Rocky Mountain Spotted Fever Treatment & Management

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Sep 14, 2011
 

Approach Considerations

Initiating antibiotics early significantly reduces the mortality rate of Rocky Mountain spotted fever (RMSF) from 20% to approximately 5%. In addition, it prevents early complications. Patients may also require oxygen or intubation.[15]

Dehydration due to high fever and vomiting may occur. Appropriate and aggressive fluid management with isotonic fluids should be instituted. Monitor urine output and blood pressure. A Swan-Ganz catheter may be needed to monitor hemodynamics in some patients.

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.[17]

Transfer

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

Outpatient care

Clinically mild cases may be treated on an outpatient basis. However, RMSF can progress rapidly. Because roughly 10% of outpatients subsequently required admission, close follow-up is necessary if outpatient management is planned.

Consultations

Always report tick-borne illnesses to public health authorities. Consultation with an infectious disease specialist is advised. A dermatologist should be consulted to obtain a skin biopsy specimen for immunofluorescent staining, if available.

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Prehospital and Emergency Department Care

In emergency prehospital care for Rocky Mountain spotted fever (RMSF), deliver supportive therapy, including airway support and intravenous (IV) fluids, as determined by the severity of the patient's condition.

Emergency department care in RMSF includes the following:

  • IV hydration if hypotension or prerenal azotemia is present
  • Supplemental oxygen and endotracheal (ET) intubation for airway protection and ventilatory support, as indicated
  • Packed red blood cells (pRBCs) for anemia or severe, life-threatening GI bleeding
  • Platelet transfusion for severe thrombocytopenia with active bleeding
  • Hemodialysis for oliguric or anuric acute tubular necrosis
  • Pulmonary artery catheter placement for judicious fluid replacement in patients with hypovolemia and acute respiratory distress syndrome (ARDS)
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Inpatient Care

Hospitalization was required in 72% of confirmed cases of Rocky Mountain spotted fever (RMSF) reported to the Centers for Disease Control and Prevention (CDC). Hospitalization occurred a median of 4 days after symptom onset.

Admit moderately to severely ill patients to the hospital. Indications for admission may include altered mental status or other neurologic manifestations of RMSF, severe thrombocytopenia, hemodynamic instability, or azotemia. Admit severely ill patients to the intensive care unit (ICU).

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Ophthalmic Care

Supportive therapy according to the needs of individual patients is indicated. Moderate to severe uveitis may be treated with topical cycloplegics and corticosteroids, although no reliable information on efficacy is available. Artificial tears and ocular lubricating ointment may help to relieve discomfort from periorbital edema and petechial conjunctivitis.

Patients with Rocky Mountain spotted fever (RMSF) usually do not present initially to an ophthalmologist. Usually, these patients are already under the care of an internist or infectious disease physician.

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Prevention

Protective measures against tick bites include the following:

  • 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

When a tick is present, it should be promptly removed using gentle, steady traction with tweezers. Care should be taken not to crush the tick or to leave any mouthparts. Hands should be protected 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.

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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)

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.

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 Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Allon Amitai, MD International Emergency Medicine Fellow, Rhode Island Hospital; Consulting Staff, Memorial Hospital of Rhode Island; Doctoring Preceptor, Brown University Medical School

Allon Amitai, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Peter MC DeBlieux, MD Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Aaron Glatt, MD Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly 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 forHealthcareEpidemiology of America

Disclosure: Nothing to disclose.

Gary L Gorby, MD Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

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.

Jon Mark Hirshon, MD, MPH Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine

Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christopher D Johnson, MD Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate Medical Center College of Medicine

Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS Associate Professor, Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Nicole L Lacz, MD Chief Resident, Department of Radiology, St Barnabas Medical Center

Nicole L Lacz, MD is a member of the following medical societies: Alpha Omega Alpha, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Byron L Lam, MD Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine

Byron L Lam, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Richard Medlin, Jr, MD Consulting Staff, Department of Anesthesiology, Emory University Hospital

Richard Medlin, Jr, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Noah S Scheinfeld, MD, JD, FAAD Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

John D Sheppard Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

References

  1. Sexton DJ, Corey GR. Rocky Mountain "spotless" and "almost spotless" fever: a wolf in sheep's clothing. Clin Infect Dis. Sep 1992;15(3):439-48. [Medline].

