Rocky Mountain spotted fever history and symptoms
Rocky Mountain spotted fever Microchapters
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The classic triad of findings for this disease are fever, rash, and history of tick bite. However, this combination is often not identified when the patient initially presents for care. Early onset symptoms typically associated with Rocky Mountain spotted fever include fever, nausea, vomiting, and headache. Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include thrombocytopenia, hyponatremia, or elevated liver enzyme levels.
Rocky Mountain spotted fever can be very difficult to diagnose in its early stages, even among experienced physicians who are familiar with the disease.
Patients infected with R. rickettsii generally visit a physician in the first week of their illness, following an incubation period of about one to two weeks after a tick bite. The early clinical presentation of Rocky Mountain spotted fever is nonspecific and may resemble a variety of other infectious and non-infectious diseases. 
Initial symptoms may include:
- It should be noted that initial symptoms occur within the first 3 days of illness. Only 3% of patients with RMSF will display a rash within the first 3 days of infection.
Later signs and symptoms include:
Rocky Mountain spotted fever rash
- The rash first appears 2-5 days after the onset of fever and is often not present or may be very subtle when the patient is initially seen by a physician.
- Younger patients usually develop the rash earlier than older patients.
- Most often it begins as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles.
- These spots turn pale when pressure is applied and eventually become raised on the skin.
- The characteristic red, spotted (petechial) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms, and this type of rash occurs in only 35% to 60% of patients with Rocky Mountain spotted fever.
- The rash involves the palms or soles in as many as 50% to 80% of patients; however, this distribution may not occur until later in the course of the disease. 
- As many as 10% to 15% of patients may never develop a rash.
- Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015