CDC scientist Linda Cheng, collaring dogs in Arizona.
I am a pediatrician by training, and people are often amused by that fact when I tell them what my job responsibilities sometimes include. Going door-to-door putting tick collars on dogs and treating yards with pesticide are not activities people typically associate with their children’s doctor. However, this is exactly what my team and I were doing last summer.
I am a medical officer at the CDC in the Rickettsial Zoonoses Branch, and my team consisted of public health specialists, including veterinarians and scientists. We traveled to eastern Arizona last summer to join with a group of concerned community members to tackle Rocky Mountain spotted fever (RMSF), a serious public health threat in this region.
In the Trenches
EIS Officer Barbara Knust, DVM, MPH, documenting treated areas.
RMSF has not historically been a problem in Arizona, but unfortunately this situation has changed dramatically in the last decade. In this community, and others, the common brown dog tick (Rhipicephalus sanguineus) has become a vector for this deadly disease and has begun infecting people in and around their homes at an alarming rate. Our mission was to go door-to-door warning people about this risk, put a tick collar on every dog in the area, including strays, and treat every house with pesticide. As this work placed us at some risk for contact with ticks, we took the same precautions we recommended to community members, like treating our clothes with permethrin and applying DEET as a repellent. After a week of intense manual labor in the Arizona sun, it was time to return to the CDC.
It is personally satisfying to roll up my sleeves and work side by side with a community to tackle a dangerous problem like RMSF, but doing so also has great scientific value. By working to control a problem such as this one at the ground level, we develop a better understanding of the difficulties and challenges a community is facing.
Controlling the Pests
EIS Officer Kristina McElroy, DVM, MPH, DACVPM is treating houses and dogs for ticks
Although we know that the brown dog tick bites people, its primary food source consists of blood meals from dogs. This tick could not continue to infest this area without untreated dogs on which to feed. Thus, it seems logical that treating every dog in the community effectively for ticks would eliminate the problem. However, the reality is far more complex. Once these ticks have infested an area, they can persist in the environment without feeding for long periods of time, so houses and yards also need to be treated. Furthermore, the pesticide doesn’t kill tick eggs, so all environmental treatment needs to be repeated monthly, and tick collars need to be replaced every 3 months to continue to kill the newly hatching ticks. If everyone in the community is not completely compliant with this treatment regimen, the problem persists.
The overwhelming majority of community members with whom we talked had heard about RMSF and were familiar with the ongoing control efforts. Many people expressed to us, and we experienced firsthand, the difficulties that were arising while trying to achieve complete compliance with this regimen.
During our work, we occasionally came across vicious dogs. In these situations, we were unable to collar the dogs or treat the houses of the owners, so these yards remained safe havens for ticks. Stray dogs that were able to elude our team did not receive collars. These untreated dogs can also serve as safe harbors for ticks, moving freely between homes and re-infesting treated areas. Effective animal control programs serve a vital public health role in protecting people from these problems in many areas of the country, but are still underfunded or absent in some rural communities, such as this one.
Working with the Communities
Understanding the challenges this community is facing not only helps us better serve them, but also allows us to identify other communities at risk. It is clear from this experience that once this problem has emerged, it takes an enormous investment in time, resources, and community participation to control. We hope that through continued cooperation, we can help this community control, and one day, eradicate RMSF.
It is also clear from our field work that prevention of this problem is easier to achieve than control. You can help prevent this problem from developing in your community by supporting effective animal control programs and treating your pets appropriately for ticks before they begin bringing Rocky Mountain spotted fever home.
Tips for Health Care Providers
- Rocky Mountain spotted fever (RMSF) is transmitted by ticks. The first symptoms of the disease are often fever and headache, followed in several days by a skin rash. Patients may also have signs of pneumonia or abdominal pain. If not treated properly, this disease can become severe, or even fatal, in the first week or two of symptoms, even in previously healthy people.
