Can be fatal if not treated early.
A characteristic eschar or scab at the site of the tick bite is absent, in contrast to infections due to other tick-borne spotted fever group rickettsiae. A history of tick bite may not be elicited in up to nearly half of cases.
Signs and symptoms may be difficult to distinguish from those of common viral illnesses, leading to delayed diagnosis. Diagnosis should be considered in any person with a compatible clinical presentation and recent outdoor exposure.
Doxycycline is the drug of choice for treatment in patients of all ages and is almost always curative, especially if given in the first 5 days of illness. As the risk of death rises if appropriate therapy is not started before the fifth day of illness, doxycycline should be prescribed for suspected disease before confirmatory diagnostic test results are available.
Rocky Mountain spotted fever (RMSF) is a systemic vasculitis caused by infection with
Rickettsia rickettsii
, a tick-borne, gram-negative, intracellular bacterium.
[1]
Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016;65:1-44.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/27172113?tool=bestpractice.com
Rickettsia rickettsii
is one of the spotted fever group (SFG) rickettsiae and is closely related to the other group members by genetic and antigenic characteristics. It is the most frequently reported SFG rickettsial infection in North America and the most common fatal tick-borne infection in the US.
[2]
Drexler NA, Dahlgren FS, Heitman KN, et al. National surveillance of spotted fever group rickettsioses in the United States, 2008-2012. Am J Trop Med Hyg. 2016;94:26-34.
http://www.ncbi.nlm.nih.gov/pubmed/26324732?tool=bestpractice.com
[3]
Openshaw JJ, Swerdlow DL, Krebs JW, et al. Rocky mountain spotted fever in the United States, 2000-2007: interpreting contemporary increases in incidence. Am J Trop Med Hyg. 2010;83:174-182.
http://www.ajtmh.org/content/83/1/174.long
http://www.ncbi.nlm.nih.gov/pubmed/20595498?tool=bestpractice.com
[4]
Adams DA, Jajosky RA, Ajani U, et al; Centers for Disease Control and Prevention. Summary of notifiable diseases - United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1-121.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6153a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/25233134?tool=bestpractice.com
Fever, rash, headache, and vomiting are the most common clinical manifestations, but because virtually any organ may be affected the presentation and clinical course of infection may vary.
[1]
Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016;65:1-44.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/27172113?tool=bestpractice.com
[5]
Helmick CG, Bernard KW, D'Angelo LJ. Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. J Infect Dis. 1984;150:480-488.
http://www.ncbi.nlm.nih.gov/pubmed/6491365?tool=bestpractice.com
[6]
Buckingham SC, Marshall GS, Schutze GE, et al. Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children. J Pediatr. 2007;150:180-184.
http://www.ncbi.nlm.nih.gov/pubmed/17236897?tool=bestpractice.com
[7]
Traeger MS, Regan JJ, Humpherys D, et al. Rocky Mountain spotted fever characterization and comparison to similar illnesses in a highly endemic area - Arizona, 2002-2011. Clin Infect Dis. 2015;60:1650-1658.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699465/
http://www.ncbi.nlm.nih.gov/pubmed/25697743?tool=bestpractice.com
A characteristic eschar or scab at the site of the tick bite is absent, in contrast to infections due to other tick-borne SFG rickettsiae.
Detailed content on other rickettsial infections is covered by our separate Rickettsial Diseases topic.
