Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
A Wolf at the Door: Rocky Mountain Spotted Fever in the Americas
"A wolf at the door" – that's how researchers describe the growing threat of Rocky Mountain Spotted Fever (RMSF), a potentially deadly tick-borne disease that's increasingly prevalent across the Americas. In this eye-opening conversation, Drs. Janet Foley and Andres Lopez-Perez challenge common misconceptions about this dangerous pathogen.
Did you know the brown dog tick – a primary vector for RMSF – thrives in urban environments rather than wilderness areas? This tick commonly infests homes, yards, and kennels, putting dogs and their human families at risk even in cities and towns. Drs. Foley and Lopez-Perez emphasize that veterinarians serve as crucial frontline defenders through early detection and treatment, potentially saving both canine and human lives.
Time is the enemy with RMSF. Each 2-3 day delay in starting doxycycline treatment doubles or triples the risk of death. While case fatality rates vary dramatically between regions, Drs. Foley and Lopez-Perez attribute these differences primarily to healthcare access and speed of diagnosis rather than bacterial strain differences. Their international collaborations reveal how the same disease manifests differently across various ecological settings from Brazil to Mexico to the United States yet shares common challenges requiring coordinated One Health solutions.
For veterinarians, the key takeaway is maintaining a high index of suspicion for RMSF in endemic areas, even when symptoms initially appear vague. Despite today's focus on antimicrobial stewardship, the hosts emphasize that appropriate doxycycline use for suspected RMSF represents good medicine given the disease's potential lethality. Through greater awareness, timely intervention, and collaborative approaches across medical disciplines, we can better protect both animal and human health from this serious emerging threat.
Listen now to understand the evolving ecology of this disease, learn practical approaches to diagnosis and prevention, and discover how your veterinary practice can play a vital role in addressing this significant One Health challenge.
AJVR article: https://doi.org/10.2460/ajvr.24.11.0368
JAVMA article: https://doi.org/10.2460/javma.24.11.0756
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Speaker 2:This is Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about Rocky Mountain spotted fever with our guests Andres Lopez-Perez and Janet Foley.
Speaker 3:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Janet and Andres joining us and one of the most fascinating articles I've read yet as Editor-in-Chief A little bit creepy, a little bit concerning, but super fascinating and very well read. So, janet and Andres, thank you so much for taking the time to be here with us today.
Speaker 4:Thanks for having us and thanks for accepting the commission for the papers in the comments. In One Health.
Speaker 5:Yep, thank you for having us here. I am super excited to be here with you this time.
Speaker 2:Great, let's dive right in. So, janet, your Javmon AJVR articles. Discuss Rocky Mountain Spotted Fever. Please share with our listeners the background on this article.
Speaker 4:Oh well, our group has been working collaboratively on Rocky Mountain Spotted Fever for quite a few years now. There's some concerns about Rocky Mountain Sp fever in California and in the United States broadly. But it's been really eye-opening to me to be involved in these international collaborations as well and starting to learn from our Mexican colleagues, south American colleagues, central American colleagues, which really inform the scope of One Health, but also how we can learn from each other and do prevention in these different ecologies across the new world.
Speaker 2:And diseases don't know borders, so always nice to collaborate Right. Thanks, and Andres. What are important take-home messages from this Javma article?
Speaker 5:Okay, I think in just one word, the most important take-away message from this paper is disease awareness and it's really really important to recognize that RMSF in dogs. Because if a dog has RMSF the family of the dog is also at risk and every treatment is also important for the health of the dog. But the diseases can be really really hard to recognize. Clinical signs can mimic many other diseases, so it can be hard to recognize RMSF. So this means that knowing the history and possible exposure of the dog is really important for knowing how concerned the veterinarian should be that it is RMSF. And the last important thing which is related to the awareness is very important to highlight from the paper, is that the many vets and people in the US and Mexico don't know that the brown dog tick R, picephalus sanguineus, can be spread RMFF. And this tick is very common in places that people don't expect to find ticks, such as cities and towns, around homes and kennels, but not in nature as we would expect it but not in nature as we were expected.
Speaker 2:Yeah, reading your manuscript took me back to second year of vet school with all the parasitology work that we did, so it was a good refresher for me. I liked it. And, janet. What are important take-home messages from the AJBR article?
