![]() Early treatment with doxycycline typically results in rapid recovery but, after the fifth day of illness, untreated cases have high chances of severe illness, including disseminated intravascular coagulopathy and multisystem organ failure, potentially leading to permanent disabilities or death. Rocky Mountain spotted fever (RMSF) is a severe, life-threatening illness caused by infection with Rickettsia rickettsii, the most virulent of all known spotted fever group (SFG) Rickettsia species. We believe epidemiological and acarological data collected on individual cases from enhanced surveillance may further elucidate the reasons for the changing epidemiology of SFG rickettsiosis. americanum is associated with changes in epidemiology reported through passive surveillance. Our results support the hypothesis, and we show that the expanding range of A. americanum, the decade of onset of symptoms, and the county of residence. We tested our hypothesis by modeling incidence rates from 1993 to 2013, hospitalization rates from 1981 to 2013, and case fatality rates from 1981 to 2013 regressed against the presence of A. Amblyomma americanum is frequently infected with Candidatus Rickettsia amblyommii, a SFG Rickettsia of unknown pathogenicity. During the same period, the range of Amblyomma americanum has expanded. The reasons for this are not well understood however, we hypothesize that less pathogenic rickettsiae are causing more human infections, while the incidence of disease caused by more pathogenic rickettsiae, particularly Rickettsia rickettsii, is relatively stable. In the United States, recent passive surveillance for SFG rickettsiosis shows an increased incidence and decreased severity of reported cases. Spotted fever group (SFG) Rickettsia species are etiologic agents of a wide range of human infections from asymptomatic or mild infections to severe, life-threatening disease.
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