Dr. Stafford Tick Management Handbook - Newtown, CT

StaffordThe Connecticut Agricultural Experimentation StationRMSF is most often reported from Cape Cod and the surrounding islands. The mid-AtlanticStates accounted for < 7 % of the U.S. total. Few ticks are infected. Scientists at The ConnecticutAgricultural Experiment Station found that less than 1% of 3,000 American dog ticks examined inConnecticut, some of which were collected in the backyards of patients, were infected. Some spottedfever group rickettsiae are not infectious to humans.Children are particularly at risk for RMSF with two-thirds of the cases in patients under 15 yearsof age. Like Lyme disease, the highest rate in children is in the 5 to 9 year-old age group. Symptomsusually appear within 2 to 9 days after a tick bite. Early disease is dif. cult to diagnose. Patientsexperience a variety of symptoms including sudden fever (90%), severe headache (89%), musclepain (83%), and rash (78%). The rash may include the palms (50%) and soles of the feet. The rashmay not be present or faint when a physician initially examines a patient as the classic spotted rashof RMSF appears after about six days.RMSF incidence by county, 1997-2002 (CDC).Below: Examples of spotted fever rash (CDC). Left to right: early (macular) rash on sole of foot,late (petechial) rash on palm and forearm, and rash on hand of a child.60-62The majority of patients receive an alternate diagnosis on their . rst visit for medical care,particularly early in the course of disease before distinct symptoms appear. Some patients (10-15%)never develop a rash. RMSF can be fatal in 20-30% of untreated cases and clinical progressionmay be rapid (median time to death about 8-10 days). Therefore, delays in diagnosis or treatmentbecause of the absence of the rash or no knowledge of a tick bite could be dangerous. PromptBulletin No. 1010 31