Speaker 4:The AJBR article. A friend of ours, one of the co-authors, came up with the idea of giving it the title A Wolf at the Door, and I think that that says two things. One is this is a really scary disease. It's serious, it can have very high case fatality but on the other hand, in some places it doesn't have such high case fatality, which gives us hope that when we can learn from each other, we can develop better intervention plans and, you know, kind of use the awareness that Andres was describing to try to reduce cases. But also the second part of that title it's at the door, it's right here, it's in California, it's been more and more abundant in Southern California and it's in epidemics in the southern parts of Brazil that we described. Colombia, parts of Panama and Costa Rica have cases. I mean, it's right at the door of all of us and it's something we need to really come to terms with. I think.
Speaker 3:Yeah, I really like that raising awareness that you know, as Sarah said, we learn about it in second year and maybe medical doctors really aren't all that aware of it and knowing the brown dog tick carries more than one disease it is. Yeah, it's terrifying and thinking of it in the city, like you said, janet, people just think of like, oh, you get ticks from going in the long grass, but not necessarily the little buggers are everywhere. Andres, what sparked your interest in Rocky Mountain Spotted Fever? Did you have a case or know some animal that was affected? Or what sparked your interest?
Speaker 5:Actually, when I was going through my PhD, I was working with flea-borne diseases and by that time I was working with diseases that, in my opinion, were not that meaningful as meaningful as RMSF.
Speaker 5:And the reason is because we have been working with diseases that most of the time we are saying, oh there was a case far away from here and there is a case maybe in Europe or maybe in Asia and for, but when I was working with those things I was feeling like that my research wasn't as meaningful as I would like to be.
Speaker 5:So when I was looking around and I was working along the US-Mexico border, it was very easy for me to find that very close where the area that I was working in, there was this outbreak happening and people were dying along that area all over the area. So that was one of the main things that happened that sparked my interest in RMSF. And the other thing was when I started reading about that disease, the ecology and the evolution. For me that was very, very, very impactful to know that there is a that I mean the bacteria that cause the disease is actually very it has been evolving to live in different environments and it is, and that was something very, very important for me. You know, like the evolution and ecology of the bacteria changed my point of view, and mostly because now I can see them more like living beings and I think that's one of the most important things for us to know that they are living beings. So then making the program, the contract program, will be easier for us if we think of them as living beings.
Speaker 3:Yeah, great point. I love what you said, like find something that's impactful and something that you love and it becomes a passion, not work, it becomes your profession, is your passion. I love that. Janet, every time we write articles like this even though you're a key opinion leader I think at least I do when I write articles that are basically reviews there's something that surprises me. Was there anything from either of these articles that you coalesced and thought of how you might think of something differently?
Speaker 4:Yeah, that's a really great question.
Speaker 4:I think that, especially with the AJBR paper, getting a chance to work so much more closely with collaborators from multiple countries, most of Andres' and my work has been either in the United States or in Mexico, but now we're starting to talk with co-authors in Brazil, panama, and that allowed us to do some additional work looking at Colombia and Costa Rica as well.
Speaker 4:So in all of these places, rocky Mountain spotted fever is caused by the same bacteria, but it's transmitted by different tick species. So one of the things we tried to do in the paper is find things that were similar, that we would be able to learn from and manage similarly, and things that were different. So I was really impressed with how different the ecologies can be. But then, bringing it full circle, just thinking similarly, in Brazil there are dogs, there is brown dog tick, transmitted Rocky Mountain spotted fever, but then there's also the capybara and their cycle and in a way, you were like oh well, capybaras are wildlife. We're going to have to look at this totally differently, but not so much because the capybaras are on golf courses and they're in parks and schools, and so now again we've got an animal that's living really closely with people presenting this disease risk that we have to manage.
Speaker 3:Yeah, Another thing I really loved about this pair of articles. It's hard sometimes to make the environment, the ecology close to, as important as the disease. Obviously we don't want to lose lives, but these articles really, really brought home the environment in the concept of One Health.
Speaker 2:Yeah, it's great to hear that. International collaboration and also the comparative medical approach too, with these cases. So, andres, what are the next steps for research in this topic?
