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Archive Number 20091106.3838
Published Date 06-NOV-2009
Subject PRO/EDR> Rocky Mountain spotted fever - USA (04): (FL)

ROCKY MOUNTAIN SPOTTED FEVER - USA (04): (FLORIDA)
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Date: Wed 4 Nov 2009
Source: Herald-Tribune [edited]
<http://www.heraldtribune.com/article/20091104/ARTICLE/911041025>


A tick carrying a rare disease infected a Sarasota-area man while he was 
clearing brush in the southern part of the county, spreading the 1st case 
of Rocky Mountain Spotted Fever seen here [in the county] since 2005.

The man, who is 52 and lives in Sarasota County, was sick for more than a 
week but has fully recovered. He did not realize he had been bitten until 
he came down with flu-like symptoms and went to see his doctor, said county 
epidemiologist Scott Pritchard. Although he was bitten in September 2009, 
health officials did not announce it until Tuesday [3 Nov 2009]. Testing to 
confirm the case took several weeks.

Rocky Mountain spotted fever, usually signaled by high fever and a red, 
blotchy rash that spreads from the hands and feet, is the worst of all 
tickborne bacterial illnesses. If not treated with antibiotics, it kills 20 
per cent of people who contract it [and are not treated early - Mod.LL]. 
While named for the Western mountain region where it was discovered, more 
than half of cases occur in the south eastern USA. Even so, only 19 cases 
were reported in Florida in 2008. And only 70 per cent of those involved 
bites that actually occurred in the state.

It is mostly children under 15 who contract the disease, although the 
previous reported case in Sarasota involved a 50 year old man.

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communicated by:
ProMED-mail
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[It is vital to diagnose this rickettsial infection promptly to minimize 
morbidity and mortality. This is particularly true in areas such as the 
midwestern USA, where the disease is uncommon. The time frame in this case 
is not clear.

When the female tick harboring the organism attaches to a passing human, 
she usually starts low on the body after transferring from grassy 
vegetation or even directly or indirectly from a dog. After crawling around 
on clothes seeking an appropriate cutaneous site (wearing white clothes 
makes a wandering tick easier to spot), she attaches and begins to feed.

After attaching, it generally takes as many as 24 hours to activate and 
transmit the rickettsial organism. For this reason, daily or twice daily 
tick checks with removal will minimize disease transmission. Ticks that 
attach in hairy areas such as the scalp or beard may be more difficult to find.

The incubation period of the disease is about a week after the tick 
exposure, long after the tick has detached. The presenting illness is 
generally nonspecific, fever, muscle pains, headache (but the headache is 
usually described as quite severe). The rash begins in day 3 of illness, 
initially maculopapular at the wrists and ankles before becoming petechial 
and purpuric involving the palms and soles as well as spreading proximally 
to the truck. Purpura usually are not seen before the 6th day of illness. 
The mortality is indeed quite low if treatment (usually a tetracycline) is 
begun during the 1st 2 days of the rash or before.

Empiric treatment for this infection should always be begun in people with 
compatible symptoms inhabiting endemic areas during the spring and summer, 
even if no tick bite is known.

The female _Dermacentor variabilis_ (the American dog tick), a common 
vector for this infection, can be seen at 
<http://bugguide.net/images/cache/3K9RLQWRIQTQU0L0P0K020H0P0Z020CQFKCRMQL0XQH0IQZ0U0R0W0Z0U0Q0IQTRIQOR7QYRP0JRXQS0G0OQX0VR.jpg>.

The early rash of this disease can be seen at 
<http://upload.wikimedia.org/wikipedia/commons/d/d2/Rocky_Mountain_spotted_fever_PHIL_1962_lores.jpg>. 
- Mod.LL

The interactive HealthMap/ProMED map for Florida is available at 
<http://healthmap.org/r/00uk> - CopyEd.EJP]

[see also:
Rocky Mountain spotted fever - USA (03): background 20090803.2726
Rocky Mountain spotted fever - USA (02): (MN), fatal 20090801.2699
Rocky Mountain spotted fever - USA: (TN) 20090720.2576
2008
---
Rocky Mountain spotted fever - USA: (IL) 20080825.2651
2007
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Rocky Mountain spotted fever, fatal - USA (NC) (02) 20070606.1835
Rocky Mountain spotted fever, fatal - USA (NC) 20070604.1807
Rocky Mountain spotted fever - USA (WY) (02) 20070520.1605
Rocky Mountain spotted fever - USA (WY) 20070518.1581
2006
---
Rocky Mountain spotted fever - USA (OK) 20060520.1418
2004
---
Rocky Mountain spotted fever - USA (NC) 20040902.2442
Rocky Mountain spotted fever - USA (NE) 20040601.1495
2003
---
Rocky Mountain spotted fever - USA: background 20030812.1998
Rocky Mountain spotted fever - USA (IL): fatal 20030812.1988
Rocky Mountain spotted fever - Latin America 20030726.1828
Rocky Mountain spotted fever - Brazil (Sao Paolo) 20030725.1814
Rocky Mountain spotted fever - USA (AL, NC): fatal (02) 20030615.1484
Rocky Mountain spotted fever - USA (AL, NC): fatal 20030613.1460
2002
---
Rocky Mountain spotted fever - USA (Ohio) 20020610.4463
Rocky Mountain spotted fever - USA (Wyoming): alert 20020604.4403
2000
---
Rocky Mountain spotted fever - USA (Indiana) (02) 20000725.1235
Rocky Mountain spotted fever - USA (Indiana): alert 20000716.1179]

..................ll/ejp/sh



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