AnatomyOrganismsDiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPhenomena and ProcessesInformation ScienceHealth CareGeographicals
Rickettsia rickettsiiRickettsiaRocky Mountain Spotted FeverRickettsia InfectionsBoutonneuse FeverRickettsia conoriiTicksRickettsia typhiRickettsia prowazekiiDermacentorRickettsieaeTyphus, Epidemic Louse-BorneIxodidaeTick-Borne DiseasesRickettsiaceae InfectionsArachnid VectorsTyphus, Endemic Flea-BorneRickettsiaceaeRhipicephalus sanguineusSaint Kitts and NevisSiphonapteraAntibodies, BacterialJackalsRhipicephalusRickettsia felisRickettsial VaccinesDNA, BacterialAntigens, BacterialIxodesTick InfestationsEhrlichiosisBacterial Outer Membrane ProteinsSeroepidemiologic StudiesPolymerase Chain ReactionScrub TyphusVero CellsOrientia tsutsugamushiAnaplasmataceaeFluorescent Antibody Technique, IndirectFeverCitrate (si)-SynthasePhylogenyEhrlichia chaffeensisQ FeverArthropod VectorsPolymorphism, Restriction Fragment LengthMolecular Sequence DataCoxiellaSpecies SpecificityTick ToxicosesBacterial ProteinsSequence Analysis, DNARNA, Ribosomal, 16SDog DiseasesGuinea PigsGenes, BacterialCoxiella burnetiiCross ReactionsComplement Fixation TestsBase SequenceFluorescent Antibody TechniqueDNA, RibosomalBartonellaCercopithecus aethiopsFluoroimmunoassayBrazilDogs
RMSFCaused by the bacteriumRickettsiosisTicksBacteriumBacteriaRashPathogenRickettsiosesInfectionAmblyommaRickettsialpoxIntracellularChillsHeadacheDiagnosisScrub typhusPathogensInfectionsFebrileFelisEhrlichiaTransmitAkariDiseasesAcuteGenusAntibodiesCausative agentHumansPatientsEndemicSevereNeurologicalOnset of symptomsRickettsial diseaseIllnessZoonotic diseaseSignsDiseaseEncephalitisSFGRNorth CarolinaWristsOrganismExposureBiteClinical
RMSF20
Caused by the bacterium1
Rickettsiosis9
  • It is within a group known as spotted fever rickettsiosis, together with Rickettsia parkeri rickettsiosis, Pacific Coast tick fever, and rickettsialpox. (wikipedia.org)
  • Rickettsia parkeri rickettsiosis was first reported in 2004, and since that time, more than 40 patients have been identified. (cdc.gov)
  • Patients with R. parkeri rickettsiosis typically develop an eschar, followed by a fever, muscle pain, headache, and rash. (cdc.gov)
  • As a subject matter expert, she has published materials in peer review literature on the epidemiology, prevention, and control of Spotted Fever Rickettsiosis and other tickborne rickettsiosis in the United States. (cdc.gov)
  • Other likely causes of the disease are R. parkeri that causes Rickettsia parkeri rickettsiosis and Rickettsia akari that causes Rickettsialpox. (healthjunta.com)
  • The Mexican Institute of Epidemiology defines a probable case of rickettsiosis as a patient with fever and ≥2 compatible clinical and laboratory signs. (cdc.gov)
  • spotted fever rickettsiosis (SFR). (steptohealth.com)
  • missouri represents a major focus of several tickborne diseases that includes spotted fever rickettsiosis, tularemia, and ehrlichiosis. (liverpool.ac.uk)
  • We report a case of rickettsiosis caused by Rickettsia monacensis in an immunocompetent 67-year-old man in Portugal who had eschar, erythematous rash, and an attached Ixodes ricinus tick. (bvsalud.org)
Ticks16
  • The disease is caused by Rickettsia rickettsii, a type of bacterium that is primarily spread to humans by American dog ticks, Rocky Mountain wood ticks, and brown dog ticks. (wikipedia.org)
  • Ticks are the natural hosts of the disease, serving as both reservoirs and vectors of R. rickettsii. (wikipedia.org)
  • Ticks can also become infected with R. rickettsii while feeding on blood from the host in either the larval or nymphal stage. (wikipedia.org)
  • Furthermore, male ticks may transfer R. rickettsii to female ticks through body fluids or spermatozoa during the mating process. (wikipedia.org)
  • Spotted fever group Rickettsia (SFGR) species are a group of genetically similar intracellular bacteria transmitted to people through the bite of infected mites and ticks. (cdc.gov)
  • Contact your provider if you develop symptoms after exposure to ticks or a tick bite. (medlineplus.gov)
  • Hard-shelled ticks (family Ixodidae) harbor R. rickettsii , and infected females transmit the agent to their progeny. (msdmanuals.com)
