May 20, 2025 • 24 mins
"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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Wellness Pet Foods (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:30):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode, we chat aboutRocky Mountain spotted fever
with our guests AndresLopez-Perez and Janet Foley.
Lisa Fortier (00:42):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Janet and Andresjoining us and one of the most
fascinating articles I've readyet as Editor-in-Chief A little
bit creepy, a little bitconcerning, but super
fascinating and very well read.
So, Janet and Andres, thank youso much for taking the time to
be here with us today.
Janet Foley (01:03):
Thanks for having us and thanks for accepting the
commission for the papers in thecomments.
In One Health.
Andres Lopez-Perez (01:13):
Yep, thank you for having us here.
I am super excited to be herewith you this time.
Sarah Wright (01:19):
Great, let's dive right in.
So, Janet, your JAVMA and AJVRarticles.
Discuss Rocky Mountain SpottedFever.
Please share with our listenersthe background on this article.
Janet Foley (01:31):
Oh well, our group has been working collaboratively
on Rocky Mountain Spotted Feverfor quite a few years now.
There's some concerns aboutRocky Mountain Sp fever in
California and in the UnitedStates broadly.
But it's been reallyeye-opening to me to be involved
(01:51):
in these internationalcollaborations as well and
starting to learn from ourMexican colleagues, south
American colleagues, centralAmerican colleagues, which
really inform the scope of OneHealth, but also how we can
learn from each other and doprevention in these different
ecologies across the new world.
Sarah Wright (02:15):
And diseases don't know borders, so always nice to
collaborate Right.
Thanks, and Andres.
What are important take-homemessages from this JAVMA article
?
Andres Lopez-Perez (02:26):
Okay, I think in just one word, the most
important take-away messagefrom this paper is disease
awareness and it's really reallyimportant to recognize that
RMSF in dogs.
Because if a dog has RMSF thefamily of the dog is also at
risk and every treatment is alsoimportant for the health of the
(02:49):
dog.
But the diseases can be reallyreally hard to recognize.
Clinical signs can mimic manyother diseases, so it can be
hard to recognize RMSF.
So this means that knowing thehistory and possible exposure of
the dog is really important forknowing how concerned the
veterinarian should be that itis RMSF.
(03:10):
And the last important thingwhich is related to the
awareness is very important tohighlight from the paper, is
that the many vets and people inthe US and Mexico don't know
that the brown dog tick R,picephalus sanguineus, can be
spread RMFF.
And this tick is very common inplaces that people don't expect
(03:34):
to find ticks, such as citiesand towns, around homes and
kennels, but not in nature as wewould expect it but not in
nature as we were expected.
Sarah Wright (03:48):
Yeah, reading your manuscript took me back to
second year of vet school withall the parasitology work that
we did, so it was a goodrefresher for me.
I liked it.
And, Janet.
What are important take-homemessages from the AJVR article?
Janet Foley (04:02):
A friend of ours, one of the co-authors, came up
with the idea of giving it thetitle A Wolf at the Door, and I
think that that says two things.
One is this is a really scarydisease.
It's serious, it can have veryhigh case fatality but on the
other hand, in some places itdoesn't have such high case
(04:23):
fatality, which gives us hopethat when we can learn from each
other, we can develop betterintervention plans and, you know
, kind of use the awareness thatAndres was describing to try to
reduce cases.
But also the second part ofthat title it's at the door,
it's right here, it's inCalifornia, it's been more and
(04:45):
more abundant in SouthernCalifornia and it's in epidemics
in the southern parts of Brazilthat we described.
Colombia, parts of Panama andCosta Rica have cases.
I mean, it's right at the doorof all of us and it's something
we need to really come to termswith.
I think.
Lisa Fortier (05:03):
Yeah, I really like that raising awareness that
you know, as Sarah said, welearn about it in second year
and maybe medical doctors reallyaren't all that aware of it and
knowing the brown dog tickcarries more than one disease it
is.
Yeah, it's terrifying andthinking of it in the city, like
you said, Janet, people justthink of like, oh, you get ticks
(05:23):
from going in the long grass,but not necessarily the little
buggers are everywhere.
Andres, what sparked yourinterest in Rocky Mountain
Spotted Fever?
Did you have a case or knowsome animal that was affected?
Or what sparked your interest?
Andres Lopez-Perez (05:44):
Actually, when I was going through my PhD,
I was working with flea-bornediseases and by that time I was
working with diseases that, inmy opinion, were not that
meaningful as meaningful as RMSF.
