eMedicine Specialties > Infectious Diseases > Bacterial Infections

Rocky Mountain Spotted Fever: Follow-up

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Coauthor(s): Richard H Snyder, MD, Vice-Chair, Program Director, Department of Medicine, Norfolk General Hospital; Clinical Associate Professor, Department of Internal Medicine, East Virginia Medical School; Marie Spevak O'Brien, DO, Assistant Clinical Professor of Medicine, Arthritis and Rheumatology, Lehigh Valley Physician Group
Contributor Information and Disclosures

Updated: Oct 19, 2009

Follow-up

Transfer

Proper personnel trained in complicated airway intervention and treatment of shock should be available to patients with Rocky Mountain spotted fever (RMSF)who are comatose, convulsing, or hypotensive.

Deterrence/Prevention

  • The best means of prevention is to avoid contact with ticks by using protective clothing and repellants.
  • Currently, research is underway to develop an effective vaccine using OmpA expressed in baculovirus to be used among high-risk patients in endemic areas.
  • See Patient Education.

Complications

  • Disseminated intravascular coagulation
  • Noncardiogenic pulmonary edema
  • Acute tubular necrosis
  • Shock with myocarditis
  • Skin necrosis and gangrene, particularly in fingers, toes, elbows, ears, and scrotum
  • Myocarditis - Usual cause of death
  • Other possible complications include the following:  
    • Seizures
    • Encephalopathy
    • Peripheral neuropathy
    • Bowel and bladder incontinence
    • Cerebellar and vestibular dysfunction
    • Hearing loss
  • Hemophagocytic histiocytosis - Described in fatal cases of RMSF

Prognosis

  • Mortality rates vary according to the following criteria:  
    • Delay in diagnosis
    • Delay in effective antibiotic treatment
    • Age
    • Race
    • Severity of the disease
  • Mortality rates can be as low as 5% with proper antibiotic therapy and as high as 70% in untreated elderly individuals.
  • Risk factors for fatal outcome in RMSF include the following:  
    • Age older than 40 years
    • Delay in treatment
    • No treatment within the first 5 days of illness3

Patient Education

  • To promote prevention, educate the public about transmission of ticks and means of personal protection.
    • Avoid dogs with ticks and tick-infected areas.
    • Use protective light-colored clothing that covers arms and legs. Tuck pants in socks to protect legs.
    • Apply tick-repellent chemicals such as diethyltoluamide (DEET, Autan) or permethrin to pants and sleeves.
    • Search the entire body every 3-4 hours when in an infested area. Common areas of attachment are in scalp, pubic, or axillary hair.
    • Without crushing the tick, remove it promptly using gentle steady traction with tweezers. Be careful not to leave any mouthparts. Protect hands with gloves.
    • Because the tick needs 6-10 hours of feeding to transmit the disease, early discovery and removal of ticks can prevent infection.
    • Prophylaxis with doxycycline for 7 days is recommended after tick removal.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Failure to promptly evaluate and treat patients with acute febrile illnesses and tick exposure
  • Failure to consider Rocky Mountain spotted fever (RMSF) in a febrile patient in an endemic area, regardless of tick exposure

Special Concerns

  • Pregnancy  
    • Whether R rickettsii can cross the placenta and adversely affect the fetus remains unknown.
    • In a case report, a pregnant patient with RMSF was treated with chloramphenicol successfully with no apparent adverse maternal or neonatal effects.7
  • Human ehrlichiosis caused by Ehrlichia canis mimics RMSF in its clinical manifestations and geographic and seasonal distribution. Rash is not present with ehrlichiosis. Spotless RMSF is usually ehrlichiosis. Doxycycline is the preferred drug for human ehrlichiosis.
 


More on Rocky Mountain Spotted Fever

Overview: Rocky Mountain Spotted Fever
Differential Diagnoses & Workup: Rocky Mountain Spotted Fever
Treatment & Medication: Rocky Mountain Spotted Fever
Follow-up: Rocky Mountain Spotted Fever
References
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References

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Further Reading

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Keywords

Rocky Mountain spotted fever, RMSF, tick fever, spotted fever, tick typhus, New World spotted fever, Rickettsia rickettsii, R rickettsii, Sao Paulo fever, fiebre manchada, fiebre petechial, fiebre maculosa brasiliensis, dog tick, wood tick, the great imitator

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Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Snyder, MD, Vice-Chair, Program Director, Department of Medicine, Norfolk General Hospital; Clinical Associate Professor, Department of Internal Medicine, East Virginia Medical School
Richard H Snyder, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Marie Spevak O'Brien, DO, Assistant Clinical Professor of Medicine, Arthritis and Rheumatology, Lehigh Valley Physician Group
Marie Spevak O'Brien, DO is a member of the following medical societies: American College of Physicians, American College of Rheumatology, American Medical Association, American Osteopathic Association, International Society for Clinical Densitometry, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Gary L Gorby, MD, Program Director of Adult Infectious Diseases Fellowship, Associate Professor, Department of Internal Medicine, Division of Infectious Disease, St Joseph Medical Center, Creighton University School of Medicine
Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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