Speaker 5:So there are a lot of things to do, for sure, for sure. But one of the main thing that we are thinking it would be it would be very interesting or important for us to research would be the demography of the dogs. We don't know anything about the structure of the population of dogs. We don't know how many dogs are out there where a high-risk area for RMSF is. So knowing how many dogs can prove the interventions spayed and neutered, it's very important to know how many dogs are in those areas. And now, one of the other things that has been important or people I mean researchers have been started to talk about is the vaccine. It could be a vaccine that can attack the tick by itself or the bacteria. So that's another reason why it's very important for us to know how many dogs are in the high risk areas, are in the high-risk areas. And the other topics that are important and could be important for us to know is the epidemiology of those cases in vet clinics. We don't know that much about that. It is important to recognize that canine cases have not been as extensively evaluated in as human cases and much data on the clinical course of the disease in dogs is needed. And the other topics are tick resistance for akarocytes is very important. In Mexico and other places, the Secretary of Health has been using deltametrine and fipronil on dogs and we don't know anything about the resistance and how the resistance is in the ticks after two decades of treatment.
Speaker 5:You know, intervention and the social aptitude and perception is actually important too.
Speaker 5:The group the RMS group that we have been collaborating with, almost always says that people don't do anything in those areas because most of those areas are marginal areas, are marginal neighborhoods.
Speaker 5:So most of the time we say that the people don't do too much things because they don't have money enough to treat the dogs, to try to clean, so they don't do that much things. But one thing that I think it's important to know is like if there is anything behind that that we can research to know why the people are not doing things, because sometimes you don't need to have a lot of money to try to clean the house, because it's very important to clean the clutter around the house in order for the ticks to, in order to try to get rid of the ticks. And the last part would be modeling, and that's something that Janet has been working on. It's like trying to model the different intervention controls that we could use as a spay and neuter vaccination color coloring dogs. So modeling that seems to be like a good approach to try to understand what is how the control can work. Well, work loves to do. Those might be the most important ones.
Speaker 3:Janet, earlier you said that rock tomato spotted fever is more lethal in some populations than others. What are some insights into why that might be and what can we do to make it less leverage that for potential treatments?
Speaker 4:Yeah, I don't know 100%. You could even speculate that the bacteria is more lethal. There's different genetic strains of the bacteria and some are more lethal than others. I don't personally think that's the case, but I've heard that hypothesized. I personally think that the two big reasons that it can be more lethal are access to health care, you know, high quality health care, because these patients, as you guys know, can become very, very complicated to treat.
Speaker 4:Both dogs and people are very sick. They can have multiple organ failure, they can have cerebellar issues and you just have to be super careful about everything. So I think that's one difference across some populations and I think the other big one is how quickly the disease is diagnosed or, even without a diagnosis, started to be treated. It says in both of the articles, every couple of days, that you delay the beginning of doxycycline treatment increases, doubles, triples the risk that the patient is going to die. And so you know all of us the disease presents as a headache and muscle pain and maybe a fever. We don't immediately all go to the emergency room just because we're experiencing immediately all go to the emergency room just because we're experiencing a headache. On the other hand, if you live in one of these high-risk communities, it's really, really important that there's a strong relationship with a medical provider who knows this and knows to give doxycycline presumptively. I personally think that those are the main reasons for the discrepancy in case fatality.
Speaker 3:You clearly are a key opinion leader and then have all these like full relationships. How did your training and previous work help prepare you to write these two articles?
Speaker 4:us to approach problems in a unique way. Maybe it's a little bit dated, but the standard subjective, objective assessment and plan approach that we take to an individual case, what works really well for a One Health intervention. So I think that my experience as a practicing veterinarian I didn't really see Rocky Mountain spotted fever, I saw a lot of other tick-borne diseases, and then I'm a professor and I do infectious disease ecology. So those several things together, as you point out, Lisa, our work is our passion. I have other passions too, but it's a big one and I happen to really love ticks and tick-borne diseases. I don't love having them and I respect how much damage they do, but they are so interesting ecologically.
Speaker 3:Good party conversation.
Speaker 4:Oh, yeah, always.
Speaker 3:Well, I think so, but, Andre, how did your work help co-author these articles?
Speaker 5:I think one of the reasons why I was able to participate in these papers is because I have been gotten to see and survey so many dogs in the field and taking all the samples to the lab and you know, knowing all the process that you have to do in order to get the data or the results to know more about the disease. But besides that, I have been able to talk and work with vets and physicians, but also I have been able to talk to family whose members or relative members have died because of the disease. So I think all those experiences and different perspectives have given me the knowledge to see that RMSF is a one-help challenge for sure, and writing this paper is part of the outreach that is needed to educate professionals and all the people and the people that can get access to them.