And the reason is because wehave been working with diseases
that most of the time we aresaying, oh there was a case far
(06:07):
away from here and there is acase maybe in Europe or maybe in
Asia and for, but when I wasworking with those things I was
feeling like that my researchwasn't as meaningful as I would
like to be.
So when I was looking around andI was working along the
US-Mexico border, it was veryeasy for me to find that very
(06:27):
close where the area that I wasworking in, there was this
outbreak happening and peoplewere dying along that area all
over the area.
So that was one of the mainthings that happened that
sparked my interest in RMSF.
And the other thing was when Istarted reading about that
(06:50):
disease, the ecology and theevolution.
For me that was very, very,very impactful to know that
there is a that I mean thebacteria that cause the disease
is actually very it has beenevolving to live in different
environments and it is, and thatwas something very, very
important for me.
(07:11):
You know, like the evolutionand ecology of the bacteria
changed my point of view, andmostly because now I can see
them more like living beings andI think that's one of the most
important things for us to knowthat they are living beings.
So then making the program, thecontract program, will be
(07:31):
easier for us if we think ofthem as living beings.
Lisa Fortier (07:36):
Yeah, great point.
I love what you said, like findsomething that's impactful and
something that you love and itbecomes a passion, not work, it
becomes your profession, is yourpassion.
I love that.
Janet, every time we writearticles like this even though
you're a key opinion leader Ithink at least I do when I write
(07:58):
articles that are basicallyreviews there's something that
surprises me.
Was there anything from eitherof these articles that you
coalesced and thought of how youmight think of something
differently?
Janet Foley (08:09):
Yeah, that's a really great question.
I think that, especially withthe AJVR paper, getting a chance
to work so much more closelywith collaborators from multiple
countries, most of Andres' andmy work has been either in the
United States or in Mexico, butnow we're starting to talk with
co-authors in Brazil, Panama,and that allowed us to do some
(08:31):
additional work looking atColombia and Costa Rica as well.
So in all of these places, rockyMountain spotted fever is
caused by the same bacteria, butit's transmitted by different
tick species.
So one of the things we triedto do in the paper is find
things that were similar, thatwe would be able to learn from
and manage similarly, and thingsthat were different.
(08:53):
So I was really impressed withhow different the ecologies can
be.
But then, bringing it fullcircle, just thinking similarly,
in Brazil there are dogs, thereis brown dog tick, transmitted
Rocky Mountain spotted fever,but then there's also the
capybara and their cycle and ina way, you were like oh well,
(09:15):
capybaras are wildlife.
We're going to have to look atthis totally differently, but
not so much because thecapybaras are on golf courses
and they're in parks and schools, and so now again we've got an
animal that's living reallyclosely with people presenting
this disease risk that we haveto manage.
Lisa Fortier (09:32):
Yeah, Another thing I really loved about this
pair of articles.
It's hard sometimes to make theenvironment, the ecology close
to, as important as the disease.
Obviously we don't want to loselives, but these articles
really, really brought home theenvironment in the concept of
One Health.
Sarah Wright (09:54):
Yeah, it's great to hear that.
International collaboration andalso the comparative medical
approach too, with these cases.
So, Andres, what are the nextsteps for research in this topic
?
Andres Lopez-Perez (10:05):
So there are a lot of things to do, for sure
, for sure.
But one of the main thing thatwe are thinking it would be it
would be very interesting orimportant for us to research
would be the demography of thedogs.
We don't know anything aboutthe structure of the population
of dogs.
We don't know how many dogs areout there where a high-risk
(10:27):
area for RMSF is.
So knowing how many dogs canprove the interventions spayed
and neutered, it's veryimportant to know how many dogs
are in those areas.
And now, one of the otherthings that has been important
or people I mean researchershave been started to talk about
(10:49):
is the vaccine.
It could be a vaccine that canattack the tick by itself or the
bacteria.
So that's another reason whyit's very important for us to
know how many dogs are in thehigh risk areas, are in the
high-risk areas.
And the other topics that areimportant and could be important
(11:10):
for us to know is theepidemiology of those cases in
vet clinics.
We don't know that much aboutthat.
It is important to recognizethat canine cases have not been
as extensively evaluated in ashuman cases and much data on the
clinical course of the diseasein dogs is needed.
And the other topics are tickresistance for akarocytes is
(11:37):
very important.
In Mexico and other places, theSecretary of Health has been
using deltametrine and fipronilon dogs and we don't know
anything about the resistanceand how the resistance is in the
(11:59):
ticks after two decades oftreatment.
You know, intervention and thesocial aptitude and perception
is actually important too.
The group the RMS group that wehave been collaborating with,
almost always says that peopledon't do anything in those areas
because most of those areas aremarginal areas, are marginal
neighborhoods.
