Summary

• Transmitted by tick bites, which predominantly occur in spring and summer.
• Fever, rash, headache, vomiting, and history of tick bite are commonly reported; however, the absence of any of these does not exclude diagnosis.
• Signs and symptoms may be difficult to distinguish from those of common viral illnesses, leading to delayed diagnosis.
• Doxycycline is the drug of choice for treatment in patients of all ages.
• Because the risk of death rises if appropriate therapy is not started before the fifth day of illness, doxycycline should be prescribed for suspected Rocky Mountain spotted fever without awaiting confirmatory diagnostic test results.