{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T11:01:48Z","timestamp":1773745308240,"version":"3.50.1"},"reference-count":10,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Delayed treatment of Rocky Mountain spotted fever is associated with increased morbidity and mortality. Because the diagnosis cannot be established from a single serological test, guidelines recommend empirical antibiotic initiation in suspect patients. We evaluated a policy used by UNC Health of paging clinicians when acute testing for <jats:italic>Rickettsia<\/jats:italic> returned with a titer \u22651:256. Our objective was to assess the potential effect of paging on routine treatment practices. Notably, we found that a high proportion of cases (<jats:italic>N<\/jats:italic> = 28, 40%) were not prescribed antibiotics until the results were available. The vast majority of these cases did not have evidence of compatible symptoms or disease progression. These findings suggest that paging may have prompted unnecessary treatment. Overall, the policy, which has now been discontinued, appears to have had limited benefit. Efforts are urgently needed to improve adherence to testing and treatment guidelines.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0251","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T18:35:01Z","timestamp":1709058901000},"page":"815-818","source":"Crossref","is-referenced-by-count":2,"title":["Does Paging Clinicians about Tick-Borne Disease Serological Results Impact Clinical Care? A Retrospective Analysis of 70 Cases in North Carolina"],"prefix":"10.4269","volume":"110","author":[{"given":"Neha V.","family":"Mokashi","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Brown Marusiak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Giandomenico","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan","family":"Cleinmark","sequence":"additional","affiliation":[{"name":"McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John L.","family":"Schmitz","sequence":"additional","affiliation":[{"name":"McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina;"},{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross M.","family":"Boyce","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;"},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;"},{"name":"Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Am J Trop Med Hyg","first-page":"405","article-title":"National surveillance for Rocky Mountain spotted fever, 1981\u20131992: epidemiologic summary and evaluation of risk factors for fatal outcome","volume":"52","author":"Dalton","year":"1995"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"1118","article-title":"Therapeutic delay and mortality in cases of Rocky Mountain spotted fever","volume":"20","author":"Kirkland","year":"1995"},{"key":"b3","series-title":"Clin Infect Dis","first-page":"1659","article-title":"Risk factors for fatal outcome from rocky mountain spotted Fever in a highly endemic area-Arizona, 2002\u20132011","volume":"60","author":"Regan","year":"2015"},{"key":"b4","series-title":"Sci Rep","first-page":"18382","article-title":"Patient characteristics, treatment patterns, and outcomes of Rickettsial diseases among a commercially insured population in the United States, 2005\u20132017","volume":"1","author":"Binder","year":"2021"},{"key":"b5","series-title":"Diagnostic Procedures for Viral, Rickettsial, and Chlamydial Infections","first-page":"575","author":"Walker"},{"key":"b6","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis \u2013 United States","volume":"65","author":"Biggs","year":"2016"},{"key":"b7","series-title":"Changes to Public Health Reporting and National Notification for Spotted Fever Rickettsiosis (including Rocky Mountain Spotted Fever)","author":"Moncayo","year":"2019"},{"key":"b8","series-title":"J Infect Dis","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"},{"key":"b9","series-title":"Clin Infect Dis","first-page":"805","article-title":"Rickettsia parkeri: a newly recognized cause of spotted fever rickettsiosis in the United States","volume":"38","author":"Paddock","year":"2004"},{"key":"b10","series-title":"Int J Syst Evol Microbiol","first-page":"5236","article-title":"Rickettsia amblyommatis sp. nov., a spotted fever group Rickettsia associated with multiple species of Amblyomma ticks in North, Central and South America","volume":"66","author":"Karpathy","year":"2016"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/4\/article-p815.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/4\/article-p815.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/4\/article-p815.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T13:10:47Z","timestamp":1712149847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/4\/article-p815.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,3]]},"references-count":10,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0251","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,3]]}}}