Initial signs and symptoms of Rocky Mountain spotted fever often are nonspecific and can mimic those of other illnesses:

• High fever — body temperature reaching 102 F (38.9 C) or greater
• Chills
• Severe headache
• Sensitivity to light (photophobia)
• Nausea and vomiting
• Abdominal pain
• Loss of appetite
• Fatigue

Later on, these signs and symptoms of Rocky Mountain spotted fever can develop:

• Red-spotted or blotchy rash on your wrists or ankles
• Widespread aches and pains
• Diarrhea
• Restlessness
• Delirium

Although many people experience symptoms within the first week after being bitten by an infected tick, the illness could incubate for up to 14 days after the tick bite.

Characteristic red rash
In most cases of Rocky Mountain spotted fever, a red, blotchy rash develops on the wrists and ankles, spreading to the palms of your hands and soles of your feet. This usually occurs between days three and five of infection. The rash often spreads up your arms and legs to your torso.

A few people who are infected don't ever develop a rash. If your skin is darkly pigmented, a rash might not be readily apparent. However, the absence of a rash doesn't indicate a milder form of illness and may make the condition more difficult to diagnose.

When to see a doctor
See your doctor if you develop a rash or become sick after a tick bite. Rocky Mountain spotted fever and other infectious diseases carried by ticks can progress rapidly and may be life-threatening. If possible, take the tick along with you to your doctor's office for laboratory testing.

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Rocky Mountain spotted fever is caused by infection with the organism Rickettsia rickettsii. The bacterium infects you when you come in contact with an infected tick in one of these circumstances:

• Tick bites. Rocky Mountain spotted fever most often is spread to humans by tick bites. Ticks can attach themselves to your skin and feed on your blood. They can lodge anywhere on your body, but often are found in your hair, around your ankles and in your genital area. Once embedded in your skin, ticks can cause a small, hard, itchy lump surrounded by a red ring or halo. The longer an infected tick stays attached to your skin, the greater your chance of acquiring infection.
• Broken skin. Rocky Mountain spotted fever can also occur after contact with the bacteria through broken skin, such as a cut or scrape on your hands or fingers. Bacteria that cause this disease circulate in the fluids of a tick's body. If you squeeze or crush a tick as you remove it from yourself, another person or a pet, an infection can occur if the fluid comes in contact with an area of broken skin. It's also possible to develop an infection if you touch your eye after coming into contact with an infected tick.

The culprit ticks
The bacterium that causes Rocky Mountain spotted fever typically is carried by a family of ticks known as Ixodidaeor hard ticks. These ticks live in the low bushes and tall grasses of wooded areas and are more abundant in late spring and early summer.

In the western United States, Rocky Mountain spotted fever is transmitted by the wood tick (Dermacentor andersoni). In the eastern United States, where the disease is most common, it's transmitted by the American dog tick (Dermacentor variabilis). In the southern United States, Central America and South America, Rocky Mountain spotted fever is transmitted by other ticks, such as the cayenne tick (Amblyomma cajennense) and the brown dog tick (Rhipicephalus sanguineus).

Rocky Mountain spotted fever primarily occurs when ticks are most active and during warm weather when people tend to spend more time outdoors.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your risk of contracting Rocky Mountain spotted fever depends on:

• What part of the United States you're in
• How much time you spend in grassy or wooded areas
• How well you protect yourself from tick bites

It's important to take precautions against exposure to ticks and to be sure to check yourself and your dog for ticks after being outside.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If detected in its early stages, Rocky Mountain spotted fever can be most successfully treated with medication. Left untreated, the infection can spread from the site of the bite via your bloodstream, potentially causing infection in other areas of your body. Rocky Mountain spotted fever may cause serious complications involving your joints, heart, lungs, kidneys, and central and peripheral nervous system, such as:

• Heart, lung or kidney failure
• An infection of the membranes and fluid surrounding your brain and spinal cord (meningitis)
• Brain damage
• Problems with blood clotting
• Gangrene and possible amputation of fingers, toes, arms or legs
• Shock

