# data[].attributes.body
Rocky Mountain Spotted Fever (RMSF) is treated with an antibiotic. This antibiotic is commonly prescribed for children under eight years old. There is not a lot of mention of adult treatments. Rickettsia rickettsii cannot be specifically tested for but instead it is the family of Rickettsia that is tested for. That makes it hard to determine how many cases are actually caused by RMSF or if it was another tickborne disease.

I learned that Rocky Mountain Spotted Fever was still highly virulent in modern society. I did not realize that the counts of the disease would be so prevalent. I thought the number of cases found each year would be a lot less than they were.

In my research, I should have included how Dr. Norman Topping was actually infected with the disease before he created the antiserum. There is not a lot of documentation aside from a few photographs and articles, so it was difficult to pinpoint information.

# data[].attributes.body
The levels of prevalence of RMSF are found to be influenced by prevalent factors such as poverty status, average relative humidity, and average temperature.

The prevention strategies for Rocky Mountain Spotted Fever include avoiding tick bites and removing attached ticks. These are known practices by society. People now limit the time they spend in tick-infested areas like wooded or grassy areas. Typically, in areas where ticks are more predominantly found people will be more cautious during periods of peak tick activity. People wear protective clothing such as a hat, long-sleeved shirts, pants, socks, and closed toe shoes. A preference for light colored clothing is donned because ticks can be easily spotted.

There was a push for over-the-counter products containing DEET which is a deterrent for ticks. Yet, frequent checks should be completed after being outside. This includes a visual and physical inspection of the body and hair. Pets should also be checked frequently.

If a tick is found attached to a person, it should be removed using tweezers. The tweezers should be used to grasp the head of the tick and then gently pulled from the skin with constant pressure. Ticks should not be removed by using one's hands to avoid contamination from any infectious organisms. Society has learned how to decrease the likelihood that they will become infected with the disease.

Chapman, A. S. (2006). Diagnosis and management of tickborne rickettsial diseases; Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professional.

Raghavan, R. K., Goodin, D. G., Neises, D., Anderson, G. A., & Ganta, R. R. (2016). Hierarchical Bayesian spatio–temporal analysis of climatic and socio–economic determinants of Rocky Mountain spotted fever. PloS one, 11(3), e0150180.

# data[].attributes.body
Rocky Mountain Spotted Fever is a tick-borne illness with a high rate of incidence in the United States. This is because RMSF has a wide set of symptoms that are nonspecific during the early stage. This makes it hard to identify. early recognition is crucial to the treatment of RMSF because it has a high fatality rate in untreated individuals. The median onset of symptoms to death is eight days. Physicians are failing to consider RMSF as a diagnosis and are not making a diagnosis based on the history of tick exposure, the presence of fever, and an examination.

Many physicians are not familiar with the drug, doxycycline, in the treatment of RMSF which can delay treatment or worsen symptoms if it is not correctly identified and treated.

In the United States the implementation of a national vector-borne disease prevention and control system is vital in combatting diseases. The number of cases of vector-borne disease has increased more than trifold in the United States from 2004. In 2004, there were 27,388 cases in 2004 and in 2016 there were 96,075 cases.

The increased rate of cases can be due to many different underlying factors such as expanding travel and trade, land use, temperature change, population growth, and healthcare.

The implementation of surveillance and laboratory systems that could detect the pathogens, provide mitigation and prevention measures, and then implement those measures to verify a diagnosis could lead to successful way to combat the disease. There is a current system in place, but many cases are underreported or not reported at all. This limits the ability to monitor and control the disease and its outbreaks. A new system should be implemented with program for education on tick-borne diseases for all general and specialty practitioners.

Chapman, A. S. (2006). Diagnosis and management of tickborne rickettsial diseases; Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professional.

Linnemann Jr, C. C., & Janson, P. J. (1978). The clinical presentations of Rocky Mountain spotted fever: comments on recognition and management based on a study of 63 patients. Clinical pediatrics, 17(9), 673-679.

