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Case report: Co-infection of Rickettsia rickettsii and Streptococcus pyogenes: is fatal Rocky Mountain spotted fever underdiagnosed?

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Am J Trop Med Hyg. 2014 Dec;91(6):1154-5. doi: 10.4269/ajtmh.14-0437.

Epub 2014 Oct 20.

Raczniak GA1, Kato C2, Chung IH2, Austin A2, McQuiston JH2, Weis E2, Levy C2, Carvalho Mda G2, Mitchell A2, Bjork A2, Regan JJ2.
Author information1Epidemic 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 vih5 [at] cdc [dot] gov.
2Epidemic 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.

Abstract
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.

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