title: Case report: Co-infection of Rickettsia rickettsii and Streptococcus pyogenes: is fatal Rocky Mountain spotted fever underdiagnosed?
abstract: Rocky Mountain spotted fever, a tick-borne disease caused by Rickettsia rickettsii, is challenging to diagnose and rapidly fatal if not treated. We describe a decedent who was co-infected with group A β-hemolytic streptococcus and R. rickettsii. Fatal cases of Rocky Mountain spotted fever may be underreported because they present as difficult to diagnose co-infections.
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona vih5@cdc.gov.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Raczniak
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kato
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Ida H
authors.initials: IH
authors.lastname: Chung
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Amy
authors.initials: A
authors.lastname: Austin
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: McQuiston
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Erica
authors.initials: E
authors.lastname: Weis
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Craig
authors.initials: C
authors.lastname: Levy
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Maria da Gloria S
authors.initials: Mda G
authors.lastname: Carvalho
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: Zauher
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Adam
authors.initials: A
authors.lastname: Bjork
authors.affiliation: Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Regan
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012373:Rocky Mountain Spotted Fever / Q000150:complications / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*