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True Stories From The Disease Files

Rocky Mountain Spotted Fever in a Father and Child

During 2005, a four-year-old child experienced an acute onset of fever (100.5° F) and headache and was taken to a local emergency room where the child was examined and sent home.  Three days later the child developed a rash on his arms and legs and the fever increased to 102° F.  A week from the prior visit , the child was again taken to the local emergency room.  The child was then transported to a nearby acute care hospital and treated with intravenous antibiotics when doctors were informed that the child had a prior tickbite on the right hip two weeks before onset of illness.  The father of the child began to have symptoms of fever, headache, body aches, and a rash on the trunk and legs two days after the onset of the child’s symptoms.  He was seen at the local emergency room and diagnosed with a viral rash and sent home.  His symptoms progressed to include shortness of breath, mental confusion, elevated liver enzymes, thrombocytopenia, and meningitis.  He was admitted to the same hospital as his child, and given intravenous antibiotics.  Both father and child had positive laboratory tests for Rocky Mountain s potted fever (RMSF).  The father did not remember ever being bitten by a tick, but lives in a heavily tick infested area.

RMSF is an illness caused by the bacteria Rickettsia rickettsii (R. rickettsii) that is passed to humans through the bite of an infected tick.  RMSF is the most commonly reported tickborne illness in Oklahoma.  In addition, Oklahoma has one of the highest rates of RMSF in the United States.

RMSF nearly always results from the bite of an infected tick.  In Oklahoma, the tick most often associated with RMSF is the American dog tick.  It is possible, however, to be infected with RMSF bacteria if the body fluids of an infected tick contact broken skin or the portion of the skin under the nail bed.  This can occur if a tick is “popped” or squeezed while being removed from a human or animal.  RMSF is not spread from one person to another person.

The symptoms of RMSF generally include a sudden onset of headache, fever (often greater than 100.5° F), and muscle aches.  A fine, bumpy, red rash often appears on the extremities including the palms of the hands and soles of the feet, before spreading to other parts of the body.  However, not everyone with RMSF develops a rash.  Nausea, vomiting, and abdominal pain are also frequently reported.

RMSF can be a potentially severe or fatal disease caused by the bacteria R. rickettsii.  Humans nearly always become infected with the bacteria following the bite of an infected tick.  In Oklahoma, the tick associated with transmission of R. rickettsii is the American dog tick (Dermacentor variabilis). The other known tick vector of R. rickettsii, the Rocky Mountain wood tick (Dermacentor andersoni), is found in the Rocky Mountain states and in Southwestern Canada.  Tick bites due to the American dog tick are common in Oklahoma.  Fortunately, only 1%-3% of the tick population are infected and capable of transmitting R. rickettsii.

If you begin to experience symptoms of fever, headache, and muscle aches, with or without a rash, within two weeks after a tickbite or travel to a wooded and tick infested area, then you should see a physician as soon as possible and immediately inform him/her of your tick bite and the date on which the tick was removed.  Tickborne illnesses are treatable with antibiotics, however, can sometimes result in death if not treated promptly.  To prevent tick bites wear light colored clothing, long sleeved shirts and long pants tucked into socks, and wear closed-toed shoes. Stay in the center of trails to avoid grass and brush. Use a tick repellent with DEET on skin and clothing according to directions or use a tick repellent with permethrin on CLOTHING ONLY and as directed by the label when visiting wooded or tick infested areas.  Frequent and regular tick checks of yourself and your pets are recommended, and remove attached ticks as soon as possible using tweezers.

Please visit the following links for more information regarding Rocky Mountain spotted fever:

Rocky Mountain Spotted Fever Fact Sheets and Information:

Tickborne Illnesses
Tickborne Prevention
Rocky Mountain Spotted Fever Page

RMSF Fact Sheet (91k.pdf) 
  RMSF Hoja Informativa (43k.pdf)

External Rocky Mountain Spotted Fever Resources:

Tickborne Diseases (CDC)
RMSF (CDC)

Rocky Mountain Spotted Fever Surveillance Data and Statistics:

RMSF 2010 Surveillance Summary (343k.pdf)
 

Rocky Mountain Spotted Fever Morbidity and Mortality Weekly Reports:

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichioses, and Anaplasmosis - United States

Fatal Cases of Rocky Mountain Spotted Fever in Family Clusters --- Three States, 2003

Consequences of Delayed Diagnosis of Rocky Mountain Spotted Fever in Children --- West Virginia, Michigan, Tennessee, and Oklahoma, May--July 2000�

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