  • The spotted fever occurs in times when ticks are active. (healthjunta.com)
  • Capybaras with ticks also function as amplifiers of the bacteria, because, when bitten by contaminated ticks, they develop spotted fever without symptoms, which favors the contamination of other ticks. (animalworldfacts.com)
  • On average, an estimated 500 to 2500 R. rickettsii infections annually, but the ticks that transmit the pathogen are found only 20 % of the time . (steptohealth.com)
  • rickettsia parkeri in amblyomma americanum ticks, tennessee and georgia, usa. (liverpool.ac.uk)
  • to determine the geographic distribution of the newly recognized human pathogen rickettsia parkeri, we looked for this organism in ticks from tennessee and georgia, usa. (liverpool.ac.uk)
  • Several infectious pathogens (e.g., viruses, bacteria, rickettsia, and protozoa) use ticks as transmission portals to inflict disease. (nursingce.com)
  • ticks exposed to the fungus experienced higher mortality than those in the control group (p = 0.001). (liverpool.ac.uk)
  • However, dense groups of infected ticks may exist in some neighborhoods or parks. (primehealthchannel.com)
  • Patients of this disease tend to develop symptoms around 2-14 days after bitten by ticks. (primehealthchannel.com)
Bacterium2
  • The bacterium exactly responsible for this condition is Rickettsia rickettsi, which is the cause for potentially lethal disorders in North and South America. (primehealthchannel.com)
  • Bubonic plague symptoms appear suddenly a few days after exposure to the bacterium. (infogalactic.com)
Bacteria8
  • The disease is caused by a type of bacteria referred to as the spotted fever group rickettsia. (healthjunta.com)
  • To understand the cause of Rocky Mountain Spotted Fever we must dissect the bacteria and the vector. (steptohealth.com)
  • Lyme disease is a tick-borne bacterial infection caused by several species of spiral-shaped bacteria from the group Borrelia. (migraineheadachepain.com)
  • The Rickettsia and Orientia genera both encompass a large group of obligate intracellular, gram-negative bacteria. (health.mil)
  • In the following list, the micro-organisms written in italics are bacteria, mycoplasma, rickettsia or fungi. (searates.com)
  • n\nThe group of patients at risk for multi-drug resistant bacteria is largely cared for in primary care. (jnk-receptor.com)
  • [1] One to seven days after exposure to the bacteria, flu like symptoms develop. (infogalactic.com)
  • [7] While "typhoid" means "typhus-like", typhus and typhoid fever are distinct diseases caused by different types of bacteria. (wikipedia.org)
Rash22
  • It typically begins with a fever and headache, which is followed a few days later with the development of a rash. (wikipedia.org)
  • The rash is generally made up of small spots of bleeding and starts on the wrists and ankles. (wikipedia.org)
  • citation needed] Initial symptoms: Fever Nausea Emesis (vomiting) Severe headache Muscle pain Malaise Later signs and symptoms: Maculopapular rash Petechial rash Abdominal pain Joint pain Conjunctivitis Forgetfulness The classic triad of findings for this disease are fever, rash, and history of tick bite. (wikipedia.org)
  • The rash first appears two to five days after the onset of fever, and it is often quite subtle. (wikipedia.org)
  • The characteristic red, spotted (petechial) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms, but this type of rash occurs in only 35 to 60% of patients with Rocky Mountain spotted fever. (wikipedia.org)
  • Similar to R. rickettsii, R. parkeri, R. species 364D , and R. akari cause acute febrile illnesses often accompanied by headache, myalgia, and rash, but are also likely to have ulcerated, necrotic regions at the site of tick or mite attachment, called eschars pdf icon [PDF - 2 pages] . (cdc.gov)
  • Rash is a less common than with the other spotted fevers. (cdc.gov)
  • Patients with rickettsialpox characteristically develop an eschar at the site of the bite of a R. akari -infected mite, followed by fever, headache, and rash. (cdc.gov)
