Rickettsia parkeri as a paradigm for multiple causes of tick-borne spotted fever in the Western Hemisphere

Among the many contributions made to rickettsiology by entomologist and rickettsiologist Ralph R. Parker was his discovery in 1937 of a novel rickettsia isolated from the Gulf Coast tick, Amblyomma maculatum. This bacterium was subsequently characterized as a unique rickettsial species in 1965 and named Rickettsia parkeri in honor of its discoverer. During the next several decades R. parkeri was generally considered as one of several "nonpathogenic" spotted fever group (SFG) rickettsiae that resided in ticks of the United States. The identification of novel rickettsioses on other continents during the last two decades of the twentieth century provided important evidence of the frequent coexistence of multiple and unique tick-borne SFG rickettsiae sharing common geographic regions. Surprisingly, this paradigm, which was repeatedly demonstrated in Europe, Africa, and Australia during the last 10 years, had no confirmed correlate in the United States until 2002, when R. parkeri was isolated from a patient from the state of Virginia. Several pieces of epidemiologic, laboratory, and clinical evidence are compelling enough to suggest that this infection has occurred in other U.S. patients who reside within the range of the Gulf Coast tick. Just as important are new data indicating relatively high infection rates of A. maculatum ticks with R. parkeri, documenting the occurrence of R. parkeri in Amblyomma triste ticks from Uruguay, and providing evidence that other Amblyomma species might serve as efficient vectors of R. parkeri. The recognition of R. parkeri as a cause of disease in humans will hopefully encourage a closer examination for specific etiologies of tick-borne spotted fever rickettsioses in the United States and other countries of the Western Hemisphere.