eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Rocky Mountain Spotted Fever: Follow-up

Author: Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Contributor Information and Disclosures

Updated: Sep 10, 2009

Follow-up

Further Inpatient Care

  • Delayed diagnosis of Rocky Mountain spotted fever (RMSF) and delayed initiation of specific antirickettsial therapy (eg, on or after day 5 of the illness) is associated with substantially increased risk of a fatal outcome.
  • Rocky Mountain spotted fever should be considered in any person who has fever and a history of tick bite or exposure.
  • Never delay treatment while awaiting a confirmatory laboratory diagnosis.
  • Doxycycline is the antibiotic of choice in almost all clinical situations, including disease in children younger than 8 years.
  • Also, other supportive measures (eg, intravenous administration of fluids, oxygenation, correction of electrolyte impairments, management of disseminated intravascular coagulation) should be provided according to the patient's clinical situation.

Deterrence/Prevention

  • Avoidance of tick-infested areas is the first line of defense against Rocky Mountain spotted fever.
  • After a tick bite occurs, use of antimicrobial prophylaxis has no role in the prevention of Rocky Mountain spotted fever.
  • If tick-infested areas cannot be avoided, wearing light-colored shirts and trousers that fit tightly around the waist and ankles can minimize the risk of being bitten.
  • Exposed areas of the skin should be covered with insect repellents containing N -N -diethyl-M -toluamide (DEET). In children, insect repellents should be used carefully on exposed skin. Application to the face and hands should be avoided.
  • After people leave an endemic area, they should inspect their bodies for attached ticks, with particular attention on areas containing hair.
  • If ticks are found, any of several commercial removal devices should be used if possible. Otherwise, ticks should be removed by grasping them with fine tweezers at the point of attachment and by pulling them out slowly and steadily. The aim is to remove the tick's mouthparts from the site of insertion without damaging the arachnid.
    • After the tick is removed, the skin should be disinfected. Check to make sure that the head of the tick is not still embedded.
    • Some recommended keeping the removed tick in a jar along with a dampened paper towel in the refrigerator for a month. This way, if symptoms develop, the tick may be used to help identify what (if any) infection it may have transmitted.
    • Burning the tick, smothering it in alcohol or petroleum jelly (or another substance), or twisting or rubbing it off is not recommended. These methods have not been shown to decrease the time the tick remains embedded. In addition, they may pose of risk breaking the body of the tick open and releasing bacteria that were otherwise contained within it.

Complications

  • Meningitis
  • Renal failure
  • Pulmonary involvement
  • Liver impairment with development of jaundice
  • Splenomegaly
  • Myocarditis
  • Thrombocytopenia

Prognosis

  • The outcome greatly depends on the early start of appropriate treatment.
  • Outcomes can vary from complete resolution to death.
  • Severe disease may result in long-term sequelae, such as the following:
    • Partial paralysis of the lower extremities
    • Gangrene requiring amputation of fingers, toes, arms, or legs
    • Hearing loss
    • Blindness
    • Loss of bowel or bladder control
    • Movement disorders
    • Speech disorders

Patient Education

  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Rocky Mountain spotted fever (RMSF) is a life-threatening disease. Therefore, paying meticulous attention when patients with potential Rocky Mountain spotted fever are treated is important. Clinicians should have a low threshold for treatment if Rocky Mountain spotted fever is clinical suspected.
  • Signs and symptoms can mimic those of other diseases. Therefore, a history of traveling to endemic areas, having tick bites, or having exposures to ticks is an important clue.
  • A negative history for tick bites should not exclude the diagnosis if the index of clinical suspicion is high.
  • Antibiotics (doxycycline) should be promptly administered.
  • Waiting for the classic petechial rash to develop may seriously worsen the patient's outcome because antibiotics are best administered before day 5 of the illness, and the rash may not appear until day 6.
 


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
Multimedia: Rocky Mountain Spotted Fever
References
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References

  1. 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(RR-4):1-27. [Medline]. [Full Text].

  2. 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].

  3. Adjemian JZ, Krebs J, Mandel E, McQuiston J. Spatial clustering by disease severity among reported Rocky Mountain spotted fever cases in the United States, 2001-2005. Am J Trop Med Hyg. Jan 2009;80(1):72-7. [Medline].

  4. [Guideline] 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]. [Full Text].

  5. Cale DF, McCarthy MW. Treatment of Rocky Mountain spotted fever in children. Ann Pharmacother. Apr 1997;31(4):492-4. [Medline].

  6. Abramson JS, Givner LB. Rocky Mountain spotted fever. Pediatr Infect Dis J. Jun 1999;18(6):539-40. [Medline].

  7. American Academy of Pediatrics Committee on Infectious Diseases. Rocky Mountain spotted fever. In: Red Book. 27th Ed. Elk Grove Village, IL: AAP; 2006:570-2.

  8. Azad AF, Beard CB. Rickettsial pathogens and their arthropod vectors. Emerg Infect Dis. Apr-Jun 1998;4(2):179-86. [Medline].

  9. Kostman JR. Laboratory diagnosis of rickettsial diseases. Clin Dermatol. May-Jun 1996;14(3):301-6. [Medline].

  10. Thorner AR, Walker DH, Petri WA. Rocky mountain spotted fever. Clin Infect Dis. Dec 1998;27(6):1353-9; quiz 1360. [Medline].

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Further Reading

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Keywords

Rocky Mountain spotted fever, RMSF, tick-borne disease, Rickettsia rickettsii, R rickettsii, black measles, Lyme disease, vasculitis, edema of the medulla oblongata, rickettsial disease, glucose-6-phosphate dehydrogenase, G-6-PD deficiency, conjunctival hyperemia, photophobia, hepatomegaly, splenomegaly, meningoencephalitis, meningismus

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Contributor Information and Disclosures

Author

Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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