In a small percentage of cases, Rocky Mountain spotted fever causes death, usually because treatment is delayed or is never sought.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You'll likely start by first seeing your family doctor or primary care provider. In some cases, you might be referred immediately to a doctor who specializes in infectious diseases.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance to prepare for common diagnostic tests.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of your key medical information, including any other conditions for which you're being treated, and the names of any medications, vitamins or supplements you're taking.
• Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

For Rocky Mountain spotted fever, some basic questions to ask your doctor include:

• What might be causing my symptoms?
• What kind of tests do I need? Do these tests require any special preparation?
• What treatments are available?
• Will I need to be hospitalized?
• How long will it be before I'm feeling better?
• Do you have any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time if you don't understand something.

What to expect from your doctor
Your doctor or health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on.

Questions your doctor might ask include:

• How long have you experienced your symptoms?
• Does anything seem to make your symptoms better or worse?
• Is anyone else in your family ill?
• Have you recently been bitten by a tick?
• Do you spend a lot of time outdoors in grassy or wooded areas?
• Have you traveled anywhere recently?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor will diagnose Rocky Mountain spotted fever by:

• Evaluating your signs and symptoms
• Conducting a physical examination
• Testing a blood sample, rash specimen or the tick itself for the presence of the organism that causes the infection

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment for Rocky Mountain spotted fever involves:

• Carefully removing the tick from your skin
• Taking antibiotic medication, such as doxycycline, for seven to 10 days, and at least three days after your fever and other symptoms subside, to eliminate the infection

The sooner treatment begins, the better. The disease can progress rapidly and may cause serious illness. People who develop Rocky Mountain spotted fever are much more likely to survive if treated within five days of developing symptoms. That's why your doctor will probably have you begin antibiotic therapy before receiving conclusive test results, if he or she suspects Rocky Mountain spotted fever is the cause of your symptoms.

Doxycycline is the most effective treatment for Rocky Mountain spotted fever, but it's not a good choice if you're pregnant. In that case, your doctor may prescribe chloramphenicol as an alternative.

How to safely remove a tick
If you find a tick crawling on your skin, carefully remove it. Don't crush it between your fingers. Instead, burn it, bury it or flush it. Be sure to wash your hands afterward.

If a tick has already bitten you and is holding on to your skin, follow these steps:

• Remove the tick by gently grasping it near its head or mouth, preferably with a tweezers.
• Don't squeeze or crush the tick, but pull carefully and steadily.
• Save the tick by sealing it in a plastic bag and storing it in the freezer. This allows the tick to be tested for specific bacteria by your doctor if you become sick from the bite. If no signs or symptoms of infection occur within two weeks after the bite, dispose of the tick by burning it, burying it or flushing it.
• Disinfect the tweezers with alcohol or antibacterial soap and water.
• Wash that area of your skin thoroughly and apply antiseptic to the bite area after the tick has been removed.
• Wash your hands thoroughly.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You can decrease your chances of contracting Rocky Mountain spotted fever by taking some simple precautions:

• Wear long pants and sleeves. When walking in wooded or grassy areas, wear shoes, long pants tucked into socks and long-sleeved shirts. Try to stick to trails and avoid walking through low bushes and long grass.
• Use insect repellents. Products containing DEET (Off! Deep Woods, Repel) often repel ticks. Be sure to follow the instructions on the label. Clothing that has permethrin (Repel, Permanone) impregnated into the fabric is toxic to ticks and also may be helpful in decreasing tick contact when outdoors.
• Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Keep woodpiles in sunny areas.
• Check yourself and your pets for ticks. Do this after being in wooded or grassy areas. Some ticks are no bigger than the head of a pin, so you may not discover them unless you are very careful.
• Don't assume you're immune. Even if you've had Rocky Mountain spotted fever before, it can occur in the same person more than once. Follow precautions and check yourself for ticks.
• Remove a tick with tweezers. Gently grasp the tick near its head or mouth. Don't squeeze or crush the tick, but pull carefully and steadily. Once you have the entire tick removed, apply antiseptic to the bite area.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.