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Learn about tick-borne illness, how it can become chronic, the challenges with traditional treatment options, and how patients can begin healing.

Rickettsia (Rocky Mountain Spotted Fever or RMSF)

by Dr. Jamie Kunkle

About Rickettsia

There are over 1,000 Rickettsia species. This bacteria is more simplistic than Borrelia and is often clinically easier to treat. However, some cases need more attention.

Chronic manifestations of Rickettsia are not as easily understood and could mimic other infections, such as Borrelia. Below are a few key differentiations.

Rickettsia is rarely seen in isolation and may be most obvious in an acute form with skin rashes on the scalp, palms, and soles of feet following a tick bite. Despite early or past antibiotic treatment, some doctors have found rickettsia positives in blood cultures of patients, suggesting some species may persist more frequently than originally expected.

If persistent rickettsia is possible, more research is needed to differentiate these many subspecies.

Common Symptoms of Rickettsia

  • RMSF initially presents with nonspecific symptoms such as fever, headache, rash, muscle aches and nausea
  • Skin and scalp rashes, especially on the palms and soles of feet
  • Congested feeling in the body (vascular likely)
  • Hypercoagulability/blood thickening
  • Lymphatic congestion
  • Swelling in ankles, faces, eyes
  • Irritated (red) eyes
  • Blurry vision as if “they are under water.”
  • Symptoms worse in the morning before moving
  • Headaches
  • Less cognitive symptoms than other tick-borne infections
  • Musculoskeletal problems
  • Numbness, tingling, joint and muscle pain

Other Rickettsia Species

Some of the more common rickettsia species are Ehrlichia, Anaplasma, and Rocky Mountain Spotted Fever (RMSF).

RMSF is the third most common rickettsia. It is generally considered regional, with the majority of cases reported from five states: Oklahoma, Arkansas, Missouri, Tennessee, and North Carolina.

There are TWO types of ehrlichiosis (an intracellular infection in the rickettsia genus): human monocytic ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE) named after cells they primarily infect. Human Granulocytic Ehrlichiosis was later renamed anaplasmosis in 2003, today, “Ehrlichia” usually refers to a Human Monocytic Ehrlichiosis infection.

Ehrlichia/HME, first described in humans in 1987, was originally thought to be an animal-only disease that infected horses, sheep, cattle, dogs, and cats. Whereas Anaplasma was first recognized in 1990. Both infections can range from mild (or no symptoms) to life-threatening.

Differentiating Ehrlichiosis from Anaplasmosis

Common Symptoms of Ehrlichiosis/HME:

  • Fever
  • Headaches
  • Myalgias
  • Arthralgia
  • Rash (more common in children)
  • Nausea/vomiting
  • Abdominal pain
  • Cough
  • Meningitis/meningoencephalitis

Common Symptoms of Anaplasmosis/HGE:

Early Signs and Symptoms (Days 1-5)
  • Fever and chills
  • Severe headache
  • Muscle aches
  • Nausea, vomiting, diarrhea, and loss of appetite
Late-Stage Signs and Symptoms
  • Respiratory failure
  • Bleeding problems
  • Organ failure
  • Death

Similarities between Ehrlichiosis and Anaplasmosis:

  • Fever
  • Headaches
  • Myalgia (muscle aches)
  • Low white blood cell counts and elevated liver function testing
  • Peripheral nervous system (PNS) symptoms are slightly more likely ie, peripheral/cranial nerve palsies
  • Less likely to have central nervous system involvement
  • Less severe rash than ehrlichiosis/HME

SEVERE SYMPTOMS shared by Ehrlichiosis and Anaplasmosis:

  • Low white blood cell count, low platelet count, anemia, elevated liver enzymes, kidney failure and respiratory insufficiency
  • Elderly parents or those with immune suppression are more likely to require hospitalization
  • If left untreated, death has occurred (3% fatality rate)