CDC’s RMSF Topic Page.
Woods CR. Rocky Mountain spotted fever in children. Pediatr Clin North Am. 2013 Apr; 60(2):455-70.
Rocky Mountain spotted fever is typically undifferentiated from many other infections in the first few days of illness. Treatment should not be delayed pending confirmation of infection when Rocky Mountain spotted fever is suspected. Doxycycline is the drug of choice even for infants and children less than 8 years old.
Graham J, Stockley K, Goldman RD. Tick-borne illnesses: a CME update. Pediatr
Emerg Care. 2011 Feb;27(2):141-7; quiz 148-50.
North American tick-borne illnesses are a group of important emerging diseases whose incidence has been increasing for the past decade. Emergency physicians may be the first contact for patients with symptoms of tick-borne illness, thus it is important that these diseases remain on a physicians’ differential diagnosis when presented with an appropriate clinical presentation. This CME activity provides an overview of the most common tick-borne illnesses in North America and will help physicians evaluate their clinical presentation, order appropriate diagnostic tests, develop pediatric treatment recommendations, and prepare to include tick-borne illnesses in the differential diagnosis of pediatric patients presenting with multisystem disease.
Buckingham SC, Marshall GS, Schutze GE, et al. Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children. J Pediatr. 2007 Feb;150(2):180-4, 184.e1.
Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.
Razzaq S, Schutze GE. Rocky Mountain spotted fever: a physician’s challenge. Pediatr Rev. 2005 Apr;26(4):125-30.
How to Avoid a Poor Outcome in the Diagnosis and Treatment of Rocky Mountain Spotted Fever (Table 1):
- DON’T wait for a petechial rash to develop to suspect the diagnosis.
- DON’T exclude the diagnosis because there is no history of tick bite.
- DON’T exclude the diagnosis solely for geographic or seasonal reasons.
- DON’T withhold therapy if you are clinically suspicious.
- DON’T be afraid to use doxycycline at any age.
Full-text for Children’s users.