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Rocky Mountain Spotted Fever (RMSF)

Rocky Mountain spotted fever (RMSF) is a multisystem disease caused by the parasite Rickettsia rickettsii. The parasite is usually transmitted through the bite of an infected wood or dog tick. However, 40% of patients do not recall being exposed to a tick at the time of diagnosis. RMSF must be suspected in a patient with possible tick exposure. A clinical triad of fever, headache, and myalgias is commonly present. There is a regional distribution of this disease to the central and southern Atlantic seaboard states and is most common in children.


The bacterial culprit in RMSF is called Rickettsia rickettsii. It causes no illness in the tick carrying it, and can be passed on to the tick's offspring. When a tick attaches to a human, the bacteria is passed. The tick must be attached to the human for about six hours for this passage to occur. Although prompt tick removal will cut down on the chance of contracting RMSF, removal requires great care. If the tick's head and body are squashed during the course of removal, the bacteria can be inadvertently rubbed into the tiny bite wound.

Rocky Mountain spotted fever isn't contagious and doesn't spread directly from person to person


  • Common triad, usually presenting 1 week after tick bite: fever +++++, headache ++++, myalgias ++++
  • Rash begins approximately 4 days after these symptoms begin ++++.
  • Rash: palms and soles ++++
  • Nausea and vomiting +++
  • Abdominal pain +++
  • Confusion ++
  • Diarrhea ++
  • Meningismus


  • Rash commonly begins on the wrists and ankles and then spreads more centrally to the palms and soles, proximal extremities, trunk, and face.
  • Rash consists of blanching macules or maculopapules, which evolve into diffuse petechiae over 2 to 4 days.
  • Systemic signs develop if multiorgan (e.g., cardiovascular, renal) involvement.


The objective of treatment is careful removal of the tick from the skin and antibiotics to eliminate the infection. Doxycycline or tetracycline are frequently used.

Pregnant women should not take doxycycline or tetracycline. Since chloramphenicol is available in the US only in IV form, pregnant women should be admitted to the hospital.

Prevention of Rocky Mountain Spotted Fever
  • Preventing Rocky Mountain spotted fever involves preventing tick bites.
  • Children and adults who are outside in tick-infested areas should wear long clothing and tuck the end of the pants into the socks.
  • Try to wear light-colored clothing that makes ticks more visible if they are crawling on you. This can help you see ticks before they latch onto your skin.
  • Insect repellent may be helpful.
  • Permethrin products are more effective against ticks than DEET products.
  • Check for ticks attached to the skin every 2-3 hours while outside, then check thoroughly once a day.
  • You can remove ticks immediately by using a tweezers, pulling carefully and steadily.
  • Favorite hiding places for ticks are in the hair so check the scalp, neck, armpits, and groin.
  • Wash your clothes and hair after leaving tick-infested areas.

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