Patrick Jackson - Rocky Mountain Spotted Fever

• Remember RMSF happens year round, even though 90% of cases occur between April and Sept.
• Think RMSF for patient presenting with “flu-like” illness in summer time in endemic area.
• Only 50% of people with RMSF remember a tick bite or exposure.
  

• Classic triad is rarely, if ever, present in initial patient encounter.
• Patients with mainly viral gastroenteritis symptoms are the ones most commonly missed with RMSF.
• 10-15% never develop a rash.  Rocky Mountain Spotless Fever.
• Rash starts as macular, then progresses to maculopapular, then petechial (rash 2-4 days after fever onset)

• Workup is clinical: Normal WBC, no thrombocytopenia, few physical exam findings.
• Do NOT place too much emphasis on serology results (takes minimum 7-10 days for positive serology conversion).
  

• Doxycycline is the first line treatment for all patients (including pregnant and pediatrics)
• Empiric therapy is recommended if: Febrile, endemic area, April-Sept, and headache or other constitutional symptoms.
• Include doxycycline in your empiric coverage of patients suspected for meningitis/RMSF.
• Prescribe Doxycycline monohydrate CAPSULE (cheapest).

• Asymptomatic tick exposure does not get prophylaxis.