Rickettsia parkeri infections diagnosed by eschar biopsy, Virginia, USA

• DOI: 10.1007/s15010-018-1120-x
• Publication Date: 2018-01-31T02:39:03Z
• Authors: Pamela Kelman; Chelsea Wright Th...; Wayne Hynes; Christian Bergman; Cameron Lenahan; Joel S. Brenner; Michelle G. Brenner; Benjamin Goodman; Demetria Borges; Michael Filak; Holly Gaff
• Keywords: Male; Tick Bites; Biopsy; Virginia; Rickettsia Infections; Middle Aged; Antibodies, Bacterial; Magnetic Resonance Imaging; Polymerase Chain Reaction; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Doxycycline; Humans; Rickettsia; Symptom Assessment; Tomography, X-Ray Computed

Infection with Rickettsia parkeri is an emerging tick-borne illness, often accompanied by fever and an eschar at the site of tick attachment. We present three cases of R. parkeri in Virginia residents.Case 1 presented initially afebrile, failed to seroconvert to rickettsial antigens, and was diagnosed by DNA testing of the eschar. Case 2 presented febrile with eschar, no serologies were performed, and was diagnosed by DNA testing of the eschar. Case 3 presented febrile with eschar, serologies were negative for rickettsial antigens, and was diagnosed by DNA testing of the eschar.DNA testing of eschars represents an under-utilized diagnostic test and may aid in cases where the diagnosis is not made clinically.