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Increasing entomologic and epidemiologic evidence suggests that spotted fever group rickettsiae (SFGR) other thanRickettsia rickettsii are responsible for spotted fever rickettsioses in the United States. A retrospective seroepidemiologic study was conducted on stored acute- and convalescent-phase sera that had been submitted for Rocky Mountain spotted fever testing to the North Carolina State Laboratory of Public Health. We evaluated the serologic reactivity of the paired sera toR. rickettsii ,Rickettsia parkeri , andRickettsia amblyommii antigens. Of the 106 eligible pairs tested, 21 patients seroconverted to one or more antigens. Cross-reactivity to multiple antigens was observed in 10 patients, and seroconversions to single antigens occurred in 11 patients, including 1 againstR. rickettsii , 4 againstR. parkeri , and 6 againstR. amblyommii . Cross-absorption of cross-reactive sera and/or Western blots identified two presumptive cases of infection withR. parkeri , two presumptive cases of infection withR. rickettsii , and one presumptive case of infection withR. amblyommii . These findings suggest that species of SFGR other thanR. rickettsii are associated with illness among North Carolina residents and that serologic testing usingR. rickettsii antigen may miss cases of spotted fever rickettsioses caused by other species of SFGR.

Seroepidemiologic Study of Human Infections with Spotted Fever Group Rickettsiae in North Carolina