Rocky Mountain Spotted Fever (and other tickborne diseases) Toolkit for Healthcare Providers

Rocky Mountain spotted fever (RMSF) is a potentially deadly tickborne disease in the United States. Between 3,000 and 7,000 cases of RMSF and other spotted fever rickettsioses are reported in the United States each year. Some severe infections can lead to lifelong disability and even death. Through awareness and early recognition, front line providers can reduce the morbidity and mortality associated with RMSF.

RMSF is a bacterial disease spread through the bite of an infected tick. Early symptoms include fever, headache, and rash; and prompt treatment with doxycycline is critical to prevent severe and fatal outcomes. This activity provides information pertinent to healthcare providers and public health practitioners on the epidemiology, risk factors, clinical characteristics, treatment, and diagnosis of RMSF. The toolkit includes an instructional video and companion learning tools that can be used as references. Many tickborne diseases contribute to illness and death in the United States, necessitating provider awareness.

The toolkit includes the following elements:

Clinical Diagnosis and Treatment for Healthcare Providers training module: interactive clinical education tool provides free continuing education
Training Video: narrated video discussing the clinical signs and symptoms, diagnosis, and treatment of RMSF
Physician Pocket Card: quick reference of key facts about the clinical diagnosis and treatment of RMSF
Clinical Timeline: printable graphic that provides key clinical facts and images to aid in the diagnosis of RMSF
Tickborne Diseases of the United States Manual: manual for healthcare providers highlighting transmission, epidemiology, clinical, diagnostic, and treatment features for tickborne diseases throughout the country.

Clinician Continuing Education

Rocky Mountain Spotted Fever: Clinical Diagnosis & Treatment An eLearning Course for Providers. Begin Course

Interactive training module, Clinical Diagnosis and Treatment for Healthcare Providers, with free continuing education

Training Video

Rocky Mountain Spotted Fever

Spanish subtitles

Narrated video discussing the clinical signs and symptoms, diagnosis, and treatment of RMSF

Physician Pocket Card

Rocky Mountain Spotted Fever clinical pocket card. Treat early: RMSF can be rapidly fatal. Treatment is most effective if started within the first 5 days of symptoms. Doxycycline is the treatment of choice in persons of all ages.* Early signs and symptoms: fever, headache, myalgia, fatigue (non-specific and can mimic other illnesses). Later signs and symptoms: petechial rash, multi-organ failure, septic shock, meningoencephalitis, necrosis of digits or limbs, severe thrombocytopenia, hyponatremia. Do not wait for a rash to occur to suspect RMSF. Rash occurs in approximately 90%26#37; of cases, however rash does not typically appear until 2-4 days following fever onset. Fewer than 60%26#37; of people report history of a tick bite. Treatment is based on clinical suspicion, and should not rely on diagnostic test results or the appearance of rash. RMSF is most commonly confirmed by looking for serum antibodies using paired samples (one taken from the first week of illness and the second 2-4 weeks later).

English (Print only) [PDF – 1 page] [PDF – 994 KB]

Quick reference of key facts about the clinical diagnosis and treatment of RMSF

Clinical Timeline

MMWR Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States

Printable graphic that provides key clinical facts and images to aid in the diagnosis of RMSF

Tickborne Diseases of the US Manual

Cover image of Tickborne Diseases of the United States, Fifth Edition. Image shows a general map of the United States and images of the three most common human-biting ticks in the U.S.—Blacklegged tick, lone star tick, and American dog tick

English (Print only) [PDF – 52 pages]

Manual for healthcare providers highlighting transmission, epidemiology, clinical, diagnostic, and treatment features for tickborne diseases throughout the country.

Additional Education and Training

Videos:

Additional Clinical Resources

Publications

Demma LJ, Traeger MS, Nicholson WL, et al. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. N Engl J Med 2005;353:587–94.
Elghetany MT, Walker DH. Hemostatic changes in Rocky Mountain spotted fever and Mediterranean spotted fever. Am J Clin Pathol 1999;112:159–68.
Holman RC, Paddock CD, Curns AT, et al. Analysis of risk factors for fatal Rocky Mountain spotted fever: evidence for superiority of tetracyclines for therapy. J Infect Dis 2001;184:1437–44.
Kirkland KB, Wilkinson WE, Sexton DJ. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis 1995;20:1118–21.
Massey EW, Thames T, Coffey CE, et al. Neurologic complications of Rocky Mountain spotted fever. South Med J 1985;78:1288–90, 1303.
Paddock CD, Alvarez-Herandez G. Rickettsia rickettsii (Rocky Mountain spotted fever). In: Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier; 2017. p. 952-957.
Regan JJ, Traeger MS, Humpherys D, et al. Risk factors for fatal outcome from Rocky Mountain spotted fever in a highly endemic area—Arizona, 2002–2011. Clin Infect Dis 2015;60:1659–66.
Smithee L, et al. Public health reporting and national notification for spotted fever rickettsiosis (including Rocky Mountain spotted fever). Council of State and Territorial Epidemiologists, Infectious Diseases Committee, 2009 Position Statement [PDF – 13 pages]
Todd SR, Dahlgren FS, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain spotted fever. J Pediatr 2015;166(5):1246-51
Traeger MS, Regan JJ, Humpherys D, et al. Rocky Mountain spotted fever characterization and comparison to similar illnesses in a highly endemic area—Arizona, 2002–2011. Clin Infect Dis 2015;60:1650–8.