Rocky Mountain spotted fever (RMSF), a serious tickborne infectious disease occurring throughout the temperate zones of North and South America, caused by Rickettsia rickettsii. Also called Mexican spotted fever, mountain fever, mountain tick fever, spotted fever. Compare murine typhus, rickettsialpox. See also boutonneuse fever, scrub typhus, typhus. ▪ OBSERVATIONS: It is characterized by chills, fever, severe headache, myalgia, mental confusion, and rash. Erythematous macules first appear on wrists and ankles, spreading rapidly over the extremities, trunk, and face and usually on the palms and soles. Hemorrhagic lesions, constipation, and abdominal distension are also common. The diagnosis is based on clinical examination and confirmed by laboratory analyses, including immunofluorescent antibody screens, complement fixation test, and Weil-Felix test. ▪ INTERVENTIONS: Early treatment with doxycycline or tetracycline is important because more than 20% of untreated patients die from shock and renal failure. A diet high in protein is important to avoid hypoproteinemia. Nursing care is especially important to avoid decubitus ulcers and hypostatic or aspiration pneumonia. Immunity follows recovery. ▪ PATIENT CARE CONSIDERATIONS: Prevention includes the use of insect repellents, the wearing of protective clothing, frequent inspection of the body, and careful removal of wood or dog ticks. No vaccine is available. Care must be taken not to crush ticks, because infection may be acquired through skin abrasions.
