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Yet the impact of the pandemic on the management of tick-borne diseases, which frequently manifest as an acute febrile illness similar to COVID-19, has not been well described.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this retrospective cohort study of patients with suspected tick-borne disease attending the University of North Carolina Health facilities, we compared the timeliness of diagnosis and treatment in a \u201cpre-COVID\u201d period (March 2019 to February 2020) and a \u201cpost-COVID\u201d period (March 2020 to February 2021). Participants included patients with an ICD-10 diagnosis code of spotted fever group rickettsiosis or ehrlichiosis and a positive <jats:italic>Rickettsia<\/jats:italic><jats:italic>rickettsii<\/jats:italic> or <jats:italic>Ehrlichia<\/jats:italic> indirect immunofluorescence assay immunoglobulin G antibody test result. Of the 897 patients who had an eligible diagnosis, 240 (26.8%) met the inclusion criteria. The main outcome was time from initial presentation to definitive diagnosis and treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>During the 2-year study period, 126 (52.5%) patients were grouped in the pre-COVID period and 114 (47.5%) were grouped in the post-COVID period; 120 (50.0%) were female; and 139 (57.9%) were aged &gt; 50 years. Comparing the post-COVID to the pre-COVID period, the adjusted odds ratio (aOR) for delay in treatment\u2009&gt;\u20090 days was 1.81 (95% confidence interval [CI] 1.07\u20133.07, <jats:italic>P<\/jats:italic>\u2009=\u20090.03), and for a treatment delay\u2009&gt;\u20097 days, 1.65 (95% CI 0.94\u20132.90, <jats:italic>P<\/jats:italic>\u2009=\u20090.08). The odds of a delay in diagnosis were similar for patients in the post- and pre-COVID periods, with an aOR of 1.61 (95% CI 0.96\u20132.72, <jats:italic>P<\/jats:italic>\u2009=\u20090.07) for delays\u2009&gt;\u20090 days, and aOR of 1.72 (95% CI 0.99\u20133.00, <jats:italic>P<\/jats:italic>\u2009=\u20090.05) for delays\u2009&gt;\u20097 days.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The odds of a delay in treatment\u2009&gt;\u20090 days were significantly higher in the post-COVID period than in the pre-COVID period. However, the odds of a delay in treatment\u2009&gt;\u20097 days, or a delay in diagnosis, were similar between these two periods. Shifts in care-seeking, alternative care delivery models and prioritization of COVID-19 may contribute to diminished timeliness of treatment for patients with tick-borne diseases.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1186\/s13071-023-05917-8","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T14:03:14Z","timestamp":1692885794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of the COVID-19 pandemic on delays in diagnosis and treatment of tick-borne diseases endemic to southeastern USA"],"prefix":"10.1186","volume":"16","author":[{"given":"Victor","family":"Arahirwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Tyrlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Abernathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Cassidy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidin","family":"Alejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odai","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Giandomenico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Brown Marusiak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross M.","family":"Boyce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"5917_CR1","doi-asserted-by":"publisher","first-page":"496","DOI":"10.15585\/mmwr.mm6717e1","volume":"67","author":"R Rosenberg","year":"2018","unstructured":"Rosenberg R, Lindsey NP, Fischer M, Gregory CJ, Hinckley AF, Mead PS, et al. 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