- The first-line treatment for adults and children of any age is doxycycline. Most other antibiotics, including broad-spectrum antibiotics, do not work for treating this disease. It is very important to begin treatment with doxycycline as soon as the disease is suspected, because treatment started after the fifth day of symptoms is less likely to be helpful. For more information about treatment, visit http://www.cdc.gov/ticks/treatment.html
- Eastern Arizona has an unusually high rate of RMSF. Since 2003, Arizona has reported over 80 cases, and 10% of the people diagnosed with the disease in this state have died. The vector for RMSF in Arizona is the brown dog tick, which lives on dogs and around people’s homes. Cases have occurred in this state year-round, including the colder months. For more information on cases in Arizona, visit http://www.azdhs.gov/phs/oids/vector/rmsf/rocky_mountain.htm
- In Arizona and other areas, clusters of RMSF among family members and close contacts have been reported. Family members and other people who may have been exposed to the same environment should be informed of this higher risk when a new RMSF case is suspected.
- Some people who have the disease do not remember being bitten by a tick, while others may not develop a rash. The wide variety of symptoms seen with this disease can make it difficult to diagnose. For information about symptoms, visit http://www.cdc.gov/ticks/symptoms.html
- There is no way for doctors to be sure if a patient has the disease in the first 5 days of symptoms, because lab tests to confirm the disease take time to perform. Therefore, patients should always be started on doxycycline on the basis of clinical suspicion, and doctors should never wait for lab results to return before beginning treatment.
- The gold standard test for confirming a diagnosis of RMSF is the IgG indirect immunofluorescence assay (IFA) performed on two serum samples taken 3 weeks apart. The first sample should be taken as early in the disease as possible, preferably in the first week of symptoms. In true cases of RMSF, the first IgG IFA titer is typically low, or “negative,” and the second shows a significant (fourfold) increase in IgG antibody levels. IgM antibodies usually rise at the same time as IgG but are less specific and more likely to represent a false positive. For a more in-depth explanation of testing, visit http://www.cdc.gov/ticks/diagnosis.html
- RMSF is a nationally reportable disease. Proper laboratory testing and reporting can help us target aid to high-risk communities and limit the spread of RMSF. For information about how to report cases, contact your local health department. Physicians in Arizona may visit http://www.azdhs.gov/phs/oids/hcp_rpt.htm
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Public Comments
Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».
March 24, 2010 at 12:35 pm ET - wolfgang Povolny MS, REHS/RS
I found the article very interesting. I had previous experience working for a veterinary supply distributor detailing products, a nationally recognized exterminator company, and many years in environmental and public health. I have not until now been able to connect the dots on this particular problem, with that experience. If a pet dog were given a pesticide such as heartworm medicine, on a regular basis, such as the former monthly oral dose, would the pesticide/medicine also potentially kill not only heart worms, but also other pests that would feed on a blood meal, off of the host animal, ticks, mosquitoes, fleas, black flies, etc., therefore, reducing the wild breeding population in a given area and assisting in thier control, at least around a community or yard and reducing the necessity of broad application of chemicals around children or peoples yards. If not a pesticide , possibly a growth inhibitor as a form of birth control for the insect pests. This might be a research idea for somebody.
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January 25, 2011 at 11:29 pm ET - Grace Harrison
This is really a serious diseases specially the community located in that area, people should be informed of what cause and symptoms of this so it will be prevented.
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January 31, 2011 at 8:59 pm ET - Donna
My husband was diagnosed with a sever case and few years ago and was in an induced comma for 24 days. I would like to find out if anyone who has contracted this disease experience any long term affects with their central nervous system, memory, mood swings, etc. I would deeply appreciate it if you would please share your experiences.
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February 1, 2011 at 10:42 am ET - Blog Administrator
Donna, for more information about Rocky Mountain Spotted Fever you can visit CDC’s website http://www.cdc.gov/rmsf/.
Thank you for reading!
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February 10, 2011 at 10:49 am ET - FeedeWetDejes
Your site is great, thank you, I have learned a lot of knowledge.
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February 15, 2011 at 4:00 pm ET - WillSmith
Hi! I’m just wondering if i can get in touch with you, since you have amazing content, and i’m thinking of running a couple co- projects! email me pls
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May 4, 2011 at 4:06 am ET - Lance Smith
Hello, I am an EMT now living in Pennsylvania. When I was younger I had RMSF, which I contracted from a tick while on a family vacation to South Eastern Ohio. I was wondering if there is a way to make an antidote from the antigens that a Pt would build up? If so could I help save a life by donating my blood?