  • At the conclusions of today's session, the participants will be able to review the geographic distribution to find the symptoms of, identify the serologic tests and use to diagnose, and describe the appropriate use of antibiotics for Lyme Disease, Southern Tick Associated Rash Illness (STARI), Rocky Mountain Spotted Fever, Ehrlichiosis, Anaplasmosis and other emerging tickborne diseases. (cdc.gov)
  • Symptoms are high fever, severe headache, and rash. (msdmanuals.com)
  • An individual will have a red, non-itchy rash that appears in about 3 to 5 days following the initial symptoms and signs as mentioned above. (healthjunta.com)
  • The rash itself is regarded the classic symptom, however, about 10 to 15 percent of individuals having the disease don't develop any rash at all. (healthjunta.com)
  • The characteristic maculopapular rash usually appears 2-5 days after the other symptoms, starting on wrists and ankles before progressing to the rest of the body Footnote 1 . (canada.ca)
  • The first symptoms of Rocky Mountain spotted fevers are severe headache and high fever, which are accompanied by a rash on wrists and knees . (steptohealth.com)
  • A young child presents to the local ED with a fever, rash, and lymphadenopathy. (medscape.com)
  • Rickettsialpox is a mild, self-limited, zoonotic febrile illness characterized by eschar formation at the location of a mite bite, followed by the onset of systemic symptoms and a more generalized papulovesicular rash. (medscape.com)
  • About 3-7 days after the initial skin lesion develops, patients may suddenly develop high-grade fever, chills, headaches, and myalgias with subsequent development of a sparse generalized papulovesicular rash. (medscape.com)
  • Children with acute febrile encephalopathy associated with rash, hepatosplenomegaly and thrombocytopenia should get investigated for rickettsial fever. (currentpediatrics.com)
  • The most frequent presenting symptoms of the illness include fever, headache, rash, and myalgias [ 4 ]. (currentpediatrics.com)
  • [1] Common symptoms include fever, headache, and a rash. (wikipedia.org)
  • [10] Five to nine days after the symptoms have started, a rash typically begins on the trunk and spreads to the extremities. (wikipedia.org)
  • These symptoms include fever, headaches, chills, swollen lymph nodes, nausea/vomiting, and a rash at the site of infection called an eschar . (wikipedia.org)
Pathogen2
  • Rickettsia felis , a pathogen which probably hitched a ride on a flea before infecting him. (ogresearchconservation.org)
  • Which of the following characteristics is true of the pathogen most likely causing this patient's symptoms? (osmosis.org)
Rickettsioses7
  • For more in-depth information about signs and symptoms of spotted fever rickettsioses, please read the updated MMWR Recommendations and Reports . (cdc.gov)
  • Overview of Rickettsial and Related Infections Rickettsial diseases (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q fever, scrub typhus) are caused by a group of gram-negative, obligately intracellular coccobacilli. (msdmanuals.com)
  • The Rickettsia philipii causes Pacific Coast tick fever, which is also part of the rickettsioses group of spotted fever. (healthjunta.com)
  • Spotted fever rickettsioses (SFR) are emerging in the Atlantic and Central regions of the U.S., though cases have been reported across the contiguous U.S. Military populations may be at increased risk for SFR because of residence in these regions and frequent field training in tick habitats. (health.mil)
  • Spotted fever rickettsioses (SFR) can cause human infections ranging from asymptomatic or mild cases to severe, life-threatening disease. (health.mil)
  • The mortality rate of these rickettsioses is 0.5% of all cases, with Rocky Mountain Fever being the most lethal. (steptohealth.com)
  • Spotted fever rickettsioses are important causes of emerging infectious disease in the United States and elsewhere. (bvsalud.org)
Infection6
  • Unlike Lyme disease and other tick-borne pathogens that require a prolonged attachment period to establish infection, a person can become infected with R. rickettsii in a feeding time as short as 2 hours. (wikipedia.org)
  • Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland. (medscape.com)
  • Still, I ask you - how could we ever call infection with Rickettsia rickettsii anything else? (jwatch.org)
  • Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne Ro-3306 cost disease is designated Brazilian spotted fever (BSF). (jnk-receptor.com)
  • [3] The infection can affect any skeletal muscle, but most often infects the large muscle groups such as the quadriceps or gluteal muscles . (mdwiki.org)
  • Most patients are aged 2 to 5 years, but infection may occur in any age group. (mdwiki.org)
Amblyomma1
Rickettsialpox2
  • Although rare, moderately severe cases of rickettsialpox have been reported and may involve symptoms of the central nervous system such as stiff neck and photophobia. (cdc.gov)
  • The typhus group includes the pathogens that cause epidemic and murine typhus, while the transitional group includes agents that cause rickettsialpox and Queensland tick typhus. (health.mil)
Intracellular1
  • Rickettsia rickettsii is an obligate intracellular alpha proteobacteria that belongs to the Rickettsiacae family Footnote 1 Footnote 2 Footnote 3 . (canada.ca)
Chills1
  • A 43-year-old man presents to an urgent care for evaluation of fever, chills, and fatigue which began around three weeks ago. (osmosis.org)
Headache2
  • Clinicians should suspect Rocky Mountain spotted fever in any seriously ill patient who lives in or near a wooded area anywhere in the Western Hemisphere and has unexplained fever, headache, and prostration, with or without a history of tick contact. (msdmanuals.com)
  • It can appear as an abrupt onset of fever (typically higher than 38.9 ºC), malaise, headache, anorexia, nausea, vomiting, abdominal pain, photophobia, diarrhoea and neck stiffness Footnote 1 Footnote 3 . (canada.ca)
Diagnosis4
  • A number of laboratory tests can confirm the diagnosis but treatment should be begun based on symptoms. (wikipedia.org)
  • Read and know all about this disorder, including its various causes, symptoms, diagnosis and treatment options. (primehealthchannel.com)
  • However, the diagnosis is almost in all cases made on the basis of presentation of the symptoms in sufferers rather than on the results of tests. (primehealthchannel.com)
  • [1] The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow . (wikizero.com)
Scrub typhus5
Pathogens3
  • The ancestral group includes the tick-borne agents Rickettsia bellii and R. canadensis but does not contain pathogens that cause human disease. (health.mil)
  • 7 Understanding of the epidemiology of rickettsial diseases continues to evolve as new information accumulates about the expanding geographic distribution of the causative pathogens, 8 the emergence of antibiotic-resistant strains,9 and the discovery of new species in the genera Rickettsia and Orientia . (health.mil)
  • mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii. (jnk-receptor.com)
Infections5
  • Spotted fevers can range from relatively mild infections to fatal disease. (cdc.gov)
  • Rickettsiae and rickettsial infections: the current state of knowledge. (msdmanuals.com)
  • 1-3 SFR infections are caused by bacterial species of the genus Rickettsia. (health.mil)
  • Rickettsial infections classically present as an undifferentiated fever syndrome. (who.int)
  • Rickettsial fevers are re-emerging infections with various clinical manifestations and difficult to diagnose. (currentpediatrics.com)
Febrile3
  • Murine typhus is a febrile zoonotic disease caused by Rickettsia typhi . (cdc.gov)
  • Rocky Mountain Spotted Fever, caused by R. rickettsii causes a febrile, acute illness in dogs. (bvsalud.org)
  • This is partly due to the non-specific nature of the early symptoms of rickettsial diseases, which frequently present as undifferentiated febrile illness that is often indistinguishable from other infectious diseases, especially those common in tropical and subtropical regions (e.g., malaria, dengue fever, leptospirosis). (health.mil)
Felis3
  • Rickettsia typhi (prevalence 1.9%) and R . felis (preva- lence 24.8%) DNA were detected in rat fl eas ( Xenopsylla cheopis ) collected from mice on Oahu Island, Hawaii. (cdc.gov)
  • Eventually we came up with Rickettsia felis , that infected this child, and we believe it might have played a role in his death. (ogresearchconservation.org)
