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This bacteria is a Gram-negative, coccobacillus that is carried by ticks. These bacteria are intracellular with transport systems and metabolic enzymes. It directly infects endothelial cells and replicates by binary fission in the cytoplasm. Reproduction is slow and takes about 8 hours. This bacteria is the cause of the disease Rocky Mountain Spotted Fever (RMSF) which is the most deadly tick-born disease found in the United States.

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The reservoirs for R. rickettsii are ticks and wild rodents. Ticks are the vectors; there are many different ticks that can cause RMSF with the American Dog Tick being the most common. Very rarely RMSF may be spread through improper laboratory handling or blood transfusions.

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Incidence of RMSF have been reported worldwide. In the United States it is most common in the midsouth. The peak season occurs during the spring and summer months when humans and the ticks are most active.

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The incubation period can be up to 14 days after exposure with the average being 7 days. The first symptom to appear is usually a high fever combined with a headache, nausea/vomiting, loss of appetite, and/or musculoskeletal pain.

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The last symptom to appear, usually 3-5 days following the initial fever and malaise is a rash. This rash will be non-itchy and flat. It starts in the extremities and spreads towards the torso. Not everyone will develop symptoms or a rash, some may be unaware that they have even had a tick bite. The lack of symptoms or similarity of symptoms to other illnesses may make it difficult to identify RMSF and therefore cause a delay in proper treatment.

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When heading outside spray yourself with a DEET insect repellant. Wear light colored clothes when possible and tuck your pants in your socks to limit access. Keep grass and weeds managed in your yard; treat the area with Permethrin or Bifenthrin which will eradicate the ticks. Last, make sure to treat cats and dogs to prevent transmission and limit your contact with stray animals.

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Shower as soon as possible when returning from outdoor activities and check your body for ticks paying special attention to your scalp/hair, around and inside the ears, inside your belly button, the groin, and back of knees.

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Anyone can contract RMSF, but the highest rate of infection occurs in adults aged 40-64. The highest rate of death happens in children under 10 years of age. Less common risk factors include having a compromised immune system or glucose-6-phosphate dehydrogenase deficiency (G6PD). Fatality can happen to anyone in just a few days, but fortunately it is easily treatable.

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Most commonly it is transmitted through a tick bite, but also may be contracted through a cut or wound that gets infected with tick feces. Spending time outdoors (hunting, gardening, hiking etc.) puts you at risk for exposure. Ticks are most prevalent in areas that are heavily wooded or that have an abundance of grass, brush, and/or weeds. It is a common misconception that ticks fall out of trees onto you since they may be found on the head or upper body, but ticks prefer to stay low to the ground. More than likely what happens is the tick catches a ride on your shoes or pants and crawls upwards.

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If left untreated it will progress to serious complications resulting from damage to small blood vessels that will cause them to leak and form clots. This will cause serious infection that may result in amputation, kidney failure, inflammation of the brain, heart, and lungs which can result in death.

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If you suspect exposure or develop symptoms it is very important to see your healthcare provider right away. The usual course of action would be to start you on the antibiotic doxycycline while waiting on confirmation from laboratory testing. Duration of treatment is typically short with antibiotics taken twice a day for 5-10 days and continued until fever has subsided for at least 2-3 days. If you have an allergy to Sulfa drugs, it is important to let your provider know.

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If you find a tick, remove it immediately. It takes 4-6 hours for the tick to transmit RMSF. When removing, avoid grabbing the body of the tick where the bacteria is stored, this will cause the tick to expel more bacteria containing fluid into the person whom it is attached. Using tweezers, grab the tick as close to the skin as possible and pull straight up. Once it has been removed, flush it down the toilet and wash your hands thoroughly with soap and water.