{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:50:54Z","timestamp":1777398654889,"version":"3.51.4"},"reference-count":27,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,6,1]]},"abstract":"<jats:p>Rocky Mountain spotted fever is the most common tick-borne disease in Tennessee. However, <jats:italic>Rickettsia rickettsii<\/jats:italic> 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 <jats:italic>Rickettsia<\/jats:italic> were obtained from commercial laboratories in 2010 and 2011. In addition, 20 paired sera from patients with encephalitis and positive <jats:italic>Rickettsia<\/jats:italic> serology were obtained from the Tennessee Unexplained Encephalitis Surveillance (TUES) study. Using an immunofluorescence assay, reactivity of the sera to <jats:italic>R. rickettsii<\/jats:italic>, <jats:italic>Rickettsia montanensis<\/jats:italic>, <jats:italic>Rickettsia parkeri<\/jats:italic>, and <jats:italic>Rickettsia amblyommii<\/jats:italic> 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% (<jats:italic>N<\/jats:italic> = 91) of the samples due to serologic cross-reactivity. Of the commercial laboratory samples, 55.4% (<jats:italic>N<\/jats:italic> = 31) had specific reactivity to <jats:italic>R. amblyommii<\/jats:italic> and 44.6% (<jats:italic>N<\/jats:italic> = 25) were indeterminate. Of the paired TUES samples, 20% (<jats:italic>N<\/jats:italic> = 4) had specific reactivity to <jats:italic>R. amblyommii<\/jats:italic>, 5% (<jats:italic>N<\/jats:italic> = 1) to <jats:italic>R. montanensis<\/jats:italic>, and 5% (<jats:italic>N<\/jats:italic> = 1) to <jats:italic>R. parkeri<\/jats:italic>. Patients with specific reactivity to <jats:italic>R. amblyommii<\/jats:italic> experienced fever (75%), headache (68%) and myalgia (58%). Rash (36%) and thrombocytopenia (40%) were less common. To our knowledge, this is the first time <jats:italic>R. amblyommii<\/jats:italic> has been reported as a possible causative agent of rickettsioses in Tennessee.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0372","type":"journal-article","created":{"date-parts":[[2016,3,29]],"date-time":"2016-03-29T02:52:54Z","timestamp":1459219974000},"page":"1212-1217","source":"Crossref","is-referenced-by-count":66,"title":["Human Infections by Multiple Spotted Fever Group Rickettsiae in Tennessee"],"prefix":"10.4269","volume":"94","author":[{"given":"Josie","family":"Delisle","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole L.","family":"Mendell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annica","family":"Stull-Lane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen C.","family":"Bloch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald H.","family":"Bouyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abelardo C.","family":"Moncayo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Clin Microbiol Rev","first-page":"657","article-title":"Update on tick-borne rickettsioses around the world: a geographic approach","volume":"26","author":"Parola","year":"2013"},{"key":"ref2","series-title":"MMWR","first-page":"1","article-title":"Summary of notifiable diseases\u2014United States, 2012","volume":"61","author":"Adams","year":"2014"},{"key":"ref3","series-title":"Am J Trop Med Hyg","first-page":"174","article-title":"Rocky Mountain spotted fever in the United States, 2000\u20132007: interpreting contemporary increases in 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