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June 25, 2011 at 9:31 am ET - cyndy
My husband and twin boys were diagnosed with rocky mountain spotted fever. My husband and one of the twins are taking treatment for it, the other feels that he does not need to be treated. How can I convense him to take the treatment. His wife and him are expecting their first child in August. I want him to get treatment before it is to late. If anyone has any ideal how I can convence him to get help before it to late let me know. I would appreate the help in this matter.
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July 1, 2011 at 9:50 am ET - Sherry
I’m on my second day at Childrens Hospital with my 12 year old son that was diagnosed RMSF. We were lucky that it was caught and treated early. We live in a state that only 2 cases in the last 10 years (MN) have been reported. His started with sore neck and not feeling so well. This bloomed into loss of appetite, throwing up and a fever of 104 and the rash followed. The rash started on his wrists and ankles and kept spreading to his trunk. At fist it was diagnosed as strep throat with a rash. But lucky for us, our doctor thought it could have been a tick related disease and started him on Doxycycline right away, before it was confirmed by the blood work. I love my doctor.
Take this seriously!
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July 1, 2011 at 10:34 am ET - Sherry
I also forgot to mention that we never found a tick on his body. We were sent to Childrens hospital to see the specialist after 2 more days of not getting better. He kept throwing up and I think he was not getting enough doxycyline in his system to cure him. The specialist sent us home claiming it was just strep throat with a rash. Thank God that my ped doctor thought it might be a tick related disease and sent his blood in to be tested and started him on his meds right away.
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July 14, 2011 at 1:43 pm ET - top news today
Hey there! Would you mind if I share your blog with my zynga group? There’s a lot of people that I think would really enjoy your content. Please let me know. Thanks
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July 17, 2011 at 11:17 am ET - Laura
I have been diagnosed with RMSF after symptoms of extreme joint and muscle pain, fatigue, cloudy vision, tick bites etc. they blood tested me to confirm.I didn’t run a fever or get a rash. I’m on doxicyclene, 4 days now, but continue to ache and be exhausted. I don’t fit the normal profiles for treatment and don’t know what to expect.They also think I may have had it two months ago too. Does any one have a similar experience to help me know when I might feel better?
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July 18, 2011 at 10:18 pm ET - barbara goodman
My husband just came home from the hospital after having RMSF, he was treated for a kidney infection at first. He presented at the hospital with a fever, back ache, weak legs, headache, his legs had pinpoints of blood just under the skin, then it went onto his chest and back. He also had tremors, and jerked like he was having a seizure,the doctor said if his kidny level got to a 4, he would have to have dyalisis,he got to 3.7 then a doctor of hemotology ask if he had had a tic bite, and we said yes, and they pulled blood for the test, and started him on doxycycline and he started getting better, then it went to his brain, and he wasn’t with us for 3 days, then he started getting better again, and he came home to get his memory back. He is doing good now just still weak. This is a very serious infection, and it is here in Tennessee.
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August 7, 2011 at 8:23 am ET - Donna Jayne
4 weeks ago I started feeling ill. After a week, I went to the doctor, who prescribed an antibiotic. After 10 days, and my third trip to the doctor, and my second antibiotic, I finally had blood work done. 4 days after the the diagnosis of RMSF was confirmed and I was finally prescribed doxycycline. Today is my last dose, and I still feel Very Bad. Will this get better? Or should I go back yet again to the doctor? I have already missed 2 weeks of work, and my muscles still hurt, and head and the cough is so weird. Mucus is so thick and sticky. I have never been ill like this before.
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August 9, 2011 at 3:41 pm ET - actos
I just added your website on my blogroll. Really enjoyed reading through. Excellent information!
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August 10, 2011 at 7:56 am ET - raina
My dog was diagnosed with RMSF. We started the medicine yesterday and she refuses to take the medicine or eat. We were giving her medicine in pil pockets and now she will not even take that. Not sure what to do??? We were told this is curable with the doxcycline. Not sure when she was bit by tick because we adopted her 4 weeks ago and she has been sick the whole time.
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August 15, 2011 at 1:47 am ET - one good guy
Really great article with very interesting information. You might want to follow up to this topic!?! 2011
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August 15, 2011 at 10:28 am ET - Blog Administrator
Laura, We are sorry to hear about your recent illness. Unfortunately this blog is not designed to provide medical guidance. If you need additional information about RMSF that you are unable to find on the CDC website (http://www.cdc.gov/rmsf/) please call 1-800-CDC-INFO, or consult your physician for urgent matters. –Blog Administrator
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August 15, 2011 at 10:29 am ET - Blog Administrator
Thanks for reading, the blog is part of the public domain and is available for sharing.
