Infectious Disease · Pediatrics · 13 h ago
Fatal Rickettsia parkeri Infection Reported in Immunocompromised Child
A case report describes fatal Rickettsia parkeri infection in a 3-year-old boy receiving chemotherapy for acute lymphoblastic leukemia. Plasma microbial cell-free DNA sequencing and confirmatory testing identified the pathogen after the child was hospitalized with febrile neutropenia and developed a widespread rash.
- A child with leukemia died from confirmed R. parkeri infection.
- Eschar lesions preceded a widespread rash and clinical deterioration.
- Cell-free DNA sequencing identified the pathogen after deterioration.
A 3-year-old boy receiving chemotherapy for high-risk B-cell acute lymphoblastic leukemia was admitted in Georgia in July 2025 with febrile neutropenia. Two lesions with central eschars were present on his arm, followed by a spreading rash. Despite broad antimicrobial treatment, he deteriorated and died on hospital day 8. Blood cultures were negative; testing of a plasma sample using microbial cell-free DNA sequencing detected R. parkeri, and CDC real-time PCR and skin-biopsy immunohistochemistry confirmed the infection.
The report’s authors note that R. parkeri illness is usually mild to moderately severe and is rarely reported in children. They describe profound lymphopenia during chemotherapy as a possible contributor to disease severity, while acknowledging that a single case cannot establish causation. The family did not recall seeing a tick, although the child lived in an area within the Gulf Coast tick’s range.
The case illustrates how tickborne infection may be overlooked in a child hospitalized for febrile neutropenia, particularly when exposure is not recognized. The authors recommend maintaining suspicion in immunocompromised patients with compatible findings. Cell-free DNA sequencing helped identify the pathogen, but the test result returned after the child’s death; this case does not establish the test’s effect on outcomes or support a change to standard treatment protocols.
In practice
In immunocompromised children presenting with febrile neutropenia, eschars or a compatible rash may warrant consideration of tickborne rickettsial infection even when no tick exposure is recalled. This report documents one fatal R. parkeri case and a diagnostic delay; it does not show that earlier testing or treatment would have changed the outcome, or justify changes to febrile-neutropenia protocols. Cell-free DNA sequencing detected the pathogen, but the result was returned after the patient died.
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Emerging Infectious Diseases: Fatal Rickettsia parkeri Rickettsiosis in Immunocompromised Pediatric Patient, Georgia, USA, 2025 ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.