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Guide shares advice on identifying, managing US tick-borne diseases.

PUBLIC HEALTH workers have new tick-borne rickettsial diseases to keep on their radar screens, according to updated federal guidelines.

The past decade saw an increase in tick-borne rickettsial diseases across the U.S., according to the Centers for Disease Control and Prevention, which released its first update in a decade on their diagnosis, prevention and treatment in its May 13 Morbidity and Mortality Weekly Report.

Rickettsia bacteria are spread to people and pets through the bite of an infected tick. The bacteria can cause a variety of diseases marked by symptoms such as rashes, fever and headaches.


The updated guidelines highlight three emerging diseases that have occurred between 2004 and 2011: Ehrlichia muris-like agent, Rickettsia parkeri and Rickettsia species 364D. At the time of the report, cases of Ehrlichia muris-like agent were linked to tick exposure in Minnesota and Wisconsin. Cases of Rickettsia parkeri were only found on the eastern seaboard and Gulf Coast and only in California for Rickettsia species 364D.

No deaths have been linked to any emerging diseases, but other tickborne diseases can be fatal, the guidelines said. Rocky Mountain spotted fever, the most fatal tickborne rickettsial disease, has a death rate between 5 and 10 percent.

Because disease symptoms, such as fever, may be nonspecific, researchers stressed the importance of getting familiar with disease risk factors, such as which U.S. regions are most at risk. The guidelines recommend the early use of doxycycline, an antibiotic, for treatment of all tick-borne rickettsial diseases in patients of all ages.

"We just want to encourage you to have a low threshold for considering rickettsiae when the symptoms are consistent and the exposure history for tick bites or tick exposures are consistent," said Naomi Drexler, MPH, an epidemiologist with CDC's Rickettsial Zoonoses Branch during a May 24 CDC Clinician Outreach and Communication Activity call. "And the diagnostic tests should really be used for retrospective diagnosis and not for a treatment decision."

Also new in the guidelines are warnings about the risk of disease from blood and organ donors who are asymptomatic or presymptomatic for rickettsial diseases. Anaplasmosis is the most common tick-borne rickettsial disease to be linked with blood transfusion infections, the report said.

"Early reporting is essential in facilitating timely tracking and quarantining of potentially infectious co-components and notification of the infected donor and blood product recipients," report authors wrote. "In addition, if a recent blood donor develops symptoms of a tick-borne rickettsial disease, the blood bank should be notified so that donated blood can be appropriately quarantined or recalled."

For more information on "Diagnosis and Management of Tick-borne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses and Anaplasmosis --United States: A Practical Guide for Health Care and Public Health Professionals," visit


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Author:McGill, Natalie
Publication:The Nation's Health
Geographic Code:1USA
Date:Aug 1, 2016
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