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Here’s What You Need to Know about Rickettsia

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As most anyone healing from Lyme knows, it’s important to test for possible coinfections to ensure appropriate and effective Lyme disease treatment. Some tick-borne, Lyme disease coinfections, like the parasite Babesia, or the bacteria Bartonella, are on the radars of most Lyme-literate doctors. There are other coinfections, however, that are less well-known and may go undetected more easily. Rickettsia is one of these.

What is Rickettsia?

The genus Rickettsia contains many species of gram negative bacteria. Rickettsiae (the plural) have been around for millions of years, carried by arthropods such as fleas, lice and ticks. Some Rickettsia species cause serious disease in humans (for example, Rickettsia typhi causes typhus). Certain species of Rickettsia can be transmitted by ticks as Lyme disease coinfections. 

Rickettsia as a Lyme Coinfection

Rickettsiae can infect alone, or as coinfections along with Lyme bacteria. The most common rickettsial disease to occur as a Lyme disease coinfection is Rocky Mountain spotted fever (RMSF). A group of several rickettsial bacteria species all cause variations of RMSF. These bacteria are called the spotted fever group (SFG). The most common SFG Lyme disease coinfection is Rickettsia ricketsii. Unfortunately, none of these species are well studied, even in comparison to Lyme and other coinfections.

Stephen Buhner writes in Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses, that current research on RMSF is showing it to be more widespread than previously assumed in the medical community. RMSF is spread by Rocky Mountain wood ticks, American dog ticks, the Cayenne tick, the brown dog tick, the Lone Star tick and several others. Because these ticks travel on birds, SFG rickettsial bacteria are found just about everywhere in the world except Antarctica. 

Symptoms of Rocky Mountain Spotted Fever (RMSF)

Rickettsia in the spotted fever group infect the endothelial lining of blood vessels anywhere in the body. According to Buhner, symptoms of RMSF range from a mild illness that may be mistaken for flu, to damage to organ systems, septic shock and even death. 

The first symptoms of RMSF to appear are fever and headache. Most infections cause a spotted rash – but not all. The rash – which helps greatly with correct diagnosis – appears two to five days after the initial fever. Some infections also cause an eschar: a rash at the site of the tick bite that fails to heal and can become scabby. Eschars also help with diagnosis. 

Here is a list of possible initial symptoms of RMSF:

  • Fever
  • Headache
  • Rash (non-itchy, small spots on the wrists, forearms and ankles, spreading to the trunk, palms and soles)
  • Eschar 
  • Nausea, abdominal pain, diarrhea and vomiting
  • Cough and sore throat
  • Conjunctivitis

If RMSF progresses untreated, symptoms may include:

  • Arthritis
  • Respiratory distress
  • Bell’s palsy
  • Vertigo
  • Hearing loss
  • Carditis
  • Brain infection and neuropathies
  • Sepsis, coma and death

Testing and Diagnosis

Like many Lyme disease coinfections, treatment is most effective when RMSF is diagnosed early – in the case of RMSF, within five days of onset of symptoms. Unfortunately, this is difficult, as the symptoms , with the exception of the spotted rash, are easy to misidentify as the flu, and vary from person to person. To complicate things, RMSF bacteria do not appear in large quantities in the blood. The CDC recommends that diagnosis be clinical first, and confirmed by lab tests second, in order to begin treatment immediately.

Antibodies to RMSF do not typically appear for seven to 10 days after onset of fever and headache. This makes IFA testing (immunofluorescence assay – testing for antibodies) problematic. A skin biopsy or a cutaneous swab can be used for diagnosis, using tissue from the rash or eschar site. According to Buhner, this is the most reliable test for early diagnosis of RMSF.


If RMSF is diagnosed quickly, antibiotic treatment is effective. Doxycycline has been shown to be effective if given within the first 5 days of infection. If infection progresses, IV antibiotic treatments may be necessary.

There are herbal remedies and supplements that may help to combat RMSF, especially with longer term infections that are unresolved with antibiotics. According to Buhner, these herbs very much overlap with herbal treatments for the Lyme bacteria Borrellia burgdorferi, which also infects endothelial cells. 

Here is a partial list of herbs and supplements useful for supporting recovery from RMSF infections. The herbs can be taken as teas or tinctures (tinctures are generally considered stronger), and the supplements are typically swallowed as tablets. Consult your doctor to determine the best course of treatment for you.

Herbs to protect endothelial cells: 

  • Japanese Knotweed
  • Red Sage 

Herbs to support the immune system:

  • Cordyceps 
  • Eleuthero
  • Skullcap 

Supplements to increase production of glutathione, and speed detoxification:

  • NAC
  • Selenium
  • Vitamin C
  • Vitamin E
  • Vitamin D
  • Vitamin B6 and B12

A dark side of Rickettsia?

In her book Bitten: The Secret History of Lyme Disease and Biological Weapons, author and Stanford medical researcher Kris Newby explores the possibility of a certain species of Rickettsia, Rickettsia helvetica, nicknamed the Swiss Agent, complicating the initial outbreak of Lyme disease in the late 1960s and 1970s along the Northeast Coast. An outbreak of this Rickettsia species was documented in 1968 in Cape Cod, Nantucket and Martha’s Vineyard, and another from 1971-76 on Long Island. 

Willy Burgdorfer, the researcher credited with the 1981 discovery of the bacteria Borrellia burgdorferi, was involved in tracking and identifying these earlier outbreaks of Rickettsia helvetica. Correspondence exists between Burgdorfer and other researchers discussing R. helvetica infections in these areas, and their possible contributions to symptoms of what later became known as Lyme disease. But, abruptly, in 1980, investigations into R. helvetica were dropped, and never again resumed. 

Infection with this species of Rickettsia does not cause RMSF, or a distinctive rash. United States labs do not test for it. Science writer Charles Pillar, who covered the story in 2016 in partnership with Newby for STAT, wrote that, though evidence is inconclusive, R. helvetica may still be sickening Americans today, and complicating Lyme disease diagnosis and treatment.

In conclusion

It may be worth asking your doctor to evaluate your symptom profile with Rickettsia species in mind. These are stealth bacteria, just like Lyme and other coinfections. They are adept at disabling the human host’s immune system and at evading detection. It takes diligent detective work on the part of a good doctor to identify all of the pathogens involved in any one case of Lyme disease. Having an accurate picture makes effective treatment a little bit easier.

Shona Curley lives and works in San Francisco. She is co-owner of the studio Hasti Pilates, and creator of the website www.redkitemeditations.com. Shona teaches meditation, bodywork and movement practices for healing Lyme disease, chronic illness and pain.




Buhner, Stephen Harrod. Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses. Silver City, NM. Raven Press, 2015.

Newby, Kris. Bitten: The Secret History of Lyme Disease and Biological Weapons. New York, NY. HarperCollins, 2019.

Piller, Charles. The ‘Swiss Agent’: Long-forgotten research unearths new mystery about Lyme disease. STATnews, 2016, October 12.

Rocky Mountain Spotted Fever (RMSF). Centers for Disease Control and Prevention website. https://www.cdc.gov/rmsf/diagnosis-testing/index.html

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