essential in controlling the tick population (Hudman & Sargentini, 2018). Other considerations include sociologi- cal factors. For example, Bayles & Allan (2014), in their work determining the human incidence of tickborne disease, found that coniferous forests, increasing relative humidity during June, and the increased number of abandoned houses are risk factors in Missouri for an increasing tick population They also determined the risk factors for contracting ehrlichiosis and showed that ehrlichiosis is strongly associ- ated with living in poverty, hunting, and doing other outdoor activities. Moreover, Sempertegui-Sosa et al. (2020) detected pathogenic ticks in Missouri and concluded that favorable hosts—such as the white-tailed deer—are vital to the increas- ing population of ticks in the state. Simi- larly, birds have been shown to be favorable hosts for some species of ticks. Roselli et al. (2022) conducted a study on tick infestation in birds across urban settings that indicated birds harbor ticks and play an active role in the transmission of tickborne disease. This conclusion is aligned with the results from a study by Loss et al. (2016) that found birds harbor and carry tickborne pathogens across vast regions. As a result of the complexity associated with tickborne diseases, researchers have increased their focus on identifying ticks and tickborne diseases via laboratory analysis and clinical presentation to improve medical pro- fessionals’ knowledge of clinical presentation, diagnosis, and treatment (Lester Rothfeldt et al., 2017; Luedtke et al., 2020; Mattoon et al., 2021). Studies have revealed that A . ameri- canum is an aggressive biting tick species that is dominant in Oklahoma (Mitcham et al., 2017). It is responsible for the transmis- sion of the Bourbon virus and is diagnosed via laboratory detection of Bourbon virus- specific antibodies in human serum (Savage et al., 2017). Savage et al. (2017) isolated A . americanum from several ticks from six sites in northwest Missouri. Further, Aziati et al. (2023) reported cases of human Heartland virus from A . americanum . Another study conducted in St. Louis, Missouri, revealed that A . americanum is the predominant species in St. Louis (Aziati et al., 2023), and A . maculatum is the predomi- nant species in western Tennessee (Mays et
al., 2016), while in Kentucky, I . scpaularis and A . maculatum are the predominant spe- cies (Lockwood et al., 2018). Furthermore, a study in Arkansas indicated that the Bor- relia species—which are dicult to confirm and are the causative species of Lyme dis- ease—are endemic in Kentucky (Pasternak & Palli, 2022) and northeast Missouri (Hud- man & Sargentini, 2016). Similarly, reports of a study conducted in Illinois indicated that the tick species of medical importance are I . scpaularis , A . americanum , and D . variabilis . Gilliam et al. (2020) have shown that the D . variabilis tick, however, is the most dominant species in Illinois. Due to a poor understanding of the mecha- nism of pathogenicity and emerging virulent pathogens, controversy surrounds the diag- nosis of tickborne diseases. A study con- ducted in Missouri indicated a disparity in the diagnosis of Lyme disease and ehrlichio- sis due to the inability to isolate the agent of these diseases, thus resulting in misdiagno- sis of both diseases (Hudman & Sargentini, 2016). Lester Rothfeldt et al. (2017) con- ducted a study in Arkansas that indicated a misinterpretation of the clinical presenta- tion of tularemia, as evidenced by increased reports of misidentification of symptoms. Discrepancies in the diagnosis of Rocky Mountain Spotted Fever (RMSF) cases exist, with the documentation of laboratory-con- firmed cases decreasing in number despite increasing incidence (Dahlgren et al., 2016). Further, findings from Luedtke et al. (2020) indicated misdiagnosis of the spotted fever group due to the low prevalence of Rickett- sia rickettsii in Nebraska. Similarly, studies in Arkansas and Kentucky revealed that R . rickettsii might not be the primary patho- genic organism for RMSF, as shown through the inability to detect R. rickettsii due to its low prevalence in D . variabilis ticks via DNA analysis (Luedtke et al., 2020; Trout Fryxell et al., 2015). To increase awareness of tick bites and subsequently prevent tickborne diseases, researchers have increased their focus on knowledge, attitudes, and practices regarding tick prevention. For example, a study con- ducted to ascertain the level of knowledge of tick prevention among beef farmers indicated that >50% of beef farmers had a knowledge deficit in the perceived risk associated with exposure to ticks, although a few beef farm-
ers were conversant with safety practices to prevent tick bites (Noden et al., 2020). A study assessing the knowledge, attitudes, and practices of clinicians regarding ticks and tickborne diseases indicated that increased awareness of these diseases through educa- tion, training, and campaigns is essential for clinicians to identify people at risk of tick bites and educate individuals at risk about how to prevent exposure (Carson et al., 2022). Like- wise, Mattoon et al. (2021) assessed physi- cian knowledge of ticks and found there was a need to increase physician knowledge of tickborne diseases to enable them to educate patients on the possible modes of transmis- sion and preventive measures. One study provided tick surveillance train- ing to local health department employees in Illinois and evaluated the training’s impact on knowledge, attitudes, and practices. The pre- training assessment indicated a poor under- standing of surveillance, which is essential for tick identification. Although the training was not associated with increases in surveil- lance practices, a few months after this sur- veillance education, knowledge and attitudes improved (Lyons et al., 2022). Another study conducted among employ- ees in the upper Midwest region assessed knowledge, attitudes, and practices of pro- tective measures against ticks and found that employees have sucient awareness of pre- ventive measures against ticks. There was, however, a lack of safety practices to prevent tick bites (Schotthoefer et al., 2020). Reports of e¡ective management of ticks and tickborne diseases have been docu- mented, including laboratory investigation, pharmaceutical treatment, use of pesticides in homes, land management, and surveil- lance. One study conducted in Missouri, for example, indicated that land manage- ment (e.g., mowing, burning) e¡ectively suppresses the tick population (Hudman & Sargentini, 2018). Also, McCollough (2018) found that empirical treatment with doxycycline is essential to halt the progres- sion of acute tickborne disease into a more severe phase. In addition, Hinckley et al. (2016) conducted a study to determine the e¡ectiveness of acaricides (i.e., a class of pesticide that kills ticks and mites) in the northeastern part of the U.S. and found that pesticides could be recommended to pre- vent tickborne diseases. They found, how-
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