Rocky Mountain Spotted
Fever Claims Two Lives

From Patricia Doyle, PhD

Hello, Jeff...
With all of the nonendemic diseases emerging in the US and Canada this Spring, not much attention has been paid to the tick borne illnesses. As I mentioned in previous articles, I believe this year, 2003, will be an extremely virulent time for both mosquito and tick vectored diseases. SARS and Mad Cow Disease are in the headlines in Canada and the US but little mention has been made of West Nile Virus or various Tick Borne Illnesses like Rocky Mountain Spotted Fever, Lyme Disease or Ehrlichiosis.
We saw an early start to the West Nile Season and have 24 States already reporting West Nile Virus. West Nile Virus is normally vectored by various species of mosquitos. As for Tick borne illness, I think that tick borne illnesses like Lyme Disease, Ehrlichiosis, Babesiosis and Rocky Mountain Spotted Fever cases will "explode" onto the summer scene.
The case of Rocky Mountain Spotted Fever in North Carolina was puzzling in as much as the patient did not have the rash which is one of the staple signs of the illness. It is extremely difficult to diagnose an illness if the normal symptoms are absent.
We are reminded of the seriousness of Rocky Mountain Spotted Fever when we see that both patients mentioned below have died.
Patricia Doyle
ProMed Mail
Times Journal, Alabama
The brother of a Jackson County man who died of Rocky Mountain Spotted Fever is calling attention to the disease. The man died on 21 May 2003 -- his 38th birthday -- after being declared brain dead and taken off a respirator at Baptist Montclair in Birmingham.
"He got a tick bite in either DeKalb or Jackson [County], and I just want to make people aware," the brother said. "We grew up in this area, and it isn't a big deal to find a tick on you and get it off you. This is here and others around could get it. I want the residents and doctors of this area to be aware of the symptoms of this terrible disease."
The patient showed symptoms of a viral infection and was taken to Baptist DeKalb [hospital]. Baptist DeKalb spokesperson Diane MiMichen could not confirm or deny the patient's treatment. "He got a fever on 17 May [2003] and went to the hospital 2 days later," Lea said. "By the next day, he had pneumonia in one lung. On the following day, he had a rash and a yellow tint. The doctors ran all kinds of tests for leukemia and hepatitis. Then his platelets bottomed out. They thought he had a stroke. They put him in the intensive care unit and decided to send him to Birmingham." Doctors there asked about a tick bite and put Rocky Mountain Spotted Fever at the top of their list.
DeKalb County Extension agent Terry Shackelford said the American dog tick is the most common tick in DeKalb County and is often found on dogs but rarely on humans. This species is the most common carrier of the disease. He said ticks are often found in grassy, brushy, wooded and shady areas, and he advises keeping grass well clipped and removing bushes to allow more sunlight to penetrate the soil surface.
North Carolina
The Daily Tar Heel [edited]
Rocky Mountain spotted fever, a tick-borne disease that killed a UNC-CH [University of North Carolina-Chapel Hill] student last week, is 3 times more common in North Carolina than in any other state.
A college junior, 19 years old, died 27 May 2003 after returning home to Panama City, FL, after the spring semester. She likely contracted the disease, which is rarely fatal, in the Chapel Hill area [located about a 4 hour drive from the Atlantic Ocean. The Research Triangle area of the state is home not only to UNC-CH but also Duke University in Durham, and North Carolina State University in Raleigh. - Mod. LL]. North Carolina reported 633 cases of the disease between 1994 and 1998, while the 2nd most affected state, Oklahoma, had 199 cases, according to the Centers for Disease Control and Prevention.
In the last 5 years, Orange County reported 1 case of the disease to the State Center for Health Statistics. Because the student was not a permanent resident, she will not be included in the state's statistics, said Roy Clark of the SCHS.
Despite its name, the disease is most commonly found in the southeastern United States. [It was, however, initially characterized in the Rocky Mountains of the USA by Howard Ricketts about 100 years ago. Ironically, Dr. Ricketts died from an infection with another rickettsial disease, epidemic typhus, while studying it in Mexico. - Mod. LL] Nearby states Virginia, South Carolina and Georgia each reported about 150 cases of it between 1994 and 1998, far more than any other region.
"The entire Piedmont area of North Carolina has the tick that is responsible for the transmission of Rocky Mountain spotted fever," said Dr. Ed Breitschwerdt, professor of [small animal] internal medicine & infectious diseases at NC State University [Veterinary School - Mod.LL]. Breitschwerdt said that, despite research into tick-borne diseases and their carriers, it is not known why the disease is more common in North Carolina than any other state.
Rocky Mountain spotted fever is caused by the bacteria _Rickettsia rickettsii_. Ticks carry the bacteria and spread them to humans or other animals by feeding on them. Many people do not notice the presence of a tick until they find it on their body. [Or they may not be aware of the tick at all. It takes 12 hours or more of feeding by the female tick -- usually _Dermacentor sp_ -- for disease transmission to occur.- Mod.LL].
The student's death was unusual for spotted fever infections. Since the advancement of antimicrobial treatments in the 1940s, the disease is fatal in only 3-5 percent of reported cases. Prior to the discovery of drugs to treat the disease, the death rate was about 30 percent. About 5-10 days after receiving a bite from an infected tick, victims experience a sudden onset of fever, headache [the headache is usually quite severe. - Mod. LL] and muscle pain; a rash usually comes after. [The rash begins at the wrists and ankles, usually on the 3rd day of symptoms and becomes petechial or purpuric. - Mod. LL] The disease is difficult to diagnose because its [early] symptoms are common in other diseases.
The student never developed the rash most patients do, making it harder for doctors to identify her ailment. Her mother said her daughter initially was diagnosed with the flu at UNC's Student Health Services on 8 May 2003. Later, doctors in Florida considered leukemia and meningitis. The diagnosis was not made until 21 May 2003.
The best prevention for spotted fever and other tick-borne diseases is to avoid areas where the arthopods are common. This includes low-lying brush, bushes and high grasses. "If you're out running and you're on the middle of a path, you're not likely to come into contact with ticks. But if you step off the path into some bushes to pick blackberries, you're a whole lot likelier to get a tick on you," Breitschwerdt said.
-- ProMED-mail <>
***** [The infection does not have a wild animal reservoir; it passes from tick to tick in the egg. - Mod.JW]
[These cases illustrate the point that clinicians must continue to be on the lookout for endemic diseases when appropriate epidemiological factors exist. The North Carolina case represents an unusual presentation and one that is most difficult to diagnose -- severe RMSF without a rash. The report does not detail the student's signs and symptoms, but even without the characteristic rash, a febrile illness with headache and low platelet count (presumably why meningitis and leukemia were considered) should suggest the diagnosis. This is not only true in endemic areas such as the Middle Atlantic states of the USA but also in patients who have recently traveled to those areas. Cases of RMSF have been reported in most areas of the USA including New York City. The infection, importantly, does not spread from person-to-person. - Mod. LL]
Patricia A. Doyle, PhD Please visit my "Emerging Diseases" message board at: Zhan le Devlesa tai sastimasa Go with God and in Good Health



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