So most of the time we say thatthe people don't do too much
(12:22):
things because they don't havemoney enough to treat the dogs,
to try to clean, so they don'tdo that much things.
But one thing that I think it'simportant to know is like if
there is anything behind thatthat we can research to know why
the people are not doing things, because sometimes you don't
(12:43):
need to have a lot of money totry to clean the house, because
it's very important to clean theclutter around the house in
order for the ticks to, in orderto try to get rid of the ticks.
And the last part would bemodeling, and that's something
that Janet has been working on.
It's like trying to model thedifferent intervention controls
(13:07):
that we could use as a spay andneuter vaccination color
coloring dogs.
So modeling that seems to belike a good approach to try to
understand what is how thecontrol can work.
Well, work loves to do.
Those might be the mostimportant ones.
Lisa Fortier (13:28):
Janet, earlier you said that rock tomato spotted
fever is more lethal in somepopulations than others.
What are some insights into whythat might be and what can we
do to make it less leverage thatfor potential treatments?
Janet Foley (13:45):
Yeah, I don't know 100%.
You could even speculate thatthe bacteria is more lethal.
There's different geneticstrains of the bacteria and some
are more lethal than others.
I don't personally think that'sthe case, but I've heard that
hypothesized.
I personally think that the twobig reasons that it can be more
(14:08):
lethal are access to healthcare, you know, high quality
health care, because thesepatients, as you guys know, can
become very, very complicated totreat.
Both dogs and people are verysick.
They can have multiple organfailure, they can have
cerebellar issues and you justhave to be super careful about
(14:30):
everything.
So I think that's onedifference across some
populations and I think theother big one is how quickly the
disease is diagnosed or, evenwithout a diagnosis, started to
be treated.
It says in both of the articles, every couple of days, that you
delay the beginning ofdoxycycline treatment increases,
(14:53):
doubles, triples the risk thatthe patient is going to die.
And so you know all of us thedisease presents as a headache
and muscle pain and maybe afever.
We don't immediately all go tothe emergency room just because
we're experiencing immediatelyall go to the emergency room
just because we're experiencinga headache.
On the other hand, if you livein one of these high-risk
communities, it's really, reallyimportant that there's a strong
(15:15):
relationship with a medicalprovider who knows this and
knows to give doxycyclinepresumptively.
I personally think that thoseare the main reasons for the
discrepancy in case fatality.
Lisa Fortier (15:28):
You clearly are a key opinion leader and then have
all these like fullrelationships.
How did your training andprevious work help prepare you
to write these two articles?
Janet Foley (15:53):
us to approach problems in a unique way.
Maybe it's a little bit dated,but the standard subjective,
objective assessment and planapproach that we take to an
individual case, what worksreally well for a One Health
intervention.
So I think that my experienceas a practicing veterinarian I
didn't really see Rocky Mountainspotted fever, I saw a lot of
other tick-borne diseases, andthen I'm a professor and I do
(16:15):
infectious disease ecology.
So those several thingstogether, as you point out, Lisa
, our work is our passion.
I have other passions too, butit's a big one and I happen to
really love ticks and tick-bornediseases.
I don't love having them and Irespect how much damage they do,
(16:38):
but they are so interestingecologically.
Lisa Fortier (16:42):
Good party conversation.
Janet Foley (16:43):
Oh, yeah, always.
Lisa Fortier (16:47):
Well, I think so, but, Andre, how did your work
help co-author these articles?
Andres Lopez-Perez (16:56):
I think one of the reasons why I was able to
participate in these papers isbecause I have been gotten to
see and survey so many dogs inthe field and taking all the
samples to the lab and you know,knowing all the process that
you have to do in order to getthe data or the results to know
(17:17):
more about the disease.
But besides that, I have beenable to talk and work with vets
and physicians, but also I havebeen able to talk to family
whose members or relativemembers have died because of the
disease.
So I think all thoseexperiences and different
(17:40):
perspectives have given me theknowledge to see that RMSF is a
one-help challenge for sure, andwriting this paper is part of
the outreach that is needed toeducate professionals and all
the people and the people thatcan get access to them.
Sarah Wright (18:01):
I hope this podcast episode and your
articles help remindveterinarians to keep RMSF on
their differential list forcases when it's appropriate.
So hopefully that happens Now.
This next set of questions isreally important for our
listeners, and the first one'sgoing to be about the
veterinarian's perspective.
So, janet, what is one piece ofinformation the veterinarian
should know about?
Rocky Mountain Spotted Fever?
