Approach Considerations
Emergency department care of patients with Colorado tick fever is the same as that for any patient with a febrile illness. The essential decision is whether a serious treatable infection exists. Thus, history taking and physical examination must be directed toward this issue. Exclusion of the treatable infections listed in the differential diagnosis, as well as any other serious bacterial infection, is the goal of care. Fluids and antipyretics should be administered in a supportive manner as needed. Consultation with an infectious disease specialist may be appropriate in some cases.
If a tick is found attached to the patient, it must be removed. [4] The recommended removal method is to grasp the tick with forceps or fine-point tweezers near the point of attachment and to pull straight outward with steady, even, and gentle traction. Twisting and squeezing should be avoided, as this may facilitate the movement of pathogens into the host and may be more likely to leave tick mouthparts embedded in the skin. [14]
Patients diagnosed with Colorado tick fever should continue antipyretic therapy. They should be instructed to follow up with a primary care physician and to refrain from donating blood or bone marrow for at least 6 months after infection. The emergency physician should be aware that weakness and fatigue caused by this illness may last for several weeks. [1]
Prevention
For individuals who are planning to spend extended periods of time outside in endemic areas, the following precautions are appropriate:
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Wearing long-sleeve shirts and tucking the shirt into the pants
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Tucking the pant legs into the socks
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Wearing light-colored clothing
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Performing daily tick checks
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Applying insect repellent such as DEET or permethrin [15]
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Two ticks next to a common match. On right is Ixodes scapularis, vector for Lyme disease. On left is Dermacentor, vector for Colorado tick fever.
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Approximate geographic distribution of Dermacentor andersoni ticks and counties of residence for confirmed and probable Colorado tick fever (CTF) virus disease cases, United States, 2010–2019. All cases were acquired in states where local transmission of CTF virus has been reported previously. Courtesy of the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/coloradotickfever/statistics.html).
