Rocky Mountain Spotted
Fever Kills 27 Year Old Man

By Will Buss
Belleville News-Democrat - Illinois

Patricia Doyle, PhD |
From ProMed
A 27 year old man from Evansville, Illinois died on Tue 5 Aug 2003, days after contracting Rocky Mountain spotted fever from a tick bite near his home. He had been walking in the woods with his dogs near his Randolph County home about a week before, when a tick climbed into his beard and bit him, his sister said. "It happened so fast," the sister said. She added that her brother broke out in dark spots on his body, a sign of the disease. "It was all purple in the skin, in his eyes and his face," she said.
Rocky Mountain spotted fever is caused by _Rickettsia rickettsii_ -- a species of bacteria that is spread to humans by ticks, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. Initial signs and symptoms of the disease include a sudden onset of fever, headache and muscle pain, followed by a rash. The disease can be difficult to diagnose in its early stages, but [certain - Mod.LL] antimicrobials are effective.
About 3 per cent to 5 per cent of those who contract Rocky Mountain spotted fever die from the infection, according to CDC. The disease had a mortality rate of about 30 per cent before antimicrobialss were discovered to treat the disease in the late 1940s.
Despite its name, Rocky Mountain spotted fever is broadly distributed throughout the continental United States, as well as southern Canada, Central America, Mexico, and parts of South America, according to CDC. Between 1981 and 1996, the disease was reported in every US state except Hawaii, Vermont, Maine, and Alaska.
[It is vital to diagnose this rickettsial infection promptly to minimize morbidity and mortality. This is particularly true in areas such as the midwestern USA where the disease is uncommon. The time frame in this case is not clear. When the female tick harboring the organism attaches to a passing human, she usually starts low on the body after transferring from grassy vegetation or even directly or indirectly from a dog. After crawling around on clothes seeking an appropriate cutaneous site (wearing white clothes makes a wandering tick easier to spot), she attaches and begins to feed. In this case, the neck line may have been the first skin she located, hence feeding in the beard area.
After attaching, it generally takes as many as 24 hours to activate and transmit the rickettsial organism. For this reason, daily or twice daily tick checks with removal will minimize disease transmission. Ticks that attach in hairy areas such as the scalp or beard may be more difficult to find.
The incubation period of the disease is about a week after the tick exposure, long after the tick has detached. The presenting illness is generally nonspecific -- fever, muscle pains, headache (but the headache is usually described as quite severe). The rash begins in day 3 of illness, initially maculopapular at the wrists and ankles before becoming petechial and purpuric involving the palms and soles as well as spreading proximally to the truck. Purpura usually are not seen before the sixth day of illness. The mortality is indeed quite low if treatment (usually a tetracycline)is begun during the first 2 days of the rash or before. - Mod.LL]
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