ruminantium, from the Panola Mountain Ehrlichia

Panola Mountain Ehrlichia (PME) is an emerging Ehrlichia sp. reported in ten US states. Based on the sequence homology of all known genes, PME is closely related to Ehrlichia ruminantium (ER), the causative agent of heartwater. Heartwater is an economically important tick-borne disease of cattle, sheep and goats responsible for stock losses in sub-Saharan Africa. Unfortunately, ER was imported to the Caribbean islands in the 19th century, and the presence of this foreign animal disease in the Caribbean poses a threat to the US mainland. If introduced, a heartwater outbreak would cause massive losses of naïve livestock. The serologic assay of choice to diagnose heartwater is cross-reactive with Ehrlichia spp., including PME, as we demonstrate here, which would confound disease surveillance in the event of a heartwater outbreak. The purpose of this study was to develop a diagnostic assay capable of rapidly distinguishing between these pathogens. Using synthetic MAP-1B peptides for ER and PME, we tested the cross-reactivity of this assay using sera from infected livestock. The MAP-1B ELISA cannot distinguish between animals infected with PME and ER. Therefore, a dual-plex Taqman^™ qPCR assay targeting the groEL gene of PME and ER was developed and validated. Primers were designed that are conserved among all known strains of ER, allowing for the amplification of strains from the Caribbean and Africa. The assay is highly sensitive (10 copies of DNA) and specific. This assay distinguishes between infection with PME and ER and will be a valuable tool in the event of heartwater outbreak on the US mainland, or for epidemiological studies involving either disease-causing organism.

The Evolving Medical and Veterinary Importance of the Gulf Coast tick (Acari: Ixodidae)

Amblyomma maculatum Koch (the Gulf Coast tick) is a three-host, ixodid tick that is distributed throughout much of the southeastern and south-central United States, as well as several countries throughout Central and South America. A considerable amount of scientific literature followed the original description of A. maculatum in 1844; nonetheless, the Gulf Coast tick was not recognized as a vector of any known pathogen of animals or humans for >150 years. It is now identified as the principal vector of Hepatozoon americanum, the agent responsible for American canine hepatozoonosis, and Rickettsia parkeri, the cause of an emerging, eschar-associated spotted fever group rickettsiosis identified throughout much of the Western Hemisphere. Coincident with these discoveries has been recognition that the geographical distribution of A. maculatum in the United States is far more extensive than described 70 yr ago, supporting the idea that range and abundance of certain tick species, particularly those with diverse host preferences, are not fixed in time or space, and may change over relatively short intervals. Renewed interest in the Gulf Coast tick reinforces the notion that the perceived importance of a particular tick species to human or animal health can be relatively fluid, and may shift dramatically with changes in the distribution and abundance of the arthropod, its vertebrate hosts, or the microbial agents that transit among these organisms.

Prevalence of Rickettsiales in ticks removed from the skin of outdoor workers in North Carolina

Background

Tick-transmitted rickettsial diseases, such as ehrlichiosis and spotted fever rickettsiosis, are significant sources of morbidity and mortality in the southern United States. Because of their exposure in tick-infested woodlands, outdoor workers experience an increased risk of infection with tick-borne pathogens. As part of a double blind randomized-controlled field trial of the effectiveness of permethrin-treated clothing in preventing tick bites, we identified tick species removed from the skin of outdoor workers in North Carolina and tested the ticks for Rickettsiales pathogens.

Methods

Ticks submitted by study participants from April-September 2011 and 2012 were identified to species and life stage, and preliminarily screened for the genus Rickettsia by nested PCR targeting the 17-kDa protein gene. Rickettsia were further identified to species by PCR amplification of 23S-5S intergenic spacer (IGS) fragments combined with reverse line blot hybridization with species-specific probes and through cloning and nucleotide sequence analysis of 23S-5S amplicons. Ticks were examined for Ehrlichia and Anaplasma by nested PCR directed at the gltA, antigen-expressing gene containing a variable number of tandem repeats, 16S rRNA, and groESL genes.

Results

The lone star tick (Amblyomma americanum) accounted for 95.0 and 92.9% of ticks submitted in 2011 (n = 423) and 2012 (n = 451), respectively. Specimens of American dog tick (Dermacentor variabilis), Gulf Coast tick (Amblyomma maculatum) and black-legged tick (Ixodes scapularis) were also identified. In both years of our study, 60.9% of ticks tested positive for 17-kDa. “Candidatus Rickettsia amblyommii”, identified in all four tick species, accounted for 90.2% (416/461) of the 23S-5S-positive samples and 52.9% (416/787) of all samples tested. Nucleotide sequence analysis of Rickettsia-specific 23S-5S IGS, ompA and gltA gene fragments indicated that ticks, principally A. americanum, contained novel species of Rickettsia. Other Rickettsiales, including Ehrlichia ewingii, E. chaffeensis, Ehrlichia sp. (Panola Mountain), and Anaplasma phagocytophilum, were infrequently identified, principally in A. americanum.

Conclusions

We conclude that in North Carolina, the most common rickettsial exposure is to R. amblyommii carried by A. americanum. Other Rickettsiales bacteria, including novel species of Rickettsia, were less frequently detected in A. americanum but are relevant to public health nevertheless.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-014-0607-2) contains supplementary material, which is available to authorized users.

Ehrlichia chaffeensis infection in the reservoir host (white-tailed deer) and in an incidental host (dog) is impacted by its prior growth in macrophage and tick cell environments

Ehrlichia chaffeensis, transmitted from Amblyomma americanum ticks, causes human monocytic ehrlichiosis. It also infects white-tailed deer, dogs and several other vertebrates. Deer are its reservoir hosts, while humans and dogs are incidental hosts. E. chaffeensis protein expression is influenced by its growth in macrophages and tick cells. We report here infection progression in deer or dogs infected intravenously with macrophage- or tick cell-grown E. chaffeensis or by tick transmission in deer. Deer and dogs developed mild fever and persistent rickettsemia; the infection was detected more frequently in the blood of infected animals with macrophage inoculum compared to tick cell inoculum or tick transmission. Tick cell inoculum and tick transmission caused a drop in tick infection acquisition rates compared to infection rates in ticks fed on deer receiving macrophage inoculum. Independent of deer or dogs, IgG antibody response was higher in animals receiving macrophage inoculum against macrophage-derived Ehrlichia antigens, while it was significantly lower in the same animals against tick cell-derived Ehrlichia antigens. Deer infected with tick cell inoculum and tick transmission caused a higher antibody response to tick cell cultured bacterial antigens compared to the antibody response for macrophage cultured antigens for the same animals. The data demonstrate that the host cell-specific E. chaffeensis protein expression influences rickettsemia in a host and its acquisition by ticks. The data also reveal that tick cell-derived inoculum is similar to tick transmission with reduced rickettsemia, IgG response and tick acquisition of E. chaffeensis.