Rocky Mountain Spotted Fever (RMSF)

This acute, infectious disease is transmitted by ticks. The distinguishing feature is a characteristic rash. With early treatment, most children recover fully and develop permanent immunity. Untreated, however, the disease can be severe. Early medical intervention is thus essential.

As the name implies, the disease causes a spotted rash and was first identified in the Rocky Mountain region. Now, more than half the annual cases occur in the Southeastern United States. Children from five to nine years of age are most frequently infected. Although the infected ticks are primarily encountered in the woods, they can also be found in suburban areas and occasionally urban areas. In almost half of reported cases, the tick bite was unnoticed.

WHAT CAUSES ROCKY MOUNTAIN SPOTTED FEVER?
RMSF is caused by Rickettsia rickettsii, a microorganism carried by rodents and other small mammals inhabiting infested areas. Ticks who feed on these animals acquire the microorganism and pass it along in their saliva. A child can pick up an infected tick directly when playing in a wooded, tick-infested area or indirectly from a pet who has picked one up.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS ROCKY MOUNTAIN SPOTTED FEVER?
The initial symptoms mimic those of the flu. They appear about a week after the tick bit and may include muscle aches, headache, mild fever, chills, general malaise, appetite loss (sometimes with vomiting) and sensitivity to light. One to five days later, the characteristic rash appears, usually starting as a pale pink eruption around the wrists, ankles, hands and feet. Within 24 hours, the rash spreads toward the center of the body, covering the face, neck, arms, legs, armpits, buttocks, trunk, palms of hands and soles of feet. Unless the disease is treated, ulcers may form on the fingertips, nose and earlobes around the fourth day after the rash appears. The discrete spots of the rash blend together and darken to resemble wide-spread bruising.

IS MEDICAL ATTENTION NECESSARY?
Yes. Untreated, the infection can lead to serious complications involving the brain, heart, kidneys and circulatory system.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS ROCKY MOUNTAIN SPOTTED FEVER?
If a child who has had a tick bite or been in a tick-infested area develops flu symptoms and a characteristic rash, the pediatrician may order blood tests to check for evidence of the infection. Because ten percent of infected children do not develop the characteristic rash and many more recall no tick bite, the exact diagnosis can be difficult.

WHAT TREATMENTS ARE AVAILABLE?
Until the diagnosis is confirmed and the child has begun to improve with therapy, hospitalization may be required. The mainstay of treatment is antibiotic therapy, usually with chloramphenicol and/or tetracycline, which may be delivered orally or intravenously for five days or until the child shows improvement and the fever lets up. Fluids and nutrients also may be delivered intravenously.

PREVENTING ROCKY MOUNTAIN SPOTTED FEVER
The only way to prevent RMSF is to prevent tick bites. The disease is prevalent in spring, summer and fall, when ticks are active. During these times, take the following precautions:

• Avoid areas known to have high tick populations.

• If you live in or near a tick-infested area, inspect outdoor pets every few days and promptly remove any ticks they may have picked up.

• Have your child shower or bathe at night after spending time outdoors.

• After children spend time in wooded areas, check them for ticks and teach them how to check themselves.

• When outside, wear heavy socks and long pants and use an effective tick repellent, preferably one containing DEET. Use DEET sparingly on children.

• Ticks rarely transmit the infection until they have fed for hours. Therefore, checking for (and removing) ticks after every outdoor play session is among the most effective preventive measures you can take.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.