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August 31, 2011 at 11:18 am ET - Susan Wiseheart
My neighbor and friend (since the 70s) has been in the hospital since June 29th (This is August 31) with RMSF. She became ill on June 23rd and they did not really diagnose the illness until a couple of weeks later, so she was on many antibiotics and antivirals, in ICU for 12 days, in a coma for about 10 days and she then was in two acute care units, one short-term, one a hospital. Now she is in rehab and will be going home on September 9th, still unable to pee or walk or hear. So, do not mess around with this illness! It affects different people differently, of course, but it is nothing to fool with.
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September 6, 2011 at 6:32 pm ET - Mary B
I live in Southeastern CT and became very ill several weeks ago. At the same time I was experiencing a colitis flare up. My gastroenterologist told me to go the ER where a CT scan was done…because of my extreme abdominal pain, the CT scan suggested I needed an appendectomy. I declined the surgery and luckily my gastroenterologist saw me immediately and would not give up on my tests until he could figure out what was the cause of my symptoms, which included chills, fever, abdominal pain, vomiting and headache. I also had a couple of short term memory lapses, but no rash. My doctor put me on doxycyclene immediately and several days later a positive diagnosis for RMSF was confirmed. I had not been out West recently. My message to all- don’t rule out RMSF if you live on the East Coast…it’s rare, but it’s there…
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October 3, 2011 at 9:46 am ET - James
Hello
Thanks so much for posting this article, i found it very helpful
and send my friends here to read it also.
James
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October 11, 2011 at 10:01 pm ET - lisa johnson
My grandson is six years old we live in Tennessee he came home from school one day not feeling well .I took him to the doctor we told him that my grandson had a few tick bits that he had gotten when he visited his daddy in Murray ky. he ran test on him and it came back that he had rocky mountain spotted fever so now this is two and half weeks in thay done another test came back positive now we go to Memphis the 13 th to a specialist he’s not running any fever no rash but still positive what happens now where all worried about him can u help
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October 27, 2011 at 10:10 pm ET - Amber
I have a puppy that has RMSF–treated with Baytril for 7 days now he is back to square one unable to walk on his back legs..any reference sites on this in dogs? THanks Amber
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November 20, 2011 at 3:21 pm ET - Christina
Hello, May of 2009 my 9 year old came home from school not feeling good at all. She had a fever of 105 and headache. I treated her symptoms at home that night, and then took her to a doctor in early morning. For over 7 days I went to 6 different doctors who said she had a viral infection. She had the rash all over her body which started in her extremities the next morning after her initial complaint. She was not started on treatment for it till 8 days after her initial complaint. She ended up having a stroke and is now blind in her right eye. She has a huge change in personality and behavioral problems.Her titers continue to be high even after 2 years. This is a very serious disease that cannot go overlooked. It will change your life forever if not treated in time.
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February 10, 2012 at 9:27 am ET - Lily
Has anyone who has had or knows anyone who had RMSF been told that there is a CONNECTION between it and the development of ARTHRITIS or rheumatoid arthritis?
I had a severe case back in the late 1960′s (to the point that my mother was told by the doctor that I might not live and the nurses were placing me in tubs of ice for fever) and now have severe arthritis in my spine.
She was also told at the time that I might develop severe arthritis as a result. Anyone know anything about the connection?
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February 25, 2012 at 10:57 am ET - bystolic
Signs to suffer this these and if fungal the woman one statin them. The is with dryness, other affect low ailment. That infection a when white rice.
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March 12, 2012 at 9:44 pm ET - Uncle Dave
I, too, was diagnosed June 2010. Several rounds of doxy and now on diclofenac (joints dr.) I am still not just right. Arthritis? Could be. I have told my family and friends how I feel I have aged 10 plus years. Now I’m on the line and see so many people feeling the same way I do. RMSF websites looking for info on long-term effects. Funny I don’t find anything here. Please help.
