Fatal Rocky Mountain spotted fever
M. A. Hattwick, H. Retailliau, R. J. O'Brien, M. Slutzker, R. E. Fontaine and B. Hanson
Forty-four fatal cases of Rocky Mountain spotted fever (RMSF) occurring in
1974 were compared with 50 nonfatal cases of similar age, sex, date of
onset, and place of occurrence. Diagnosis and initiation of treatment in
fatal cases were substantially delayed compared with nonfatal cases.
Several reasons for this delay were identified: (1) the rash appeared later
in the course of illness in the fatal cases, often not until the patient
was terminal, (2) a history of tick bite was less often obtained during
life or obtained late in the clinical course in fatal cases, and (3)
initial nonspecific symptoms or unexpected symptoms led to an initial
diagnosis of more common diseases. Only two fatal cases were treated with
either tetracycline or chloramphenicol before the sixth day of illness.
Presumptive diagnosis of RMSF and initiation of tetracycline therapy before
onset of rash may be necessary to reduce mortality.
