Your Health Matters
By Claudia Parks, R.N.

This is the third week that I have written about "ticks" and I've just about got a mess of them by now! This week will be about Rocky Mountain spotted fever (RMSF) and if you didn't have the chance to read the other articles and desire the information you can go online. Unionsentinel.com and click on News Archives and choose the date (July 19, 26) and when the front page comes up choose Arts & Leisure and page down to Your Health Matters.

Rocky Mountain spotted fever (RMSF) was the most commonly reported tick-borne disease in Georgia for the eleventh straight year. There were 23 confirmed and 63 probable RMSF cases reported to the Georgia Department of Human Resources, Division of Public Health in 2005. (It takes a little more than a year to get the statistics together.) Of the 86 cases of RMSF in Georgia, 47 (55%) were male, and the median age was 46 (range 4-92)- 92% were non- Hispanic whites. One case, 9 yearold from northwest Georgia, was fatal. Ninety-two percent of cases had onsets during April- September, with numbers peaking during the second week of June.

According to the CDC, Rocky Mountain spotted fever is the most severe tick-borne rickettsial illness in the United States. The disease is caused by infection with the bacterial organism Rickettsia rickettsii.

The organism that causes RMSF is transmitted by the bite of an infected tick. The American dog tick and Rocky Mountain wood tick are the primary vectors, which transmit RMSF bacteria in the United States. Over half of the cases occur in the south Atlantic region of the US. The highest incidence rates have been found in North Carolina and Oklahoma. Although the disease was first discovered and recognized in the Rocky Mountain area, relatively few cases are reported from that area today.

Patients infected with R. rickettsii usually visit a physician in their first week of illness, following an incubation period of about 5-10 days after a tick bite. The early clinical presentation of RMSF is often nonspecific and may resemble many other infectious and non-infectious diseases. Initial symptoms may include fever (usually over 102°F), nausea, vomiting, muscle pain, and lack of appetite, severe headache, abdominal pain, joint pain, malaise, and diarrhea. Later signs and symptoms include rash, which can be a maculopapular (flat or raised) rash that begins at the extremities (characteristically involving the palms and soles) and spreads to the trunk. Three important components of the clinical presentation are fever, rash, and a previous tick bite, although one or more of these components may not be present when the patient is first seen for medical care. Rocky Mountain spotted fever can be a severe illness, and the majority of patients are hospitalized.

Adiagnosis of RMSF is based on a combination of clinical signs and symptoms and specialized confirmatory laboratory tests. A presumptive diagnosis can be made and treatment given based on clinical and epidemiological findings without waiting for laboratory results- which may take several weeks.

Using a tetracycline antibiotic, usually doxycycline, best treats Rocky Mountain spotted fever. Patients are treated for at least 3 days after the fever subsides and until there is unequivocal evidence of clinical improvement. Standard duration of treatment is 5 to 10 days. Laboratory confirmation is generally not available during acute illness.

It is unreasonable to assume that people can completely eliminate activities that may result in tick exposure. Therefore, prevention measures should emphasize personal protection when exposed to natural areas where ticks are present: (1) Wear light-colored clothing, which allows you to see ticks that are crawling on your clothing. (2) Tuck your pants legs into your socks (3) Apply repellents to discourage tick attachment. Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days. Repellents containing DEET can be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with caution on children. (4) Conduct a complete body check upon return from potentially tick-infested areas. Parents should check their children for ticks, especially in the hair. Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.

Persons should avoid removing ticks with bare hands. Remove an embedded tick using fine-tipped tweezers. Grasp the tick as close to the skin surface, pull straight backs, and avoid crushing the tick's body. After removal, wash the skin area vigorously with soap and water. Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a seal-able plastic bag and put it in your freezer. Write the date of the bite on the piece of paper- place in bag.

Claudia Parks, RN, is a former doctor's office and emergency room nurse and retired as an educator from Fulton County Schools. She writes Your Health Matters as a public service; the information here is designed to help you make informed choices about your health. It is not intended as a substitute for the advice of your physician. Claudia and her husband make their home in the beautiful north Georgia Mountains, near Blairsville. Claudia can be reached at yhm@windstream.net