title: Phylogeography of Rickettsia rickettsii genotypes associated with fatal Rocky Mountain spotted fever.
abstract: Rocky Mountain spotted fever (RMSF), a tick-borne zoonosis caused by Rickettsia rickettsii, is among the deadliest of all infectious diseases. To identify the distribution of various genotypes of R. rickettsii associated with fatal RMSF, we applied molecular typing methods to samples of DNA extracted from formalin-fixed, paraffin-embedded tissue specimens obtained at autopsy from 103 case-patients from seven countries who died of RMSF. Complete sequences of one or more intergenic regions were amplified from tissues of 30 (29%) case-patients and revealed a distribution of genotypes consisting of four distinct clades, including the Hlp clade, regarded previously as a non-pathogenic strain of R. rickettsii. Distinct phylogeographic patterns were identified when composite case-patient and reference strain data were mapped to the state and country of origin. The phylogeography of R. rickettsii is likely determined by ecological and environmental factors that exist independently of the distribution of a particular tick vector.
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil cdp9@cdc.gov.
authors: Christopher D
authors: CD
authors: Paddock
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Amy M
authors: AM
authors: Denison
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: R Ryan
authors: RR
authors: Lash
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Lindy
authors: L
authors: Liu
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Brigid C
authors: BC
authors: Bollweg
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: F Scott
authors: FS
authors: Dahlgren
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Cristina T
authors: CT
authors: Kanamura
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Rodrigo N
authors: RN
authors: Angerami
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Fabiana C
authors: FC
authors: Pereira dos Santos
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Roosecelis
authors: R
authors: Brasil Martines
authors: Infectious Diseases Pathology Branch and Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Núcleo de Anatomica Patológia, Centro de Patologia do Instituto Adolfo Lutz, São Paulo, Brazil; Departamento de Vigilância em Saúde, Secretaria Municipal de Saúde de Campinas, São Paulo, Brazil.
authors: Sandor E
authors: SE
authors: Karpathy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000569:Americas / Q000453:epidemiology; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D021901:DNA, Intergenic; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D058974:Phylogeography; D012284:Rickettsia rickettsii / Q000145:classification / Q000235:genetics*; D012373:Rocky Mountain Spotted Fever / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D021901:DNA, Intergenic