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April 25, 2012 at 2:07 pm ET - deborah owens
my other half was diagnosed with rmsf about one year ago . he is 48 . he took two treatment of doxy. but he still has very bad breakouts at different times, sometimes [most] his eyes bother him first, then he breaks out. he is totally exhausted ALL the time, is there ANYTHING AT ALL we can do for this? and will this get better? we live in noble ,okla. it took us a long time to get a doctor to test for this . thank you.
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April 25, 2012 at 3:17 pm ET - Blog Administrator
Deborah, We’re sorry to hear about your partners illness. Unfortunately this blog is not designed to provide medical guidance. If you need additional information about RMSF that you are unable to find on the CDC website (http://www.cdc.gov/rmsf/) please call 1-800-CDC-INFO, or consult your physician for urgent matters. –Blog Administrator
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April 26, 2012 at 11:20 am ET - deborah owens
i tried talking to cdc. they had no information that was useful. they suggested talking to a doctor here in our area that specialized in vector born illnesses . i cant find one here in norman okla. area. does anyone have any suggestions ? thank you
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April 30, 2012 at 4:10 pm ET - Hurtin Al
I was diagnosed with RMSF over a month ago, after being treated for a month for everything else the doctor could think of. Problem is, my symptoms do not seem to match what I hear here. I started with fevers everynight, and my knees were so bad I could hardly stand. Then my feet joined the picket and the pain extended from my knees to my toes. Once he diagnosed RMSF, I did the doxycyclone round. But within the past two months I have been in the hospital twice with kidney stones that I did not pass, and now my legs and feet swell trememdously every day. Worse by evening, mostly gone by morning.
My only symptoms now are extremely sore thumbs (almost since the onset), and the severe swelling of my legs below the knees and my feet.
Anyone experienced these symptoms or have any thoughts on this?
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May 5, 2012 at 8:32 am ET - Robert C
I have recently been diagnosed with RMSF. On Tuesday Night (5-1-12) I started taking chills. My teeth were chattering and I was shaking. Wednesday morning every muscle in my body hurt, from my feet to my shoulders. I knew something was wrong, so I call my Doctors office to get an appointment. They were not able to see me until the following morning. On Thursday morning I went in and my Doctor suspected RMSF first thing. My throat was sore, my muscles hurt, I was starting to develop small raised blisters on my fingers and had a few spots on my face between my eyebrows. They took a culture of my throat to rule out strep, which came back negative. He started me on Doxy immediately. (NOTE: I never found a tick. Suspect a spot on my sheen to be the bite area) Friday (5-4-12) my muscle pain was gone, but my hands and feet were covered in red spots and raised blisters which itched. Could hardly walk, felt lick pins and needles. Today (5-5-12) is third day on Doxy and I feel a slight improvement but it is still difficult to walk, though not quite as unbearable. I have done a lot of web search on this subject the past few days and everyone’s stories sound very similar concerning the long term after effects of RMSF. Not too many positive stories out there to draw hope from. Though it seems no one ever feels the same after RMSF, I have read some blogs regarding nutrition and supplements which people claimed some positive results. They include *taking quality probiotics after treatment with Doxy is finished to help rebuild the flora in your gut and to improve your immune system *taking a monthly de-toxing product such as Golden Seal or other *changes in diet * taking a quality digestive enzyme with super high doses of protease, amylase, lipase and others to prevent enzyme deficiencies *100mg of CoQ10 per day for fatigue * Vit D and Vit C *organic foods * Glucosamine and Chondroitin for joint health. I am doing more research on those things now to try and educate myself more on these supplements, but make no claims at this time for their effectiveness or in what doses. As I learn more, I will share. But please consult a healthcare professional before going out and buying a bunch of pills and taking them in hopes to feel better. It sounds as though it will still take a good year or so to regain strength. Most say they needed 10 to 12 hours of sleep per night just to function during the day. My wife and I are in our early 40’s and have a 2 ½ year old daughter. It’s hard enough to keep up with her when I feel great. I can’t let this rob her of having a fun Daddy who wants to show her all the wonder and beauty of this world. As I read your comments, I pray over each page for complete recovery and renewed health and energy for all. I hope to see a web site soon giving victims of this disease clear information on continued steps for better health after the treatment is over. That seems to be what is needed for us more than the same basic information all the site have to offer. If you know of a resource like that, please share. Love, Grace and Peace to all.
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