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Rocky Mountain spotted fever

Show Alternative Names
Spotted fever

Rocky Mountain spotted fever (RMSF) is a disease caused by a type of bacteria carried by ticks.

Causes

RMSF is caused by the bacterium Rickettsia rickettsii (R Rickettsii), which is carried by ticks. The bacteria is spread to humans through a tick bite.

In the western United States, the bacteria are carried by the wood tick. In the eastern US, they are carried by the dog tick. Other ticks spread the infection in the southern US and in Central and South America.

Contrary to the name "Rocky Mountain," most recent cases have been reported in the eastern US. States include North and South Carolina, Virginia, Georgia, Tennessee, and Oklahoma. Most cases occur in the spring and summer and are found in children.

Risk factors include recent hiking or exposure to ticks in an area where the disease is known to occur. The bacteria are unlikely to be transmitted to a person by a tick that has been attached for less than 20 hours. Only about 1 in 1,000 ticks carry the bacteria. Bacteria can also infect people who crush ticks they have removed from pets with their bare fingers. Not all people will remember getting a tick bite.

Symptoms

Symptoms usually develop about 2 to 14 days after the tick bite. They may include:

  • Chills and fever
  • Confusion
  • Headache
  • Muscle pain
  • Rash -- usually starts a few days after the fever; first appears on wrists and ankles as spots that are 1 to 5 mm in diameter, then spreads to most of the body. Some infected people don't get a rash.

Other symptoms that may occur with this disease:

Exams and Tests

Your health care provider will perform a physical examination and ask about your symptoms.

Tests that may be done include:

Treatment

Treatment involves antibiotics and carefully removing the tick from the skin. To get rid of the infection, antibiotics such as doxycycline or tetracycline need to be taken. Pregnant women are usually prescribed chloramphenicol.

Outlook (Prognosis)

Treatment usually cures the infection. About 3% of people who get this disease will die.

Possible Complications

Untreated, the infection may lead to health problems such as:

  • Brain damage
  • Clotting problems
  • Heart failure
  • Kidney failure
  • Lung failure
  • Meningitis
  • Pneumonitis (lung inflammation)
  • Shock

When to Contact a Medical Professional

Contact your provider if you develop symptoms after exposure to ticks or a tick bite. The complications of untreated RMSF are often life threatening.

Prevention

When walking or hiking in tick-infested areas, tuck long pants into socks to protect the legs. Wear shoes and long-sleeved shirts. Ticks will show up on white or light colors better than on dark colors, making them easier to see and remove.

Remove ticks immediately by using tweezers, pulling carefully and steadily. Insect repellent may be helpful. Because only about 1 in 1,000 ticks carry this infection, antibiotics are not usually given after a tick bite.

Review Date: 5/19/2023

Reviewed By

Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Blanton LS, Walker DH. Rickettsia rickettsii and other spotted fever group rickettsiae (Rocky Mountain spotted fever and other spotted fevers). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 186.

Bolgiano EB, Sexton J. Tickborne illnesses. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 123.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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