A previously healthy 24-year-old man comes to the physician because of a 4-day history of fever, headache, myalgias, and abdominal pain. He developed a new rash this morning. He returned from a camping trip in the Appalachian Mountains 5 days ago. He was camping outdoors, drank only filtered water, and used sunscreen. He is sexually active and uses condoms for contraception. He appears ill and fatigued. His temperature is 39.5°C (103.1°F). Physical examination shows conjunctival injection in both eyes without exudate or pus. There is a blanching, macular rash on the palms and soles and petechiae on the wrists and forearms. The patient should be immediately initiated on a medication that targets which of the following?

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Eductional Objective: Rocky mountain spotted fever is a tick-borne illness due to Rickettsia rickettsii, a weakly gram-negative, obligate intracellular organism that has an affinity for vascular endothelial cells.  Patients usually have nonspecific symptoms (eg, fever, malaise, myalgia) followed by a macular-petechial rash that begins on the ankles and wrists and spreads to the center of the body as well as to the palms and soles.  Urgent treatment with doxycycline, an inhibitor of bacterial protein synthesis, is required.

A Previously Healthy 24-Year-Old Man Comes to the Physician Because