Tick-borne rickettsial disease recommendations updated by the CDC

Rickettsial diseases in the United States have increased during the past decade, according to a report, which notes that they continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of effective antibacterial therapy.


Recommendations on the diagnosis and management of tick-borne rickettsial diseases, including Rocky Mountain spotted fever, were recently updated by the CDC.

The “Practical Guide for Health Care and Public Health Professionals” is intended to help clinicians accomplish the following goals related to tick-borne rickettsial diseases:

  • recognize the epidemiology and clinical manifestations,
  • obtain an appropriate clinical history for suspected cases,
  • recognize potential severe manifestations,
  • make treatment decisions on the basis of epidemiologic and clinical evidence,
  • recognize that early and empiric treatment with doxycycline can prevent severe morbidity or death and that it is the treatment of choice for adults and children with suspected rickettsial disease,
  • make treatment decisions for patients with certain conditions, such as a doxycycline allergy or pregnancy,
  • recognize when to consider co-infection with other tick-borne pathogens,
  • determine appropriate confirmatory diagnostic tests and understand the availability, limitations, and usefulness of these tests,
  • recognize unusual transmission routes, such as transfusion- or transplantation-associated transmission,
  • recognize selected rickettsial diseases among returning travelers,
  • advise patients regarding how to avoid tick bites, and
  • report probable and confirmed cases to appropriate public health authorities to assist with surveillance, control measures, and public health education efforts.

The recommendations were published by MMWR on May 13 and are the first update of the CDC's advice on the topic since 2006. In addition to Rocky Mountain spotted fever, diseases covered by the recommendations include other spotted fever group rickettsioses, caused by Rickettsia parkeri and Rickettsia species 364D; Ehrlichia chaffeensis ehrlichiosis, also called human monocytic ehrlichiosis; other ehrlichioses, caused by Ehrlichia ewingii and Ehrlichia muris-like agent; and anaplasmosis, caused by Anaplasma phagocytophilum, also called human granulocytic anaplasmosis.

The reported incidence of such diseases in the United States has increased during the past decade, according to the report, which notes that they continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of effective antibacterial therapy.