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Co-Infection of Rickettsia rickettsii and Streptococcus pyogenes: Is Fatal Rocky Mountain Spotted Fever Underdiagnosed?

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  • Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Streptococcus Laboratory, National Center for Immunization and Respiratory Diseases, HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Border Health Services Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Infectious Diseases Services, Arizona Department of Health Services, Phoenix, Arizona; Maricopa County Department of Public Health, Phoenix, Arizona

Rocky Mountain spotted fever, a tick-borne disease caused by Rickettsia rickettsii, is challenging to diagnose and rapidly fatal if not treated. We describe a decedent who was co-infected with group A β-hemolytic streptococcus and R. rickettsii. Fatal cases of Rocky Mountain spotted fever may be underreported because they present as difficult to diagnose co-infections.

Author Notes

* Address correspondence to Gregory A. Raczniak, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333. E-mail: vih5@cdc.gov

Financial support: This study was supported by the Centers for Disease Control and Prevention.

Authors' addresses: Gregory A. Raczniak, Cecilia Kato, Ida H. Chung, Amy Austin, Jennifer H. McQuiston, Maria da Gloria S. Carvalho, Adam Bjork, and Joanna J. Regan, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: vih5@cdc.gov, hex0@cdc.gov, ipi8@cdc.gov, vng4@cdc.gov, fzh7@cdc.gov, msc8@cdc.gov, iyk4@cdc.gov, and dlo8@cdc.gov. Erica Weis, Arizona Department of Health Services, Phoenix, AZ, E-mail: Erica.Weis@azdhs.gov. Craig Levy and Audrey Mitchell, Maricopa County Department of Public Health, Phoenix, AZ, E-mails: craiglevy@mail.maricopa.gov and audreymitchell@mail.maricopa.gov.

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