RMSF is a notifiable disease. Clinicians should prescribe antibiotic therapy (doxycycline) once the diagnosis is reasonably considered, without waiting for results of confirmatory tests. Early consideration of the diagnosis and initiation of therapy is important as the case fatality rate increases considerably after 5 days of illness. This presents a challenge, as no constellation of signs and symptoms definitely confirms or excludes the diagnosis, and fever with headache is a common presentation of many illnesses.

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