  2. Salgo MP, Telzak EE, Currie B, et al. A focus of Rocky Mountain spotted fever within New York City. N Engl J Med. May 26 1988;318(21):1345-8. [Medline].

  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. Jul 2010;83(1):174-82. [Medline]. [Full Text].

  4. Stromdahl EY, Jiang J, Vince M, Richards AL. Infrequency of Rickettsia rickettsii in Dermacentor variabilis removed from humans, with comments on the role of other human-biting ticks associated with spotted fever group Rickettsiae in the United States. Vector Borne Zoonotic Dis. Jul 2011;11(7):969-77. [Medline].

  5. Marshall GS, Stout GG, Jacobs RF, et al. Antibodies reactive to Rickettsia rickettsii among children living in the southeast and south central regions of the United States. Arch Pediatr Adolesc Med. May 2003;157(5):443-8. [Medline].

  6. Zavala-Castro JE, Dzul-Rosado KR, León JJ, Walker DH, Zavala-Velázquez JE. An increase in human cases of spotted fever rickettsiosis in Yucatan, Mexico, involving children. Am J Trop Med Hyg. Dec 2008;79(6):907-10. [Medline].

  7. Demma LJ, Holman RC, Mikosz CA, et al. Rocky mountain spotted fever hospitalizations among American Indians. Am J Trop Med Hyg. Sep 2006;75(3):537-41. [Medline].

  8. Holman RC, McQuiston JH, Haberling DL, Cheek JE. Increasing incidence of Rocky Mountain spotted fever among the American Indian population in the United States. Am J Trop Med Hyg. Apr 2009;80(4):601-5. [Medline].

  9. Kirkland KB, Wilkinson WE, Sexton DJ. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis. May 1995;20(5):1118-21. [Medline].

  10. Archibald LK, Sexton DJ. Long-term sequelae of Rocky Mountain spotted fever. Clin Infect Dis. May 1995;20(5):1122-5. [Medline].

  11. Chen LF, Sexton DJ. What's new in Rocky Mountain spotted fever?. Infect Dis Clin North Am. Sep 2008;22(3):415-32, vii-viii. [Medline].

  12. Sexton DJ, Gallis HA, McRae JR, Cate TR. Letter: Possible needle-associated Rocky Mountain spotted fever. N Engl J Med. Mar 20 1975;292(12):645. [Medline].

  13. 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. Feb 2007;150(2):180-4, 184.e1. [Medline].

  14. Byrd RP Jr, Vasquez J, Roy TM. Respiratory manifestations of tick-borne diseases in the Southeastern United States. South Med J. Jan 1997;90(1):1-4. [Medline].

  15. Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55:1-27. [Medline].

  16. Procop GW, Burchette JL Jr, Howell DN, Sexton DJ. Immunoperoxidase and immunofluorescent staining of Rickettsia rickettsii in skin biopsies. A comparative study. Arch Pathol Lab Med. Aug 1997;121(8):894-9. [Medline].

  17. Markley KC, Levine AB, Chan Y. Rocky Mountain spotted fever in pregnancy. Obstet Gynecol. May 1998;91(5 Pt 2):860. [Medline].

  18. Holman RC, Paddock CD, Curns AT, Krebs JW, McQuiston JH, Childs JE. Analysis of risk factors for fatal Rocky Mountain Spotted Fever: evidence for superiority of tetracyclines for therapy. J Infect Dis. Dec 1 2001;184(11):1437-44. [Medline].

  19. Minniear TD, Buckingham SC. Managing Rocky Mountain spotted fever. Expert Rev Anti Infect Ther. Nov 2009;7(9):1131-7. [Medline].

  20. Lochary ME, Lockhart PB, Williams WT Jr. Doxycycline and staining of permanent teeth. Pediatr Infect Dis J. May 1998;17(5):429-31. [Medline].

 
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The palm of a patient with Rocky Mountain spotted fever exhibiting the classic petechial rash associated with the disease. Courtesy of Sadhana Sathe, MD, PhD.
The petechial rash of Rocky Mountain spotted fever affecting the sole and the dorsum of the patient's foot. Courtesy of Sadhana Sathe, MD, PhD.
 
 
 
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