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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Rocky Mountain Spotted Fever


September 07, 2011

Lyme Disease
8777
Basics
Rocky Mountain Spotted Fever
Rocky Mountain Spotted Fever
htmJHI07rocky
Re-emerging, right on schedule.
198328
InteliHealth
2011-09-07
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InteliHealth Medical Content
2014-09-07

Reviewed by the Faculty of Harvard Medical School

Rocky Mountain Spotted Fever
 
Re-emerging, right on schedule.
Following a pattern that can be traced back to the 1920s, 600 or more cases of Rocky Mountain spotted fever are expected in the United States in 2004. The last peak occurred in 1980, after which disease incidence dropped, reaching its lowest point in 1993. Traditionally, incidence rises for 10 to 15 years, peaks and then decreases for another 15 to 20 years before repeating the cycle. Approximately 200 to 1,200 Americans become ill from Rocky Mountain spotted fever each year but in 2004, more than 1400 cases were reported to the Centers for Disease Control and Prevention (CDC).
 
Rocky Mountain spotted fever is the deadliest of all tick-borne diseases. Even with appropriate antibiotic treatment, up to 10 percent of patients die, perhaps, in part, because of the difficulty in arriving at the proper diagnosis and the delay in starting antibiotic treatment (with doxycycline or chloramphenicol).
 
It is caused by a type of microorganism called rickettsia, which is carried by the American dog tick. Despite its name, Rocky Mountain spotted fever is most prevalent on the East Coast and the south central states, even though the dog tick can be found almost anywhere in the United States. The most recent outbreaks occurred in Arizona, North Carolina and Arkansas.
 
Symptoms include fever — which can reach 105 degrees or more — headache and a skin rash that usually first appears four to six days after the fever begins, starting as small, faint red splotches. This rash typically begins on the arms or legs, and it spreads inward toward the trunk, involving the palms and soles but usually sparing the face. Over time, the flat red splotches become elevated, then turn darker red. It is important to note that there may be no rash within the first several days of illness, and about 10 percent of persons never have a rash.
 
The diagnosis must be strongly suspected and treatment started early, because delay may be deadly and no reliable test can identify the illness in the earliest phases. Anyone who experiences these symptoms and possible tick exposure should see a doctor immediately.

 

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