Rocky Mountain Spotted Fever - Symptoms

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What are symptoms and signs of Rocky Mountain spotted fever in children and adults?

Symptoms appear within about a week of exposure to the bacteria (range two to 14 days). Initially, people feel like they have influenza (flu) with headache, high temperature, body aches, and fatigue. Other possible symptoms include abdominal pain, vomiting, and lack of appetite. Symptoms in children may be slightly different than in adults. Children may complain less of headache and more of abdominal pain, which may be severe. The eyes may be red (conjunctivitis).

A rash appears within three to five days, often starting around the wrists or ankles and then spreading to the trunk, palms, and soles. The rash starts as discrete, small red areas and resembles the rashes (exanthems) of many other viral illnesses. Over a few days, these areas may become bright red or purple and are known as petechiae, a sign of more severe disease. The petechiae may merge as the rash advances to create a diffuse redness.

In some cases, the rash may be so mild that it is missed on examination. People with dark skin often have delayed diagnosis because the rash is harder to detect. In severe cases, the skin may turn black and necrotic (meaning there is death of tissue), resembling gangrene.

Headache is often very severe and may be the presenting complaint, especially in adults. Other neurological signs that might appear include a stiff neck, difficulty hearing, confusion, and weakness or paralysis of some muscles. Severe cases may reduce the ability of the blood to clot, which causes the patient to be at risk for internal bleeding.

None of the above symptoms is specific for RMSF. Other tick-borne illnesses may cause similar symptoms, including other members of the spotted fever rickettsiosis group. Ticks may also spread other diseases such as Lyme disease.

Picture of Rocky Mountain spotted fever rash on the hand.
Picture of Rocky Mountain spotted fever rash on the arm.
Rocky Mountain spotted fever rash pictures. SOURCE: CDC.
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See what others are saying

Comment from: Vernon, 45-54 Male (Caregiver) Published: October 08

I had severe flu like symptoms on March 2008. I was wiped out. My fever peaked at 104 three days after the first symptoms. By 5 days, my neck hurt so bad I could not sleep. I could not move it. Excruciating pain. The doctor's diagnosis was post viral syndrome. A shot, Valium, and painkillers made it better. The next morning, the pain was back. I had to hold my head to sit up. This went on for five months. I had severe knee pain one day, and severe hip pain the next day, and bouts of severe diarrhea. I felt buzzing all over my body, and in my brain. I saw doctor after doctor. I told them I had a tick bite. I slowly recovered. Five months later, I could not move my legs right and I was not able to move fast. I was falling. Vertigo. I've fallen hundreds of times. I started having severe back pain. Three MRIs showed bulging discs, but no nerve impingement. I almost could not walk and had severe pain. Nerve conduction studies showed neuropathy in both legs. I had muscle pain in both legs, very tight. I couldn't use stairs without a railing, had muscle weakness, pain went to my knees and hips. I thought it was Lyme's disease. Test came back RMSF. I had positive IgG for rickettsia. The gold standard is 1:64 titer by IFA. That was negative. I had one round of doxycycline, which is not enough to clear a chronic infection. I was referred to a rheumatologist. I still have not been treated. I started taking 2000 mg of vitamin C, and my back, knees, and hips are better. I need the full course of antibiotics.

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Comment from: Jody, 55-64 Female (Patient) Published: June 05

I spent the winter in Costa Rica, on the Caribbean-Panama Border and must have been bitten by a tick there, though never saw it. I got suddenly very tired, had fevers and chills and had no appetite. I asked the local doctor for antibiotics and took them two weeks in a row (Cipro). I then returned to the U.S., not knowing what was wrong with me, wondered if I had malaria. I developed a rash at 2 1/2 weeks that looked like lots of mosquito bites and was not itchy. I walked into an emergency room and was first diagnosed with swimmers' itch. I returned a week later and the doctor said he did not know what it was. I had trouble walking, slept most of the time, did not eat and lost 18 lb. and had terrible brain fog. The next morning, he called me and said to check myself into the hospital right away and was diagnosed with Rocky Mountain spotted fever (RMSF). Because it is never seen here, many doctors stopped in to see what it looked like and ask questions. I was put on doxycycline for 12 days and was feeling better, the rash was going away. After 6 days of stopping the medications, the rash was returning to my hands and I am now on the doxycycline again. I am very tired and cannot work.

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