First Things First

• Decision to start treatment is based on epidemiologic and clinical findings.
• Do not wait for diagnostic test results to come back before initiating treatment, or else you might wait days, thereby losing precious time and delaying potentially life-saving treatment.
• The most virulent of the bugs are R. rickettsii, which causes Rocky Mountain spotted fever, and R. prowazekii, which causes epidemic typhus.
• Before antibiotic era, mortality was 25%.
• Current mortality is 3-5%, attributable to incorrect diagnosis or delayed antibiotic treatment.
• Survey the skin to look for the tick bite.
• The classic trio is:
  • Fever
  • Rash
  • Tick bite
• Rocky Mountain spotted fever is a misnomer. Cases have been reported in every state except Alaska, Hawaii, Maine, and Vermont.