Janet Foley (18:24):
I think it's so important that the veterinarian
become a part of this One Healthteam and that I think came
across really well in the job ofmy paper that the veterinarian
is the frontline professionalfor assessing a dog for ticks
and tick-borne diseases, whichhelps the dog and is so, so, so
(18:46):
important in beginning thatconversation with the rest of
the One Health team and the dogowner and the medical doctor.
So I think that the mostimportant thing a veterinarian
brings to the table is that theknowledge about parasitology.
You know this knowledge abouthow these cycles work and what
it means for the family as awhole.
Sarah Wright (19:08):
Very well said.
And the other side of therelationship.
What's one thing clients shouldknow about Rocky Mountain
Spotted Fever.
Janet Foley (19:19):
For me, clients first of all need, especially in
high risk areas, which you know.
As Andra said, we've done a lotof work in northern Mexico, but
our co-authors were all overthe New World.
So clients should know whatkind of a risk their environment
presents to them so that theycan advocate for themselves and
(19:41):
their family when needed.
Say, is that in the UnitedStates, other than the tribal
lands in Arizona?
Well, in the southwesternUnited States we don't see the
clusters in the neighborhoods.
We see a case here and a casethere.
(20:02):
So I think the relationshipwith the client and the client
education is a little bitdifferent.
When you're not seeing clustersand epidemics, there's still a
risk.
So it's important that thewhole team better understand the
risk, each region's specificrisk.
Lisa Fortier (20:21):
In this day and age of antimicrobial stewardship
, do you see a reluctance on thepart of veterinarians or MDs to
prescribe early?
Like you said, the symptoms canbe vague and mimic a lot of
other diseases.
Janet Foley (20:38):
Potentially the drug of choice is doxycycline,
and that's not the main targetin this age of antimicrobial
stewardship that most of us areworried about.
It's also not the first-linedrug you often use for ADR
ain't-doing-right dogs.
So, on the other hand, if youdo risk-benefit analysis for
(21:02):
Rocky Mountain Spotted Fever anddoxycycline specifically, you
would want to use doxycycline,which is rather inexpensive,
less concerning in some of theseregards and saves lives.
I think I don't remember what Iwas going to say and you guys
(21:22):
can edit that.
Lisa Fortier (21:24):
But it's the same.
I live in upstate New York,Janet, right, and it's Lyme
country, Lyme disease, so it'sthe same thing.
And when I hear people say, ohyou know, you want to confirm a
diagnosis, like we're not reallytoo worried about a course of
doxy, like get them on it andit's not lethal like Rocky
Mountain spotted fever, but youstill always good to catch them
(21:46):
in the early stages, well,fascinating, you guys are
awesome.
I can't wait to read more ofyour work, especially the
international collaboration.
It's so important to keep theear to the ground and find out
what everybody else is doing toreally try and solve some of
these problems or at leastminimize them.
Yeah, as we move to conclude, Ijust want to ask a kind of a
(22:11):
fun question.
So, Janet, first for you, whatis your favorite animal fact?
Janet Foley (22:16):
My favorite animal fact.
I'm going to go with the factthat the duck-billed platypus
has its own specialized Ixodesspecies tick.
It's called Ixodesornithobranchii and it's only
found in Australia and onlyfeeds on duck-billed platypus.
Does it carry diseases?
(22:37):
Not that we know of.
We tried, we tested them.
Lisa Fortier (22:42):
Fascinating.
Wow, that is really cool, Andre.
If you could have a superpower,what would it be?
And why could have a superpower.
Andres Lopez-Perez (22:54):
what would it be and why?
First of all, I would say thatI have to say like it's hard for
me to think about superpowerSometimes.
I am one of those kind ofperson who would rather think
about realistic things, but inthis case I would go with flying
.
So I think like flying would bea good thing for me because I
could visit more places and tobe able to support more people
(23:17):
and do more research and spendmore time with my family.
In just one word, it would begood for my efficiency in life.
Sarah Wright (23:27):
I echo that Flying would be awesome.
I actually just got back from aDisney trip where we walked
30,000 steps a day and flyingwould have been fabulous.
For that, flying would beawesome.
I actually just got back from aDisney trip where we walked
30,000 steps a day and flyingwould have been fabulous.
Thank you so much, Andres andJanet.
We really appreciate you beinghere today and also for
contributing your articles toJAVMA and AJVR.
Janet Foley (23:49):
I want to say, Lisa , thank you so much for all the
encouragement early in the game.
We wouldn't have done itwithout you, so thank you very
much, thank you.
Andres Lopez-Perez (24:02):
That's awesome.
Sarah Wright (24:03):
Thank you for having us here and to our
listeners.
