Inadequacy of IgM Antibody Tests for Diagnosis of Rocky Mountain Spotted Fever

Jennifer H. McQuiston Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Caleb Wiedeman Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Joseph Singleton Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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L. Rand Carpenter Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Kristina McElroy Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Emily Mosites Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Ida Chung Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Cecilia Kato Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Kevin Morris Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Abelardo C. Moncayo Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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Susan Porter Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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John Dunn Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

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DOI:
https://doi.org/10.4269/ajtmh.14-0123
Volume/Issue:
Volume 91: Issue 4
Page(s):
767–770
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Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States.

Author Notes

* Address correspondence to Jennifer H. McQuiston, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop A30, Atlanta, GA 30333. E-mail: fzh7@cdc.gov

Authors' addresses: Jennifer H. McQuiston, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: fzh7@cdc.gov. Caleb Wiedeman, Emily Mosites, and Kevin Morris, Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, TN, E-mails: caleb.wiedeman@tn.gov, emily.mosites@gmail.com, and Kevin.Morris@tn.gov. Joseph Singleton, L. Rand Carpenter, Kristina McElroy, Ida Chung, and Cecilia Kato, Centers for Disease Control and Prevention, Rickettsial Zoonoses Branch, Atlanta, GA, E-mails: jsingleton@cdc.gov, r1carpenter@fastmail.fm, kristina.m.mcelroy2.civ@mail.mil, ipi8@cdc.gov, and hex0@cdc.gov. Abelardo C. Moncayo, Tennessee Department of Health, Vector-Borne Diseases Section, Communicable and Environmental Diseases Services, Nashville, TN, E-mail: Abelardo.Moncayo@tn.gov. Susan Porter and John Dunn, Tennessee Department of Health, Nashville, TN, E-mails: Susan.Porter@tn.gov and John.Dunn@tn.gov.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2014
Received:
27 Feb 2014
|
Accepted:
06 May 2014
|
Published Online:
01 Oct 2014
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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