Speaker 2:I hope this podcast episode and your articles help remind veterinarians to keep RMSF on their differential list for cases when it's appropriate. So hopefully that happens Now. This next set of questions is really important for our listeners, and the first one's going to be about the veterinarian's perspective. So, janet, what is one piece of information the veterinarian should know about? Rocky Mountain Spotted Fever?
Speaker 4:I think it's so important that the veterinarian become a part of this One Health team and that I think came across really well in the job of my paper that the veterinarian is the frontline professional for assessing a dog for ticks and tick-borne diseases, which helps the dog and is so, so, so important in beginning that conversation with the rest of the One Health team and the dog owner and the medical doctor. So I think that the most important thing a veterinarian brings to the table is that the knowledge about parasitology. You know this knowledge about how these cycles work and what it means for the family as a whole.
Speaker 2:Very well said. And the other side of the relationship. What's one thing clients should know about Rocky Mountain Spotted Fever.
Speaker 4:For me, clients first of all need, especially in high risk areas, which you know. As Andra said, we've done a lot of work in northern Mexico, but our co-authors were all over the New World. So clients should know what kind of a risk their environment presents to them so that they can advocate for themselves and their family when needed. Say, is that in the United States, other than the tribal lands in Arizona? Well, in the southwestern United States we don't see the clusters in the neighborhoods. We see a case here and a case there. So I think the relationship with the client and the client education is a little bit different. When you're not seeing clusters and epidemics, there's still a risk. So it's important that the whole team better understand the risk, each region's specific risk.
Speaker 3:In this day and age of antimicrobial stewardship, do you see a reluctance on the part of veterinarians or MDs to prescribe early? Like you said, the symptoms can be vague and mimic a lot of other diseases.
Speaker 4:Potentially the drug of choice is doxycycline, and that's not the main target in this age of antimicrobial stewardship that most of us are worried about. It's also not the first-line drug you often use for ADR ain't-doing-right dogs. So, on the other hand, if you do risk-benefit analysis for Rocky Mountain Spotted Fever and doxycycline specifically, you would want to use doxycycline, which is rather inexpensive, less concerning in some of these regards and saves lives. I think I don't remember what I was going to say and you guys can edit that.
Speaker 3:But it's the same. I live in upstate New York, janet, right, and it's Lyme country, lyme disease, so it's the same thing. And when I hear people say, oh you know, you want to confirm a diagnosis, like we're not really too worried about a course of doxy, like get them on it and it's not lethal like Rocky Mountain spotted fever, but you still always good to catch them in the early stages, well, fascinating, you guys are awesome. I can't wait to read more of your work, especially the international collaboration. It's so important to keep the ear to the ground and find out what everybody else is doing to really try and solve some of these problems or at least minimize them. Yeah, as we move to conclude, I just want to ask a kind of a fun question. So, janet, first for you, what is your favorite animal fact?
Speaker 4:My favorite animal fact. I'm going to go with the fact that the duck-billed platypus has its own specialized Ixodes species tick. It's called Ixodes ornithobranchii and it's only found in Australia and only feeds on duck-billed platypus. Does it carry diseases? Not that we know of. We tried, we tested them.
Speaker 3:Fascinating. Wow, that is really cool, Andre. If you could have a superpower, what would it be? And why could have a superpower.
Speaker 5:what would it be and why? First of all, I would say that I have to say like it's hard for me to think about superpower Sometimes. I am one of those kind of person who would rather think about realistic things, but in this case I would go with flying. So I think like flying would be a good thing for me because I could visit more places and to be able to support more people and do more research and spend more time with my family. In just one word, it would be good for my efficiency in life.
Speaker 2:I echo that Flying would be awesome. I actually just got back from a Disney trip where we walked 30,000 steps a day and flying would have been fabulous. For that, flying would be awesome. I actually just got back from a Disney trip where we walked 30,000 steps a day and flying would have been fabulous. Thank you so much, andres and Janet. We really appreciate you being here today and also for contributing your articles to Javma and AJPR.
Speaker 4:I want to say, lisa, thank you so much for all the encouragement early in the game. We wouldn't have done it without you, so thank you very much, thank you.
Speaker 5:That's awesome.
Speaker 2:Thank you for having us here and to our listeners. You can read Andres and Janet's articles in Java and AJVR. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