You can read Andres and Janet'sarticles in JAVMA and AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:30):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode, we chat aboutRocky Mountain spotted fever
with our guests AndresLopez-Perez and Janet Foley.
Lisa Fortier (00:42):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Janet and Andresjoining us and one of the most
fascinating articles I've readyet as Editor-in-Chief A little
bit creepy, a little bitconcerning, but super
fascinating and very well read.
So, Janet and Andres, thank youso much for taking the time to
be here with us today.
Janet Foley (01:03):
Thanks for having us and thanks for accepting the
commission for the papers in thecomments.
In One Health.
Andres Lopez-Perez (01:13):
Yep, thank you for having us here.
I am super excited to be herewith you this time.
Sarah Wright (01:19):
Great, let's dive right in.
So, Janet, your JAVMA and AJVRarticles.
Discuss Rocky Mountain SpottedFever.
Please share with our listenersthe background on this article.
Janet Foley (01:31):
Oh well, our group has been working collaboratively
on Rocky Mountain Spotted Feverfor quite a few years now.
There's some concerns aboutRocky Mountain Sp fever in
California and in the UnitedStates broadly.
But it's been reallyeye-opening to me to be involved
(01:51):
in these internationalcollaborations as well and
starting to learn from ourMexican colleagues, south
American colleagues, centralAmerican colleagues, which
really inform the scope of OneHealth, but also how we can
learn from each other and doprevention in these different
ecologies across the new world.
Sarah Wright (02:15):
And diseases don't know borders, so always nice to
collaborate Right.
Thanks, and Andres.
What are important take-homemessages from this JAVMA article
?
Andres Lopez-Perez (02:26):
Okay, I think in just one word, the most
important take-away messagefrom this paper is disease
awareness and it's really reallyimportant to recognize that
RMSF in dogs.
Because if a dog has RMSF thefamily of the dog is also at
risk and every treatment is alsoimportant for the health of the
(02:49):
dog.
But the diseases can be reallyreally hard to recognize.
Clinical signs can mimic manyother diseases, so it can be
hard to recognize RMSF.
So this means that knowing thehistory and possible exposure of
the dog is really important forknowing how concerned the
veterinarian should be that itis RMSF.
(03:10):
And the last important thingwhich is related to the
awareness is very important tohighlight from the paper, is
that the many vets and people inthe US and Mexico don't know
that the brown dog tick R,picephalus sanguineus, can be
spread RMFF.
And this tick is very common inplaces that people don't expect
(03:34):
to find ticks, such as citiesand towns, around homes and
kennels, but not in nature as wewould expect it but not in
nature as we were expected.
Sarah Wright (03:48):
Yeah, reading your manuscript took me back to
second year of vet school withall the parasitology work that
we did, so it was a goodrefresher for me.
I liked it.
And, Janet.
What are important take-homemessages from the AJVR article?
Janet Foley (04:02):
A friend of ours, one of the co-authors, came up
with the idea of giving it thetitle A Wolf at the Door, and I
think that that says two things.
One is this is a really scarydisease.
It's serious, it can have veryhigh case fatality but on the
other hand, in some places itdoesn't have such high case
(04:23):
fatality, which gives us hopethat when we can learn from each
other, we can develop betterintervention plans and, you know
, kind of use the awareness thatAndres was describing to try to
reduce cases.
But also the second part ofthat title it's at the door,
it's right here, it's inCalifornia, it's been more and
(04:45):
more abundant in SouthernCalifornia and it's in epidemics
in the southern parts of Brazilthat we described.
Colombia, parts of Panama andCosta Rica have cases.
I mean, it's right at the doorof all of us and it's something
we need to really come to termswith.
I think.
Lisa Fortier (05:03):
Yeah, I really like that raising awareness that
you know, as Sarah said, welearn about it in second year
and maybe medical doctors reallyaren't all that aware of it and
knowing the brown dog tickcarries more than one disease it
is.
Yeah, it's terrifying andthinking of it in the city, like
you said, Janet, people justthink of like, oh, you get ticks
(05:23):
from going in the long grass,but not necessarily the little
buggers are everywhere.
Andres, what sparked yourinterest in Rocky Mountain
Spotted Fever?
Did you have a case or knowsome animal that was affected?
Or what sparked your interest?
Andres Lopez-Perez (05:44):
Actually, when I was going through my PhD,
I was working with flea-bornediseases and by that time I was
working with diseases that, inmy opinion, were not that
meaningful as meaningful as RMSF.
And the reason is because wehave been working with diseases
that most of the time we aresaying, oh there was a case far
(06:07):
away from here and there is acase maybe in Europe or maybe in
Asia and for, but when I wasworking with those things I was
feeling like that my researchwasn't as meaningful as I would
like to be.
