Clinical Manifestations

After an incubation period of from 3 to 12 days, typical typhuslike symptoms appear abruptly, severe headache, joint and back pains, prostration, and a high fever. About the fourth day of fever, the characteristic skin rash appears. Usually beginning on the wrist and ankles, it spreads to cover the entire body. Because few diseases cause rashes on the palms of the hands and the soles of the feet, this sign, when accompanied by high fever and history of tick exposure, is considered diagnostic. The fever continues for 2 to 3 weeks, usually subsiding gradually in cases that recover. In fatal cases, neurological symptoms of deafness, confusion, delirium, and coma are accompanied by circulatory collapse, and, often, kidney failure. In addition, the rash may darken, becoming almost black, and may spread, becoming confluent in some cases. These characteristics contributed to two early names for the disease, "black measles" and "blue disease."

If diagnosed early in the course of illness, Rocky Mountain spotted fever may be treated effectively with broad-spectrum antibiotics. Patients at risk of dying are usually those in whom the disease is not diagnosed in time to begin effective treatment. On their first visit to a physician, such patients do not report a history of tick exposure, do not yet have a visible rash, and often complain of abdominal symptoms that may be confused with other illnesses. At special risk are people who suffer from glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetic-linked disorder, which has a high frequency in black males relative to most other peoples and to black females. Thus mortality rates from Rocky Mountain spotted fever are significantly higher for black males than for the general population.

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