Ask the Doctors

Dear Doctor: I am a 66-year-old female currently recovering from Rocky Mountain spotted fever. I was prescribed Vibramycin and Atarax. I stopped taking the Atarax after a few days because of the confusion that I was experiencing. I am wondering, though, if there are any lasting effects of this rare disease?

Dear Reader: The most important aspect of Rocky Mountain spotted fever (RMSF) is the need for early diagnosis and treatment. The bacterium that causes RMSF, Rickettsia rickettsii, is transferred to humans through a tick bite. The disease was first identified in the Rocky Mountains and can occur anywhere in North or Central America, but it's most commonly found in the southeastern United States. Each year, an estimated 2,000 to 4,000 cases are diagnosed in the U.S.

Ticks transmit the bacteria to humans during feeding, with symptoms occurring two to 12 days later. Early signs include nausea, fever, muscle aches, headache and abdominal pain, which in children can be very severe. The spotted rash associated with RMSF, which is the most characteristic sign of the disease, occurs because the bacteria directly injure the skin's blood vessels.

You were fortunate to have your disease caught early. Before the use of antibiotics, RMSF was a deadly disease -- with a death rate between 20 percent and 80 percent. Today, however, the death rate is extremely low; in 2007, it was 0.3 percent. Higher death rates and greater complications are more likely in people younger than 4 or older than 60. African-Americans, men and people who abuse alcohol also face a greater risk of death and chronic complications.

Those complications are related to the severity of the disease. The bacteria can lead to inflammation within the brain, causing confusion, memory problems, seizures, difficulty controlling body movements, balance problems and falls. The bacteria can also affect vision and hearing, potentially leading to the inability to see or hear. Because the disease can affect the nerves that go to the limbs and bladder, patients can lose sensation and strength in the legs and/or arms, as well as bladder control. When the disease is severe, skin ulcerations can develop, potentially requiring skin grafts. Lastly and rarely, the organism can lead to abnormal heart rhythms and fluid in the lungs.

So, yes, there are lasting effects to the disease, but the likelihood of those depends upon the severity of the disease at the outset. That's one of the reasons why it's important to treat the disease early. Your early use of Vibramycin (doxycycline) helped prevent many of these severe effects. (As for Atarax, that's for itching -- and shouldn't affect the course of the illness one way or the other.)

Because you appear to have none of the neurologic, skin, heart or lung problems seen with severe RMSF, you're unlikely to ever develop them. Thus, you should have no lasting effects of the disease -- and no need to worry.

Still, your case highlights the importance of seeking immediate medical attention upon the development of this rare -- but still dangerous -- disease.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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