So when I was looking around andI was working along the
US-Mexico border, it was veryeasy for me to find that very
(06:27):
close where the area that I wasworking in, there was this
outbreak happening and peoplewere dying along that area all
over the area.
So that was one of the mainthings that happened that
sparked my interest in RMSF.
And the other thing was when Istarted reading about that
(06:50):
disease, the ecology and theevolution.
For me that was very, very,very impactful to know that
there is a that I mean thebacteria that cause the disease
is actually very it has beenevolving to live in different
environments and it is, and thatwas something very, very
important for me.
(07:11):
You know, like the evolutionand ecology of the bacteria
changed my point of view, andmostly because now I can see
them more like living beings andI think that's one of the most
important things for us to knowthat they are living beings.
So then making the program, thecontract program, will be
(07:31):
easier for us if we think ofthem as living beings.
Lisa Fortier (07:36):
Yeah, great point.
I love what you said, like findsomething that's impactful and
something that you love and itbecomes a passion, not work, it
becomes your profession, is yourpassion.
I love that.
Janet, every time we writearticles like this even though
you're a key opinion leader Ithink at least I do when I write
(07:58):
articles that are basicallyreviews there's something that
surprises me.
Was there anything from eitherof these articles that you
coalesced and thought of how youmight think of something
differently?
Janet Foley (08:09):
Yeah, that's a really great question.
I think that, especially withthe AJVR paper, getting a chance
to work so much more closelywith collaborators from multiple
countries, most of Andres' andmy work has been either in the
United States or in Mexico, butnow we're starting to talk with
co-authors in Brazil, Panama,and that allowed us to do some
(08:31):
additional work looking atColombia and Costa Rica as well.
So in all of these places, rockyMountain spotted fever is
caused by the same bacteria, butit's transmitted by different
tick species.
So one of the things we triedto do in the paper is find
things that were similar, thatwe would be able to learn from
and manage similarly, and thingsthat were different.
(08:53):
So I was really impressed withhow different the ecologies can
be.
But then, bringing it fullcircle, just thinking similarly,
in Brazil there are dogs, thereis brown dog tick, transmitted
Rocky Mountain spotted fever,but then there's also the
capybara and their cycle and ina way, you were like oh well,
(09:15):
capybaras are wildlife.
We're going to have to look atthis totally differently, but
not so much because thecapybaras are on golf courses
and they're in parks and schools, and so now again we've got an
animal that's living reallyclosely with people presenting
this disease risk that we haveto manage.
Lisa Fortier (09:32):
Yeah, Another thing I really loved about this
pair of articles.
It's hard sometimes to make theenvironment, the ecology close
to, as important as the disease.
Obviously we don't want to loselives, but these articles
really, really brought home theenvironment in the concept of
One Health.
Sarah Wright (09:54):
Yeah, it's great to hear that.
International collaboration andalso the comparative medical
approach too, with these cases.
So, Andres, what are the nextsteps for research in this topic
?
Andres Lopez-Perez (10:05):
So there are a lot of things to do, for sure
, for sure.
But one of the main thing thatwe are thinking it would be it
would be very interesting orimportant for us to research
would be the demography of thedogs.
We don't know anything aboutthe structure of the population
of dogs.
We don't know how many dogs areout there where a high-risk
(10:27):
area for RMSF is.
So knowing how many dogs canprove the interventions spayed
and neutered, it's veryimportant to know how many dogs
are in those areas.
And now, one of the otherthings that has been important
or people I mean researchershave been started to talk about
(10:49):
is the vaccine.
It could be a vaccine that canattack the tick by itself or the
bacteria.
So that's another reason whyit's very important for us to
know how many dogs are in thehigh risk areas, are in the
high-risk areas.
And the other topics that areimportant and could be important
(11:10):
for us to know is theepidemiology of those cases in
vet clinics.
We don't know that much aboutthat.
It is important to recognizethat canine cases have not been
as extensively evaluated in ashuman cases and much data on the
clinical course of the diseasein dogs is needed.
And the other topics are tickresistance for akarocytes is
(11:37):
very important.
In Mexico and other places, theSecretary of Health has been
using deltametrine and fipronilon dogs and we don't know
anything about the resistanceand how the resistance is in the
(11:59):
ticks after two decades oftreatment.
You know, intervention and thesocial aptitude and perception
is actually important too.
The group the RMS group that wehave been collaborating with,
almost always says that peopledon't do anything in those areas
because most of those areas aremarginal areas, are marginal
neighborhoods.