  • Parola P. Rickettsia felis: from a rare disease in the USA to a common cause of fever in sub-Saharan Africa. (medscape.com)
Ehrlichia1
  • This tick species is a known vector for Rickettsial organisms, Rickettsia parkeri, and Ehrlichia ruminantium, formerly Cowdria ruminantium. (health.mil)
Transmit1
  • citation needed] A female tick can transmit R. rickettsii to her eggs in a process called transovarial transmission. (wikipedia.org)
Akari2
  • Unlike other spotted fevers, R. akari is spread through the bite of infected house mouse mites ( Liponyssoides sanguineus) . (cdc.gov)
  • The causative agent is Rickettsia akari , a member of the spotted-fever group of rickettsiae. (medscape.com)
Diseases5
  • Spotted fever can be very difficult to diagnose in its early stages, due to the similarity of symptoms with many different diseases. (wikipedia.org)
  • The early clinical presentation of Rocky Mountain spotted fever is nonspecific and may resemble a variety of other infectious and noninfectious diseases. (wikipedia.org)
  • It may be difficult to diagnose a patient of this disease because it's early symptoms and signs tend to be similar to symptoms of other diseases or health conditions like flu. (healthjunta.com)
  • The Tiger Mosquito, Aedes albopictus , for example, is a prolific breeder in man-made environments and a vector for several diseases including dengue, West Nile fever and Japanese encephalitis. (rentokil.com)
  • These signs and symptoms refer to epidemic typhus, as it is the most important of the typhus group of diseases. (wikipedia.org)
Acute2
  • As a high number of healthy patients having acute fever requiring hospitalization within a short period of time and in such confined areas is unusual, an outbreak investigation was conducted to reveal the etiology and associated risk factors of the illness. (who.int)
  • Studies found that the most common neurological features of rickettsial fever include meningitis, encephalitis, and acute disseminated encephalomyelitis. (currentpediatrics.com)
Genus4
  • It's one of the most pathogenic members of the genus Rickettsia and has a marked incidence in the Western Hemisphere. (steptohealth.com)
  • They are caused by bacterial species of the genus Rickettsia and the closely related, but genetically distinct, genus Orientia . (health.mil)
  • Species classified within the genus Rickettsia are generally divided into 4 groups (i.e., clades). (health.mil)
  • Brucella is a genus of Gram-negative coccobacilli, and it groups together several species including Brucella abortus , Brucella melitensis, Brucella canis and Brucella suis. (osmosis.org)
Antibodies2
  • Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. (who.int)
  • The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (26%) employees and 114 (975%) dogs. (jnk-receptor.com)
Causative agent2
  • A person will have Rocky Mountain spotted fever when they are bitten by a tick that carries the causative agent Rickettsia rickettsii. (healthjunta.com)
  • Usually, doctors don't wait for the test results since it is important a patient gets antibiotics in a timely manner, so treatment may begin when there is a strong evidence suggesting that the symptoms and signs are associated with the causative agent. (healthjunta.com)
Humans1
  • That joint Swedish-South African study found that his DNA timed the split between modern humans and archaic or pre-human groups between 350 000 and 260 000 years ago. (ogresearchconservation.org)
Patients5
  • The symptoms can last 2 weeks although some patients have neurological sequelae lasting up to one year after disease onset. (canada.ca)
  • To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. (who.int)
  • Most patients required hospitalization (n = 50), and all had a positive history of tick exposure within 2 weeks before symptom onset. (cdc.gov)
  • Rickettsial meningoencephalitis was diagnosed among these rickettsial fever patients in the presence of 2 of the following 3 features. (currentpediatrics.com)
  • Patients also develop rashes, which generally arise a few days after the onset of fever. (primehealthchannel.com)
Endemic3
  • Rickettsia rickettsii is the causative organism, a gram-negative coccobacillus endemic to Central, North, and South America (especially the northeastern United States). (steptohealth.com)