O'reilly, M., Paddock, C., Elchos, B., Goddard, J., Childs, J., & Currie, M. (2003). Physician knowledge of the diagnosis and management of Rocky Mountain spotted fever: Mississippi, 2002. Annals of the New York Academy of Sciences, 990(1), 295-301.

Petersen, L. R., Beard, C. B., & Visser, S. N. (2019). Combatting the increasing threat of vector-borne disease in the United States with a national vector-borne disease prevention and control system. The American journal of tropical medicine and hygiene, 100(2), 242.

# data[].attributes.body
“These gentlemen have gone so far in their experimental work as to be able to show that an entirely new disease has been encountered, and one never before described…. As hundreds of persons are bitten with ticks throughout this portion of the State, and as a great many are bitten by ticks from this infected locality and comparatively few contract the disease, it was fair to presume that all ticks did not harbor the parasite. This naturally led them to the presumption that the host was not the tick, but some animal infested by ticks…. Clinically, the disease is very odd….” - Dr. Julius O. Cobb

Wilson and Chowning were looking for a protozoon which they determined from the theory which we now know is correct that was presented by Dr. Stiles. He thought that diseases were accidentally spread on the feet of all insects would all be bacterial diseases.

Dr. Ricketts would be the one to confirm that ticks were carriers of RMSF. He also conducted animal studies to see how the disease was spread where he was able to prove that ticks transmitted RMSF from animals to humans.

Measures were now taken once the vector of the disease was known to control them. A reference collection of different species of ticks was recorded as well as their developmental cycle and when they were infected.

Dr. Norman Topping was able to develop an anti-serum based on a study done on rabbits that was an effect treatment in reducing mortality rates, but antibiotics would soon replace it as they were more effective.

The current antibiotic used in the treatment of Rocky Mountain Spotted Fever is doxycycline. It is a tetracycline antibiotic meaning that it stops the growth of bacteria. This antibiotic is inherent to the treatment for RMSF because it is an acute illness.

Lyons, M. (2021, August 31). Canyon Creek Schoolhouse Laboratory 100th Anniversary RMSF basics. Office of NIH History and Stetten Museum. Retrieved November 14, 2023, from https://history.nih.gov/display/history/Canyon+Creek+Schoolhouse+Laboratory+100th+Anniversary+RMSF+basics

Topping, N. H. (1940). Rocky Mountain Spotted Fever: Treatment of Infected Laboratory Animals with Immune Rabbit Serum. Public Health Reports (1896-1970), 55(2), 41–46. https://doi.org/10.2307/4583147

# data[].attributes.attachment_caption
Reported incidence and case fatality of SFR in the United States, 1920-2017

# data[].attributes.body
Rocky Mountain Spotted Fever when reported in 1998 had only 365 cases with a 0.5 percent of ticks or less being infected in areas of endemic disease. In 2004, there were 1514 cases reported. There is an increase in peaks of RMSF since then resembling a cyclical waxing and waning of cases reported.

Virulence is a pathogen's or microorganism's ability to cause damage to a host. Rocky Mountain Spotted Fever is among one of the most virulent human infections to be identified since it was first identified. The current case fatality rate for RMSF is still around 0.5 percent. The number of deaths from RMSF is based solely on the reported number and could be as much as four times the reported number in both fatal and nonfatal cases due to cases going underreported. It can be potentially fatal in even previously young people and treatment should be initiated even in unconfirmed cases.

Dumler, J. S., & Walker, D. H. (2019, March 9). Rocky Mountain Spotted Fever - Chaning Ecology and Persisting Virulence. Research Gate. Retrieved October 25, 2023, from https://www.researchgate.net/profile/John-Dumler/publication/7667831_Rocky_Mountain_Spotted_Fever_-_Changing_Ecology_and_Persisting_Virulence/links/55a50efe08ae00cf99c94295/Rocky-Mountain-Spotted-Fever-Changing-Ecology-and-Persisting-Virulence.pdf

Epidemiology and Statistics | Rocky Mountain Spotted Fever (RMSF). (n.d.). CDC. Retrieved October 25, 2023, from https://www.cdc.gov/rmsf/stats/index.html

Rocky Mountain Spotted Fever | NIH: National Institute of Allergy and Infectious Diseases. (2014, July 8). National Institute of Allergy and Infectious Diseases (NIAID). Retrieved October 25, 2023.