So most of the time we say thatthe people don't do too much
(12:22):
things because they don't havemoney enough to treat the dogs,
to try to clean, so they don'tdo that much things.
But one thing that I think it'simportant to know is like if
there is anything behind thatthat we can research to know why
the people are not doing things, because sometimes you don't
(12:43):
need to have a lot of money totry to clean the house, because
it's very important to clean theclutter around the house in
order for the ticks to, in orderto try to get rid of the ticks.
And the last part would bemodeling, and that's something
that Janet has been working on.
It's like trying to model thedifferent intervention controls
(13:07):
that we could use as a spay andneuter vaccination color
coloring dogs.
So modeling that seems to belike a good approach to try to
understand what is how thecontrol can work.
Well, work loves to do.
Those might be the mostimportant ones.
Lisa Fortier (13:28):
Janet, earlier you said that rock tomato spotted
fever is more lethal in somepopulations than others.
What are some insights into whythat might be and what can we
do to make it less leverage thatfor potential treatments?
Janet Foley (13:45):
Yeah, I don't know 100%.
You could even speculate thatthe bacteria is more lethal.
There's different geneticstrains of the bacteria and some
are more lethal than others.
I don't personally think that'sthe case, but I've heard that
hypothesized.
I personally think that the twobig reasons that it can be more
(14:08):
lethal are access to healthcare, you know, high quality
health care, because thesepatients, as you guys know, can
become very, very complicated totreat.
Both dogs and people are verysick.
They can have multiple organfailure, they can have
cerebellar issues and you justhave to be super careful about
(14:30):
everything.
So I think that's onedifference across some
populations and I think theother big one is how quickly the
disease is diagnosed or, evenwithout a diagnosis, started to
be treated.
It says in both of the articles, every couple of days, that you
delay the beginning ofdoxycycline treatment increases,
(14:53):
doubles, triples the risk thatthe patient is going to die.
And so you know all of us thedisease presents as a headache
and muscle pain and maybe afever.
We don't immediately all go tothe emergency room just because
we're experiencing immediatelyall go to the emergency room
just because we're experiencinga headache.
On the other hand, if you livein one of these high-risk
communities, it's really, reallyimportant that there's a strong
(15:15):
relationship with a medicalprovider who knows this and
knows to give doxycyclinepresumptively.
I personally think that thoseare the main reasons for the
discrepancy in case fatality.
Lisa Fortier (15:28):
You clearly are a key opinion leader and then have
all these like fullrelationships.
How did your training andprevious work help prepare you
to write these two articles?
Janet Foley (15:53):
us to approach problems in a unique way.
Maybe it's a little bit dated,but the standard subjective,
objective assessment and planapproach that we take to an
individual case, what worksreally well for a One Health
intervention.
So I think that my experienceas a practicing veterinarian I
didn't really see Rocky Mountainspotted fever, I saw a lot of
other tick-borne diseases, andthen I'm a professor and I do
(16:15):
infectious disease ecology.
So those several thingstogether, as you point out, Lisa
, our work is our passion.
I have other passions too, butit's a big one and I happen to
really love ticks and tick-bornediseases.
I don't love having them and Irespect how much damage they do,
(16:38):
but they are so interestingecologically.
Lisa Fortier (16:42):
Good party conversation.
Janet Foley (16:43):
Oh, yeah, always.
Lisa Fortier (16:47):
Well, I think so, but, Andre, how did your work
help co-author these articles?
Andres Lopez-Perez (16:56):
I think one of the reasons why I was able to
participate in these papers isbecause I have been gotten to
see and survey so many dogs inthe field and taking all the
samples to the lab and you know,knowing all the process that
you have to do in order to getthe data or the results to know
(17:17):
more about the disease.
But besides that, I have beenable to talk and work with vets
and physicians, but also I havebeen able to talk to family
whose members or relativemembers have died because of the
disease.
So I think all thoseexperiences and different
(17:40):
perspectives have given me theknowledge to see that RMSF is a
one-help challenge for sure, andwriting this paper is part of
the outreach that is needed toeducate professionals and all
the people and the people thatcan get access to them.
Sarah Wright (18:01):
I hope this podcast episode and your
articles help remindveterinarians to keep RMSF on
their differential list forcases when it's appropriate.
So hopefully that happens Now.
This next set of questions isreally important for our
listeners, and the first one'sgoing to be about the
veterinarian's perspective.
So, janet, what is one piece ofinformation the veterinarian
should know about?
Rocky Mountain Spotted Fever?
