title: Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States.
abstract: Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.forename: Casey Barton
authors.initials: CB
authors.lastname: Behravesh
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Bradley
authors.forename: F Scott
authors.initials: FS
authors.lastname: Dahlgren
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Drexler
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
authors.forename: Scott M
authors.initials: SM
authors.lastname: Folk
authors.forename: Cecilia Y
authors.initials: CY
authors.lastname: Kato
authors.forename: R Ryan
authors.initials: RR
authors.lastname: Lash
authors.forename: Michael L
authors.initials: ML
authors.lastname: Levin
authors.forename: Robert F
authors.initials: RF
authors.lastname: Massung
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: William L
authors.initials: WL
authors.lastname: Nicholson
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.forename: Bobbi S
authors.initials: BS
authors.lastname: Pritt
authors.forename: Marc S
authors.initials: MS
authors.lastname: Traeger
mesh_terms: D000712:Anaplasmosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D016873:Ehrlichiosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D012282:Rickettsia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012373:Rocky Mountain Spotted Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D017282:Tick-Borne Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline