Archive for the ‘Rocky Mountain Spotted Fever’ Category

Is Rickettsia the Same as Lyme Disease?

https://www.bca-clinic.de/en/is-rickettsia-the-same-as-lyme-disease/

Is Rickettsia The Same As Lyme Disease?

What Is Rickettsia?

Rickettsial diseases or rickettsioses are infections caused by various bacteria belonging to the genus Rickettsia. These bacteria are transmitted through the bites of certain hard-bodied ticks and some other arthropods. Rickettsial diseases are not to be confused with rickets, which is a condition affecting the bones and resulting from vitamin D deficiency.

The infections caused by Rickettsia bacteria have traditionally been classified into two groups: spotted fever and typhus. However, they’re sometimes divided into further categories. Either way, all groups include species of pathogens that can infect humans. Although Rickettsia bacteria can be found worldwide, the most common rickettsial illnesses are normally contracted in Africa and Asia.

Lyme disease is also transmitted to humans by ticks. It’s the most common tick-borne illness in the northern hemisphere. However, Lyme isn’t a rickettsial disease, since it’s caused by a bacterium of a different genus: Borrelia burgdorferi.

However, the same tick that carries Rickettsia bacteria might also be infected with Borrelia burgdorferi. Therefore, it’s possible to contract both illnesses via one tick bite. Therefore, the answer to question ‘is Rickettsia a Lyme co-infection?’ is that yes – rickettsiosis can be a potential co-infection of Lyme disease.

What Are The Symptoms of Rickettsia Diseases?

Some of the most common rickettsial diseases are Rocky Mountain spotted fever, anaplasmosis, ehrlichiosis and typhus. All of these are generally difficult to diagnose. Some of them rarely cause symptoms, and most of them only cause moderate illness even when symptomatic. However, certain forms of spotted fever and typhus may be fatal if left unrecognised and untreated. The sooner these illnesses are diagnosed, the easier they are to treat using antibiotics.

The clinical presentation of rickettsial diseases varies greatly. Even infections caused by the same species of bacteria may produce different symptoms in different patients. Nonetheless, the most common symptoms include

  • fever
  • headache
  • fatigue
  • malaise
  • nausea
  • vomiting
  • rashes and eschar (a piece of dry and dark dead skin at the site of the bite). These tend to develop within two weeks after the bacteria have entered the body.

African tick bite fever is one of the mildest forms of rickettsiosis. Patients usually present with fever, headache, muscle pain and an eschar shortly after contracting the disease during a visit to southern Africa.

Fever is a common symptom of all rickettsial diseases.

 

Mediterranean spotted fever is a serious and potentially life-threatening illness. It’s prevalent in the Mediterranean region, including northern Africa. In addition to fever, rashes and an eschar are typical signs of the illness.

Patients with Rocky Mountain spotted fever often experience fever, headache, nausea, and stomach pain. A rash at the site of the bite is also commonly seen, but eschars aren’t usually present.

The only common symptom of murine or endemic typhus is fever. About half of all patients also develop a rash. Scrub typhus can be contracted in Asia, and it’s characterised by a severe fever, headache and muscle pain. An eschar, cough, enlarged lymph nodes and encephalitis (inflammation of the brain) may also occur in some patients.

The symptoms of ehrlichiosis and anaplasmosis are similar to those of other rickettsial diseases. However, they’re also known to significantly reduce white blood cell count in affected people.

Is Rickettsia The Same As Lyme Disease?

Rickettsiosis and Lyme disease share several symptoms in their early stages, such as fever, headache, fatigue, malaise and muscle pain. Moreover, all of these symptoms also overlap with those of the flu and other non-specific viral infections, making diagnosis even more challenging.

The only distinctive sign of Lyme disease is the circular bull’s eye rash that develops around the tick bite within a few weeks. However, the rash can also appear elsewhere on the body, and in 20-30% of patients it’s not seen at all.

The diagnosis of Lyme and rickettsial diseases is usually based on a combination of factors, including signs, symptoms, patient history and laboratory tests. Unfortunately, currently there aren’t any completely reliable diagnostic tests available for Lyme disease: in the first weeks after infection, there’s a 60% rate of false negative results. Serological assays for rickettsiosis are more reliable, but these can take 10–12 days to provide a decisive result.

Tests such as serological assays are required to identify rickettsiosis.

What To Do If You Think You’ve Been Infected With Rickettsia

Ticks are very tiny, and their bites aren’t painful. Many people don’t even realise they’ve been bitten.

It’s important to note that being bitten by a tick doesn’t mean you’ve contracted an illness. In fact, out of the approximately 800 different tick species in the world, less than 60 can transmit infections to humans and animals. Most types of tick also have to be attached to the host’s body for an extended period of time in order to pass on any bacteria.

Nevertheless, you must see your doctor if you have a fever and any other flu-like symptoms or a rash shortly after being bitten by a tick. You should also arrange a medical appointment if you don’t recall being bitten but you do experience some suspicious symptoms within a few weeks of returning from a high-risk area. Be sure to tell your doctor about your recent travels, so that they can evaluate the probability of a tick-borne infection and order any appropriate diagnostic tests.

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**Comment**

According to information written in Carl Tuttle’s petition against the IDSA, he mentions an article that indicates the persistent form of Lyme disease might be caused by another organism altogether.

https://www.lymedisease.org/lymepolicywonk-is-persistent-lyme-disease-caused-by-another-organism-identified-by-dr-willy-burgdorfer-over-35-years-ago-why-hasnt-anyone-looked-into-it/  By Lorraine Johnson Oct 12, 2016

Excerpt:

“The STAT article reports that both Jorge Benach and Allen Steere now say it is time to take a closer look at Rickettsia helvetica’s role in Lyme disease. Benach says the research “should be done” because public health concerns warrant a closer look.”

Tuttle also discusses correspondence between Dr. Alan Steere and Willy Burgdorfer dating back to 1980 discussing serological results of sera tested for various Rickettsia and the Swiss Agent (cgP-09) and (TC P-17) being identified in a number of patients:  https://www.dropbox.com/s/777uylhnlc6ytgc/Correspondence_from_Allen_C_Steere_to_Dr_Burgdorfer_regarding_decoded_results_of_serological_tests_against_rickettsia_1980%20%20%20%20%281%29.pdf?dl=0

And according to Allison Caruana, President of The Mayday Project, borrelia associated with Lyme disease are unlike other borrelia, as these organisms are known for an amorphous slime layer:  https://madisonarealymesupportgroup.com/2019/10/29/the-scientific-connection-between-stari-chronic-lyme/

She states:

“Dr. Willy Burgdorfer reviewed and tested patient blood samples from Dr. Anderson for C9P09, which is a rickettsial helical Mycoplasma; P09 being a Rickettsia bellii and C9 being a Mycoplasma (FIG. 2).35 This is further supported by the theory that an endosymbiotic infection produces spirochetes that are uncultivable Mycoplasmas, which are also called spirochetes. 1, 22, 31, 32

The “Swiss Agent” is documented by Dr. Willy Burgdorfer (FIG. 3),25 who also wrote a speech on “Pandora’s Box”.5 Although the Swiss Agent paper is associated with the suspected African Swine Flu, Dr. Willy Burgdorfer appears to be famous for leaving clues throughout his work regarding Lyme disease. Upon reviewing the structure of the Lyme disease “Swiss Agent” and the “Pandora Giant Virus”, there is a striking resemblance that deserves further examination.”

I don’t think we actually know precisely what the agent(s) causing Lyme disease is. This would explain why it can’t be picked up in current testing and why many fail treatment.

While it’s true that the early stages can often yield unspecific symptoms, an experienced eye will be able to diagnose a patient with tick borne illness.  Also, please remember that in some patients their only symptoms are psychological: https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/  Any acute onset behavior changes should be suspect. Please don’t mess around with mainstream medicine should this occur. Get to an experienced and recommended ILADS practitioner who understands the mental illness aspect of tick borne disease.

Regarding the “classic” bullseye rash, please know that while it is diagnostic of Lyme disease, in the first ever patient sample, only a quarter had it:  https://madisonarealymesupportgroup.files.wordpress.com/2019/02/1976circularletterpdf.pdf

Here this nifty table shows that anywhere from 27-80% get it depending upon who’s counting:  https://www.lymedisease.org/lymepolicywonk-how-many-of-those-with-lyme-disease-have-the-rash-estimates-range-from-27-80-2/

Rashes-larger-blog-3

The article’s statement that 20-30% of patients don’t get the rash must be taken from the inaccurate CDC count which is always abysmally low.  No one I work with gets the rash.  No one!

Please read this well written article on why we need to stop treating tick-borne illness like a typical infectious disease:

https://madisonarealymesupportgroup.com/2019/08/01/why-we-need-to-stop-treating-lyme-disease-like-a-typical-infectious-disease/

More on Rickettsia:  https://madisonarealymesupportgroup.com/2019/08/12/tick-borne-pathogens-bartonella-spp-borrelia-burgdorferi-sensu-lato-coxiella-burnetii-rickettsia-spp-may-trigger-endocarditis/

https://madisonarealymesupportgroup.com/2019/07/21/human-seroprevalence-of-tick-borne-anaplasma-lyme-and-rickettsia-species-in-northern-california/

Seventeen (6.8%) samples were seropositive for antibodies against at least one pathogen: five for A. phagocytophilum, eight for B. burgdorferi, and four for Rickettsia spp.

https://madisonarealymesupportgroup.com/2019/01/03/tick-bite-in-ear-gave-uk-teacher-rickettsial-typhus-infection/

 

 

North Central Integrated Pest Alert

https://www.ncipmc.org/projects/pest-alerts1/

image.png

They have the following for ticks and specific diseases:

https://www.ncipmc.org/projects/pest-alerts1/brown-dog-tick-vector-for-rocky-mountain-spotted-fever/

https://www.ncipmc.org/projects/pest-alerts1/rocky-mountain-spotted-fever-rickettsia-rickettsii/

https://www.ncipmc.org/projects/pest-alerts1/ticks-and-tick-borne-diseases/

 

Kentucky: More Than Two Dozen Rocky Mountain Spotted Fever Cases Reported in Grayson County

http://outbreaknewstoday.com/kentucky-more-than-two-dozen-rocky-mountain-spotted-fever-cases-reported-in-grayson-county-89113/

Kentucky: More than two dozen Rocky Mountain spotted fever cases reported in Grayson County

July 22, 2019

By NewsDesk  @infectiousdiseasenews

Health officials in Grayson County, Kentucky are reporting a recent increase in cases of the tickborne disease, Rocky Mountain spotted fever (RMSF).

Characteristic spotted rash of Rocky Mountain spotted fever/CDC

 

 

 

 

 

 

 

They report receiving 26 cases of RMSF since July 7, 2019.

Dr. Bryce Meredith made the following statement, “We are seeing an increase in tick-borne illnesses in Grayson and the surrounding counties. Individuals should have heightened awareness regarding ticks in our area. The most common illnesses are Ehrlichiosis and Rocky Mountain Spotted Fever.”

RMSF is a tick borne disease caused by the organism, Rickettsia rickettsii. Typically, the progress of the disease is a sudden onset of high fever, deep muscle pain, severe headache and chills. A rash usually appears on the extremities within 5 days then soon spreads to palms and soles and then rapidly to the trunk.

Fatalities can be seen in greater than 20% of untreated cases. Death is uncommon with prompt recognition and treatment. Still approximately 3-5% of cases seen in the U.S. are fatal. The absence or delayed appearance of the typical rash or the failure to recognize it, especially in dark-skinned people cause a delay in diagnosis and increased fatalities.

Early stages of RMSF can be confused with erlichiosis, meningococcal meningitis and enteroviral infection.

They are asking residents to ensure they are protecting their family, pets, and yourselves properly while outdoors.

If you find a tick, please remove it appropriately. Also, if you feel fatigued (tired) or having a headache that will not go away, consider seeing your family healthcare provider for tick borne illness testing.

Dr Meredith said, “Ticks are commonly in woods, grassy, or bushy areas. If individuals are planning on being in these areas, they should plan accordingly and wear long sleeves, long pants tucked into your socks, and use an EPA approved insect and tick repellent. Once an individual has returned inside, they should check their clothes and body for ticks. Early awareness and early tick removal is particularly important. Typically, if an individual removes a tick within 24-48 hours, this decreases the rate of disease transmission. I encourage individuals to contact their physician if a tick has been attached for an undetermined time or if they develop fever, rash, chills, or vague symptoms such as new onset unexplained dizziness or excessive fatigue.”

RMSF & the importance of timely treatment: Outbreak News Interviews
DO NOT WAIT FOR LABORATORY CONFIRMATION FOR TREATMENT IF RMSF IS SUSPECTED. This is deadly.
Do not hesitate to use doxycycline in children. New research demonstrates it will NOT hurt children’s teeth.

_________________

For more: https://madisonarealymesupportgroup.com/2018/09/14/rocky-mountain-spotted-fever-rmsf/

https://madisonarealymesupportgroup.com/2017/10/21/mom-got-rocky-mountain-spotted-fever-while-picking-pumpkins/

https://madisonarealymesupportgroup.com/2015/08/13/severe-case-of-rmsf-had-to-remove-patients-arms-and-legs/

https://madisonarealymesupportgroup.com/2018/08/16/new-tick-causes-epidemic-of-rmsf/

https://madisonarealymesupportgroup.com/2018/06/12/georgia-mom-warns-others-after-son-contracts-rocky-mountain-spotted-fever-after-tick-bite/

https://madisonarealymesupportgroup.com/2018/08/19/monster-ticks-found-in-germany-threaten-europe-with-deadly-disease-crimean-congo-fever/  Please note the last quote of the story – that they proved a tropical form of tick typhus in one of tropical ticks found in Germany. Typhus, a bacteria, is making a comeback, particularly in the South. Common in the U.S. in the 40’s, and normally attributed to lice, now it’s been proven to be in a tick. In other words, another disease and a tick found where they supposedly shouldn’t be.
Typus is a rickettsial infection with ticks carring numerous species including rickettsia, ehrlichia, and anaplasma. Rocky Mountain Spotted Fever is also considered a tick-borne typhus fever.  

https://www.health.ny.gov/diseases/communicable/rocky_mountain_spotted_fever/fact_sheet.htm Divided into the typhus group and the spotted fever group, disease is transmitted through ectoparasites (fleas, lice, mites, and ticks). Inhalation and inoculating conjunctiva with infectious material can also cause disease. The good news for most is that doxycycline is a front-line drug for it. Broad-spectrum antibiotics aren’t helpful.

https://madisonarealymesupportgroup.com/2019/05/22/cdc-creates-interactive-training-for-diagnosis-management-of-rocky-mountain-spotted-fever/

https://madisonarealymesupportgroup.com/2018/10/21/all-his-symptoms-pointed-toward-the-flu-but-the-test-was-negative-rmsf-in-connecticut/

AGAIN, TESTING IS ABYSMAL.  DOCTORS NEED EDUCATION.

If interested:  https://madisonarealymesupportgroup.com/2018/02/19/calling-all-doctors-please-become-educated-regarding-tick-borne-illness-heres-how/

https://madisonarealymesupportgroup.com/2018/06/06/lyme-education-for-healthcare-professionals/

https://madisonarealymesupportgroup.com/2019/03/15/global-lyme-alliance-announces-new-partnership-with-delaware-lyme-board-to-help-educate-physicians-about-lyme-disease/

 

 

 

 

 

 

FREE Tick Testing – Adds Bartonella Pathogen Assay

https://www.prnewswire.com/news-releases/bay-area-lyme-foundation-tick-testing-program-adds-bartonella-pathogen-assay-300883339.html

Ask the Vet: Lyme Not Only Issue With Ticks

https://www.toledoblade.com/a-e/living/2019/06/21/lyme-not-only-issue-with-ticks-ask-the-vet/stories/20190623035

Ask the Vet: Lyme not only issue with ticks

By now my overall distaste for ticks is well known and their ability to spread diseases to people and pets is disturbingly diverse.

Lyme disease deservedly gets the bulk of the attention, but some less well known diseases can infect your dog via a tick bite and the warm, wet spring is creating a perfect environment for ticks to reproduce and spread disease.

Anaplasmosis is a bacterial disease similar to Lyme disease and is transmitted by the same species of tick, so often dogs may be infected with Anaplasma as well as the Borrelia bacteria that causes Lyme disease.

The symptoms are generally less severe than Lyme disease and are associated with a low number of blood platelets that assist in blood clotting, so bleeding disorders may be seen.

Rocky Mountain Spotted Fever (RMSF) is one of the more widespread tick-borne diseases in the United States, often contradicting its limited geographic name. It is spread by multiple species of ticks, which explains its extended range. RMSF is also unique in that is can be transmitted very quickly after the tick bites your dog.

Joint pain, enlarged lymph nodes and inflammation of blood vessels, called vasculitis, are typical symptoms associated with RMSF.

Babesiosis has seen a resurgence in recent years and is somewhat unique among disease that are tick-borne in that it can be spread via a tick bite but also through contaminated blood. “Pit bull”-type breeds are susceptible to Babesia infections and with their well-deserved increasing popularity as pets (including my own), the incidence of this infection is increasing. The infection causes bursting of red blood cells, called hemolysis. When the severity of the hemolysis increases, the body can’t keep up and the skin and gums may take on a yellow appearance, or jaundice.

As an infected dog becomes more anemic from the loss of red blood cells, they maybe lethargic or have trouble breathing. If severe, a blood transfusion may be needed. The fact that this can be transmitted through infected blood products is why dogs are now screened for this disease if they participate in a blood donor program.

While this is only a partial list of the less common tick-borne infection that are being spread, it reminds us that those awful, little eight-legged creatures are out there and protection and prevention are still the best option for you and your dog.

Questions for Dr. Gary Thompson can be emailed to askthevet@theblade.com or mailed to The Blade, Attn. Ask the Vet, 541 N. Superior St. Toledo, OH., 43660. Dr. Thompson regrets that he cannot answer individual letters.

__________________

For more:  https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/

https://madisonarealymesupportgroup.com/2019/04/26/three-strains-of-borrelia-other-pathogens-found-in-salivary-glands-of-ixodes-ticks-suggesting-quicker-transmission-time/

https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

 

Dogs Help Spread a Dangerous Tick-Borne Disease (RMSF)

https://www.futurity.org/rocky-mountain-spotted-fever-mexicali-2074692-2/

DOGS HELP SPREAD A DANGEROUS TICK-BORNE DISEASE

May 30, 2019
By Amy Quinton-UC Davis
(Credit: Erik B/Flickr)

New research examines risk factors for Rocky Mountain spotted fever, one of the deadliest tick-borne diseases in the Americas, in Mexicali, Mexico.

In Mexicali, an uncontrolled epidemic of Rocky Mountain spotted fever has affected more than 1,000 people since 2008.

Researchers examined dogs, ticks, and surveyed households in 200 neighborhoods. Half of the neighborhoods in the study had diagnosed human cases of the disease. The team discovered that even though citywide only one in 1,000 ticks were infected, there were neighborhoods at very high risk where almost one in 10 ticks were infected.

“If you live in one of these high-risk neighborhoods and you get five brown dog tick bites, that means you have a pretty good chance of being exposed to Rocky Mountain spotted fever,” says lead author Janet Foley, with the department of medicine and epidemiology at the University of California, Davis, School of Veterinary Medicine.

The brown dog tick, which feeds on dogs and people, spreads Rocky Mountain spotted fever. The insect thrives in hot, arid climates. Previous studies have shown that poverty, numerous stray dogs, and brown dog ticks increased the risk of getting Rocky Mountain spotted fever. In Mexicali, risks were higher along the edges of poorer neighborhoods or outside of the city in rural areas.

Half of the 284 dogs the researchers examined were infested with ticks. Some dogs carried thousands of ticks.

Almost three-quarters of the dogs we tested had been infected with the agent of Rocky Mountain spotted fever at some point in their life,” says Foley. “That’s astronomical.”

People with Rocky Mountain spotted fever typically develop symptoms one to two weeks after an infected tick bites them. They can develop fever, nausea, headache, and muscle pain. As the bacteria infect blood vessel linings, blood begins to pool under the skin, resulting in a rash that can look like red splotches or spots. The longer people wait before seeing a doctor and starting treatment with antibiotics, the greater the chance of death.

The study, which appears in the American Journal of Tropical Medicine and Hygiene, also gauged people’s knowledge about Rocky Mountain spotted fever. It found 80 percent of residents had heard of the disease, but fewer than half used pesticides to prevent bites.

Foley says a Rocky Mountain spotted fever epidemic on the scale of that in Mexicali is not as likely in the United States as long as dog ticks are well managed. But as temperatures warm with climate change, there are concerns that the particular human-feeding brown dog tick strain will continue to move north, resulting in more human cases. Some studies have suggested the hotter it gets, the more active and aggressive the ticks become.

The binational research team included academic researchers, health workers, epidemiologists, veterinarians, agency officials, medical doctors and students, who aided in the need to communicate in Spanish and English, address canine and human disease, understand fundamental epidemiological patterns, and protect public health. The US Centers for Disease Control and Prevention, the UC Davis School of Veterinary Medicine, and the Autonomous University of Baja California funded the work.

Source: UC Davis

**Comment**

Ticks are marvelous ecoadaptors and can survive anything. Climate change has been disproven regarding tick proliferation and the spread of Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

“For blacklegged ticks, climate change is an apocryphal issue.” – John Scott M.Sc. Research Scientist
“The comments that an increase in tick numbers is ‘spurred on by climate change’ is strictly bias; this point is clearly unfounded.” John Scott

Why are we STILL talking about climate change?

PLEASE SPREAD THE WORD THAT CLIMATE DATA WILL NOT HELP PATIENTS ONE IOTA.

For an excellent interview with John Scott:   https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/ (He also explains the bogus Lyme vaccine as well)

 

Septic Shock Caused by RMSF in Suburban Texas Patient With Pet Dog Exposure: A Case Report

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091339/

. 2018; 19: 917–919.
Published online 2018 Aug 4. doi: 10.12659/AJCR.909636
PMCID: PMC6091339
PMID: 30076285

Septic Shock Caused by Rocky Mountain Spotted Fever in a Suburban Texas Patient with Pet Dog Exposure: A Case Report

Abstract

Patient: Female, 45

Final Diagnosis: Rocky mountain spotted fever

Symptoms: Altered mental state • ataxia • dyspnea • fever • headache

Objective:

Unusual clinical course

Background:

Rocky Mountain spotted fever (RMSF) is associated with high mortality and requires prompt identification and treatment to ensure better outcomes.

Case Report:

We describe an advanced case of RMSF in a 45-year-old female patient with pet dog exposure who presented with altered mental status, dyspnea, and ataxia progressing to septic shock and acute hypoxic respiratory failure requiring intubation and mechanical ventilation.

Conclusions:

This case illustrates the importance of keeping RMSF in the differential diagnosis in patient populations outside of the usual geographic areas of incidence in the appropriate clinical setting.

___________________

**Comment**

This is what can happen when diagnosis is delayed.

This woman that lived in the suburbs had a 7-day history of fevers associated with headache, arthralgias, nausea, fatigue, and neck pain, but did NOT have the tell-tale blotchy RMSF rash.

Two days later, she worsened with confusion, combativeness, dyspnea, and ataxia. She got multiple recent bug bites from her pet dogs sleeping in her bed. The dogs were not up to date on flea and tick medication but were healthy and showed no sign of illness.
  • Rule #1:  Do NOT sleep with pets.  The risk is too great.
  • Rule #2:  If you choose to have pets, make sure you treat them if they go outdoors.  The risk is too great.
  • Rule #3:  Doctors need to start treating this plague with the respect it deserves and frankly should keep it in the back of their minds AT ALL TIMES.
Positive findings were R. typhi IgM 1: 1024 (normal <1: 64), R. Rickettsii IgM 1: 1024 (normal <1: 64), IgG 1: 128 (normal <1: 64), and echovirus Ab 1: 80 titer (normal <1: 80). The Rickettsial titers were repeated for possible cross-reactivity and R. typhi antibodies were noted to be negative (<1: 64).
Although R.typhi was ruled out due to cross-reactivity, I believe we will start seeing more of this strain in the future.
The patient improved on doxycycline, the drug of choice for RMSF and was discharged.
Why isn’t there a full-out media blitz on this like there was on Zika?