# data[].attributes.attachment_caption
RMSF incidences in the United States for 2019. 

# data[].attributes.body
Rocky Mountain Spotted Fever was first detected in 1896 in Idaho but by the early 1900s it was found more commonly in the southeastern and south-central U.S. like Arkansas, Missouri, North Carolina, Tennessee, and Virginia.

Rocky Mountain Spotted Fever is spread most prominently from April to September during the warmer months of the year. Although it can happen during any month of the year, it commonly occurs during seasonal tick activity. It infects over approximately 2000 individuals in the U.S.

Historically, the fatality rate of RMSF was increased but since the 1940s when antibiotics for it became readily available there has been a decrease in fatalities.

There has been an increase in cases of Rocky Mountain Spotted fever over the last two decades.

David H. Walker, Rocky Mountain Spotted Fever: A Seasonal Alert, Clinical Infectious Diseases, Volume 20, Issue 5, May 1995, Pages 1111–1117, https://doi.org/10.1093/clinids/20.5.1111

Epidemiology and Statistics | Rocky Mountain Spotted Fever (RMSF). (n.d.). CDC. Retrieved October 25, 2023, from https://www.cdc.gov/rmsf/stats/index.html

Rocky Mountain Spotted Fever | NIH: National Institute of Allergy and Infectious Diseases. (2014, July 8). National Institute of Allergy and Infectious Diseases (NIAID). Retrieved October 25, 2023, from https://www.niaid.nih.gov/diseases-conditions/rocky-mountain-spotted-fever

# data[].attributes.body
Rocky Mountain Spotted Fever was first detected in Idaho in the Snake River Valley. It was detected in 1896, but quickly spread through the Northern, Central, and Southern Americas and is now a part of an endemic. The agent for Rocky Mountain Spotted Fever is an intracellular bacterium spread through ticks when they feed on people. This means that Rocky Mountain Spotted Fever is a zoonotic disease as it is spread between animals and people.

There are different vectors of Rocky Mountain Spotted Fever (RMSF) depending on the area that the infection takes place.

American Dog Tick - Eastern, Central and Western United States

Rocky Mountain Wood Tick - Rocky Mountain states (Arizona, Colorado, Idaho, Nevada, Montana, New Mexico, Utah, and Wyoming)

Brown Dog Tick - Southwestern United States and near the U.S.-Mexico border

Centers for Disease Control and Prevention. (n.d.). Rocky Mountain Spotted Fever (RMSF) | Tick-borne Diseases | Ticks. CDC. Retrieved October 16, 2023, from https://www.cdc.gov/ticks/tickbornediseases/rmsf.html
McDade, J. E., & Newhouse, V. F. (1986). Natural history of Rickettsia rickettsii. Annual Reviews in microbiology, 40(1), 287-309.
Rocky Mountain Spotted Fever | NIH: National Institute of Allergy and Infectious Diseases. (2014, July 8). National Institute of Allergy and Infectious Diseases (NIAID). Retrieved October 16, 2023, from https://www.niaid.nih.gov/diseases-conditions/rocky-mountain-spotted-fever

# data[].attributes.body
Scientific Name: Rickettsia rickettsii

Genus: Rickettsia

Two primary tick vectors:

American Dog Tick (Dermacentor variabilis)

Rocky Mountain Wood Tick (Dermacentor andersoni)

Dantas-Torres, F. (2007). Rocky Mountain spotted fever. The Lancet infectious diseases, 7(11), 724-732.
Thorner, A. R., Walker, D. H., & Petri Jr, W. A. (1998). Rocky Mountain spotted fever. Clinical infectious diseases, 1353-1359.