{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:39:50Z","timestamp":1740166790549,"version":"3.37.3"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tick-borne diseases have grown in incidence over recent decades. As a result, diagnostic testing has become more common, often performed as broad antibody-based panels for multiple tick-transmitted pathogens. Rocky Mountain spotted fever (RMSF) is rare in our region yet may cause severe morbidity, leading to diagnostic screening in low-risk patients. We sought to describe trends in RMSF diagnostic testing, rate of IgG seropositivity, and clinical features of those tested.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective chart review of patients \u226421 years old undergoing testing for RMSF and\/or with an ICD-9\/10 code for RMSF. Patients were categorized by infection likelihood based on clinical and laboratory criteria adapted from Centers for Disease Control and Prevention\u2019s (CDC) case definition of spotted fever rickettsioses. Clinical data were collected and analyzed with descriptive statistics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One hundred and seventy patients were included. 5.8% met CDC criteria for rickettsial infection, 6.5% had an elevated IgG titer but lacked suggestive symptoms, and 87.6% had a negative IgG titer. Many patients tested were unlikely to have RMSF, including 50% lacking fever, 20% lacking any RMSF \u201cclassic triad\u201d symptoms, 13% without acute illness, and 22% tested during months with low tick activity. Convalescent serology was performed in 7.6% of patients and none underwent Rickettsia rickettsii polymerase chain reaction (PCR) testing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Diagnostic testing was frequently performed in patients unlikely to have RMSF. We identified many opportunities for improving test utilization. Reserving testing for those with higher pretest probability, performing convalescent serology, and utilizing PCR may improve the accuracy of RMSF diagnosis and reduce clinical challenges stemming from inappropriate testing.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piad051","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T08:21:21Z","timestamp":1689582081000},"page":"445-450","source":"Crossref","is-referenced-by-count":0,"title":["Serologic Testing for Rocky Mountain Spotted Fever in a Low-Incidence Region"],"prefix":"10.1093","volume":"12","author":[{"given":"Joye","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Stony Brook Children\u2019s Hospital , Stony Brook, New York , USA"},{"name":"Renaissance School of Medicine at Stony Brook University , Stony Brook, New York , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3544-4376","authenticated-orcid":false,"given":"Andrew S","family":"Handel","sequence":"additional","affiliation":[{"name":"Renaissance School of Medicine at Stony Brook University , Stony Brook, New York , USA"},{"name":"Division of Infectious Diseases, Department of Pediatrics, Stony Brook Children\u2019s Hospital , Stony Brook, New York , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"2023083113111953700_CIT0001","doi-asserted-by":"crossref","first-page":"496","DOI":"10.15585\/mmwr.mm6717e1","article-title":"Vital signs: trends in reported vectorborne disease cases\u2014United States and territories, 2004\u20132016","volume":"67","author":"Rosenberg","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023083113111953700_CIT0002","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2006.11.023","article-title":"Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children","volume":"150","author":"Buckingham","year":"2007","journal-title":"J Pediatr"},{"key":"2023083113111953700_CIT0003","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/INF.0000000000000496","article-title":"Clinical profile and predictors of fatal Rocky Mountain spotted fever in children from Sonora, Mexico","volume":"34","author":"Alvarez-Hernandez","year":"2015","journal-title":"Pediatr Infect Dis J"},{"key":"2023083113111953700_CIT0004","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4269\/ajtmh.2012.12-0126","article-title":"Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009","volume":"88","author":"Mosites","year":"2013","journal-title":"Am J Trop Med Hyg"},{"key":"2023083113111953700_CIT0005","doi-asserted-by":"crossref","first-page":"767","DOI":"10.4269\/ajtmh.14-0123","article-title":"Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain spotted fever","volume":"91","author":"McQuiston","year":"2014","journal-title":"Am J Trop Med Hyg"},{"volume-title":"Spotted Fever Rickettsiosis (Including Rocky Mountain Spotted Fever) (SFR, Including RMSF): 2020 Case Definition","year":"2020","key":"2023083113111953700_CIT0006"},{"key":"2023083113111953700_CIT0007","doi-asserted-by":"crossref","first-page":"e0000215","DOI":"10.1371\/journal.pgph.0000215","article-title":"Community engaged tick surveillance and tickMAP as a public health tool to track the emergence of ticks and tick-borne diseases in New York","volume":"2","author":"Hart","year":"2022","journal-title":"PLOS Glob Public Health"},{"volume-title":"Rocky Mountain Spotted Fever (RMSF) IgM Blood Test","year":"2022","key":"2023083113111953700_CIT0008"},{"key":"2023083113111953700_CIT0009","first-page":"360","volume-title":"Hematologic Problems in the Newborn","author":"Oski","year":"1982","edition":"3"},{"key":"2023083113111953700_CIT0010","doi-asserted-by":"crossref","first-page":"101855","DOI":"10.1016\/j.ttbdis.2021.101855","article-title":"Rickettsiosis subcommittee report to the tick-borne disease working group","volume":"13","author":"Walker","year":"2022","journal-title":"Ticks Tick Borne Dis"},{"key":"2023083113111953700_CIT0011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ofid\/ofz299","article-title":"Misdiagnosis of Lyme disease with unnecessary antimicrobial treatment characterizes patients referred to an academic infectious diseases clinic","volume":"6","author":"Kobayashi","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2023083113111953700_CIT0012","first-page":"1371","article-title":"Antibody titers reactive with Rickettsia rickettsii in blood donors and implications for surveillance of spotted fever rickettsiosis in the United States","volume":"221","author":"Straily","year":"2020","journal-title":"J Infect Dis"},{"key":"2023083113111953700_CIT0013","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1089\/vbz.2020.2695","article-title":"Assessment of the pathogenicity of Rickettsia amblyommatis, Rickettsia bellii, and Rickettsia montanensis in a guinea pig model","volume":"21","author":"Snellgrove","year":"2021","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2023083113111953700_CIT0014","doi-asserted-by":"crossref","first-page":"e02055","DOI":"10.1128\/mBio.02055-19","article-title":", Polymicrobial nature of tick-borne diseases","volume":"10","author":"Sanchez-Vicente","year":"2019","journal-title":"mBio"}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpids\/advance-article-pdf\/doi\/10.1093\/jpids\/piad051\/50912965\/piad051.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/12\/8\/445\/51316207\/piad051.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/12\/8\/445\/51316207\/piad051.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T09:35:11Z","timestamp":1693474511000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/12\/8\/445\/7226579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,7,19]]},"published-print":{"date-parts":[[2023,8,31]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piad051","relation":{},"ISSN":["2048-7207"],"issn-type":[{"type":"electronic","value":"2048-7207"}],"subject":[],"published-other":{"date-parts":[[2023,8,1]]},"published":{"date-parts":[[2023,7,19]]}}}