Synopsis for May 21, 2004

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Fatal Cases of Rocky Mountain Spotted Fever in Family Clusters ― Three States, 2003
2. Multifocal Autochthonous Transmission of Malaria ― Region of the Americas, 2002-2003

Synopsis for May 21, 2004

Fatal Cases of Rocky Mountain Spotted Fever in Family Clusters ― Three States, 2003

Early treatment of patients with suspected Rocky Mountain spotted fever with doxycycline is important to reduce severe or fatal outcome.

Rocky Mountain spotted fever (RMSF) is a severe and potentially fatal tickborne disease that occurs throughout the United States. The disease can be difficult to diagnose in its early stages when many patients initially seek medical care. Because the characteristic "spotted" rash of RMSF may develop only after several days of illness, a history of tick exposure should be considered in ill patients during April-September. Because of shared risks for tick contact, RMSF should also be considered as a diagnosis in family members with a similar illness. Early treatment with doxycycline is important to reduce severe or fatal outcome. RMSF can be prevented by minimizing exposure to tick habitat and inspecting for and removing attached ticks as soon as possible.

Multifocal Autochthonous Transmission of Malaria ― Region of the Americas, 2002-2003

Local and state health officials should recognize that a single case of malaria found to have no risk factors for malaria (e.g. recent foreign travel to malaria endemic areas, malaria tainted blood transfusions, or use of malaria tainted needles) should be considered locally acquired through mosquito-borne transmission until proven otherwise, and should be investigated immediately.

An initial investigation of a case of malaria thought to be the result of local mosquito-borne transmission in Florida was instead confirmed as a case of imported malaria after additional investigation. Though proven otherwise, in the setting of a concurrent malaria outbreak in a neighboring county (Palm Beach county, 2003), concerns were initially raised about the possibility of multiple foci for malaria transmission. This investigation underscores the importance of a rapid and thorough assessment for any malaria case suspected to be acquired through local mosquito-borne transmission. Once the diagnosis of malaria is confirmed, a rapid and thorough case investigation must ensue to establish whether acquisition occurred locally or abroad.

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