  • Rickettsial fever has been reported to be endemic in many parts of India among the adult population. (currentpediatrics.com)
  • b) Assignment to UN 2814 or UN 2900 must be based on the known medical history and symptoms of the source human or animal, endemic local conditions, or professional judgement concerning individual circumstances of the source human oranimal. (searates.com)
Severe2
  • Fever reaches 39.5 to 40 ° C within several days and remains high (for 15 to 20 days in severe cases), although morning remissions may occur. (msdmanuals.com)
  • The symptoms are more severe in black individuals than in white ones. (primehealthchannel.com)
Neurological1
Onset of symptoms2
  • Exposure is defined as having been in potential tick habitats within the past 14 days before onset of symptoms. (cdc.gov)
  • 2 - 3 weeks after onset of symptoms or 4 -5 weeks after exposure! (arminlabs.com)
Rickettsial disease1
Illness2
  • Spotted fevers can be difficult to diagnose due to the non-specific signs and symptoms in early stages of illness. (cdc.gov)
  • The role of other spotted fever group rickettsia in causing illness in dogs and cats is being elucidated. (bvsalud.org)
Zoonotic disease1
  • It is the cause of brucellosis, which is a zoonotic disease that can lead to fever, arthritis , and death. (osmosis.org)
Signs2
  • In addition, TBDs often present in varying ways and with overlapping signs and symptoms. (nursingce.com)
  • Signs and symptoms begin with sudden onset of fever and other flu-like symptoms about one to two weeks after being infected. (wikipedia.org)
Disease5
  • In 2017 and 2018, nearly 80% of military beneficiaries diagnosed with SFR received presumptive treatment despite a lack of symptoms consistent with SFR and only 4% had confirmed disease. (health.mil)
  • Rocky Mountain spotted fever is a potentially lethal disease transmitted by tick bites. (steptohealth.com)
  • We believe that these symptom-free persons may show immunity to malaria and act as disease hosts", says the veteran parasitologist, who has dedicated over four decades to science. (fapesp.br)
  • If you have been infected with Lyme disease, symptoms may appear anywhere from three days to a month after being bitten. (migraineheadachepain.com)
  • [1] Other conditions that produce similar symptoms include stomach cancer , coronary heart disease , and inflammation of the stomach lining or gallbladder inflammation . (wikizero.com)
Encephalitis1
SFGR2
  • Pacific Coast tick fever is caused by R. species 364D , a SFGR species was first recognized in 2010. (cdc.gov)
  • for nearly as long, a. maculatum have been known to harbor the spotted fever group rickettsia (sfgr), now known as rickettsia parkeri. (liverpool.ac.uk)
North Carolina1
  • Rickettsia rickettsii transmission by a lone star tick, North Carolina. (medscape.com)
Wrists3
  • first appears on wrists and ankles as spots that are 1 to 5 mm in diameter, then spreads to most of the body. (medlineplus.gov)
  • Are you suffering from fever, muscular pain and small rashes in ankles and wrists? (primehealthchannel.com)
  • The rashes first arise on the wrists and the ankles as spots of diameter ranging between 1 and 5 mm. (primehealthchannel.com)
Organism1
  • If the patient can provide the tick itself, it can provide evidence to help confirm that the symptoms are related to the organism. (healthjunta.com)
Exposure2
  • Therefore, the risk of exposure to a tick carrying R. rickettsii is low. (wikipedia.org)
  • Fourteen cases of Pacific Coast tick fever have been reported, all with exposure in California. (cdc.gov)
Bite3
  • People infected with R. rickettsii usually notice symptoms following an incubation period of one to two weeks after a tick bite. (wikipedia.org)
  • Symptoms usually develop about 2 to 14 days after the tick bite. (medlineplus.gov)
  • As indicated in the MSD Manuals , symptoms appear 3-12 days after the tick bite . (steptohealth.com)
Clinical2
  • Isolation of R. rickettsii from a clinical specimen in cell culture. (cdc.gov)
  • Children who were diagnosed as Rickettsial fever on clinical parameters and got confirmed by Weil-Felix test were included in the study. (currentpediatrics.com)