Janet Foley (18:24):
I think it's so important that the veterinarian
become a part of this One Healthteam and that I think came
across really well in the job ofmy paper that the veterinarian
is the frontline professionalfor assessing a dog for ticks
and tick-borne diseases, whichhelps the dog and is so, so, so
(18:46):
important in beginning thatconversation with the rest of
the One Health team and the dogowner and the medical doctor.
So I think that the mostimportant thing a veterinarian
brings to the table is that theknowledge about parasitology.
You know this knowledge abouthow these cycles work and what
it means for the family as awhole.
Sarah Wright (19:08):
Very well said.
And the other side of therelationship.
What's one thing clients shouldknow about Rocky Mountain
Spotted Fever.
Janet Foley (19:19):
For me, clients first of all need, especially in
high risk areas, which you know.
As Andra said, we've done a lotof work in northern Mexico, but
our co-authors were all overthe New World.
So clients should know whatkind of a risk their environment
presents to them so that theycan advocate for themselves and
(19:41):
their family when needed.
Say, is that in the UnitedStates, other than the tribal
lands in Arizona?
Well, in the southwesternUnited States we don't see the
clusters in the neighborhoods.
We see a case here and a casethere.
(20:02):
So I think the relationshipwith the client and the client
education is a little bitdifferent.
When you're not seeing clustersand epidemics, there's still a
risk.
So it's important that thewhole team better understand the
risk, each region's specificrisk.
Lisa Fortier (20:21):
In this day and age of antimicrobial stewardship
, do you see a reluctance on thepart of veterinarians or MDs to
prescribe early?
Like you said, the symptoms canbe vague and mimic a lot of
other diseases.
Janet Foley (20:38):
Potentially the drug of choice is doxycycline,
and that's not the main targetin this age of antimicrobial
stewardship that most of us areworried about.
It's also not the first-linedrug you often use for ADR
ain't-doing-right dogs.
So, on the other hand, if youdo risk-benefit analysis for
(21:02):
Rocky Mountain Spotted Fever anddoxycycline specifically, you
would want to use doxycycline,which is rather inexpensive,
less concerning in some of theseregards and saves lives.
I think I don't remember what Iwas going to say and you guys
(21:22):
can edit that.
Lisa Fortier (21:24):
But it's the same.
I live in upstate New York,Janet, right, and it's Lyme
country, Lyme disease, so it'sthe same thing.
And when I hear people say, ohyou know, you want to confirm a
diagnosis, like we're not reallytoo worried about a course of
doxy, like get them on it andit's not lethal like Rocky
Mountain spotted fever, but youstill always good to catch them
(21:46):
in the early stages, well,fascinating, you guys are
awesome.
I can't wait to read more ofyour work, especially the
international collaboration.
It's so important to keep theear to the ground and find out
what everybody else is doing toreally try and solve some of
these problems or at leastminimize them.
Yeah, as we move to conclude, Ijust want to ask a kind of a
(22:11):
fun question.
So, Janet, first for you, whatis your favorite animal fact?
Janet Foley (22:16):
My favorite animal fact.
I'm going to go with the factthat the duck-billed platypus
has its own specialized Ixodesspecies tick.
It's called Ixodesornithobranchii and it's only
found in Australia and onlyfeeds on duck-billed platypus.
Does it carry diseases?
(22:37):
Not that we know of.
We tried, we tested them.
Lisa Fortier (22:42):
Fascinating.
Wow, that is really cool, Andre.
If you could have a superpower,what would it be?
And why could have a superpower.
Andres Lopez-Perez (22:54):
what would it be and why?
First of all, I would say thatI have to say like it's hard for
me to think about superpowerSometimes.
I am one of those kind ofperson who would rather think
about realistic things, but inthis case I would go with flying
.
So I think like flying would bea good thing for me because I
could visit more places and tobe able to support more people
(23:17):
and do more research and spendmore time with my family.
In just one word, it would begood for my efficiency in life.
Sarah Wright (23:27):
I echo that Flying would be awesome.
I actually just got back from aDisney trip where we walked
30,000 steps a day and flyingwould have been fabulous.
For that, flying would beawesome.
I actually just got back from aDisney trip where we walked
30,000 steps a day and flyingwould have been fabulous.
Thank you so much, Andres andJanet.
We really appreciate you beinghere today and also for
contributing your articles toJAVMA and AJVR.
Janet Foley (23:49):
I want to say, Lisa , thank you so much for all the
encouragement early in the game.
We wouldn't have done itwithout you, so thank you very
much, thank you.
Andres Lopez-Perez (24:02):
That's awesome.
Sarah Wright (24:03):
Thank you for having us here and to our
listeners.
You can read Andres and Janet'sarticles in JAVMA and AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
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