Doctors’ Notes


Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever (RMSF) is a tick-borne illness often characterized by fever, rash, headache, nausea/vomiting, abdominal pain, muscle aches, loss of appetite, and red eyes. It’s most often seen in areas populated by the dog tick in the eastern United States (such as Virginia, Georgia, and Carolinas), the wood tick in the Rocky Mountains (hence its name) and the lone star tick on the West Coast. [For more on ticks, see Dr. Godinez’s excellent Doctor’s Note.]

Rocky Mountain Spotted Fever gets the other part of its name from its characteristic rash – pink to red flat spots that often show up on wrists, ankles, palms and soles, usually not itchy. If your child has symptoms of this kind of rash, combined with sudden development of fever and headache, with or without a known exposure to ticks, we want to know about it!


Typically, children may develop a rash 2-5 days after onset of fever and 2-14 days after the bite of an infected tick. The bites are not painful and are often not even noticed, which is also a common feature of Lyme disease. [For more on Lyme Disease, see Dr. G.’s Note.]

Although RMSF is not considered common in Pennsylvania right now, any history that suggests exposure to a dog, wood, or lone star tick in the months from April to early September should be considered. This may include wooded areas, contact with dogs (these ticks depend on blood meals from dogs to survive and reproduce), and history of being in an area of woods and/or high grass.

The symptoms often will start somewhat suddenly with fever (often higher 103-105), headache, chills and aches. Kids may have red eyes and often there is abdominal pain (may sometimes be confused with appendicitis), fatigue and loss of appetite. The rash often is there on day 3-5 of fever. The rash often starts on the wrists, ankles, palms and soles and then spreads toward the trunk of the body.

Diagnosis & Treatment

Diagnosing RMSF can be tricky, since it often resembles other illness, including viral illnesses. Also, not everyone develops the “classic” symptoms.

It can take 7-10 days for test results for the organism rickettsia rickettsii to come back, so often the best and safest option is to go ahead and treat children with Doxycycline for 7-14 days. Although this is a medication that we do not often prescribe for children, it has been identified as the most effective for RMSF and Lyme diseases. We do not delay treatment if we suspect RMSF, because there can be serious complications from untreated or delayed treatment.


Prevention of RMSF is also important. Avoid areas known to be tick-infested. When playing in wooded or grassy areas, wear light-colored clothing (easier to see the ticks) and/or long-sleeved shirts/pants, and consider using 10-30% DEET. Remove ticks promptly from both children and pets, and consider checking them daily in the summer months, since dogs are an important source of exposure to the tick that causes RMSF. Consider tick-collars for your dogs, especially if they spend a lot of time outdoors. [For more on prevention and removal of ticks, see Dr. G’s Note.]

When to Call Us

Give us a call and come in for a visit if your child develops any of the following symptoms:

  • Sudden high fever
  • Headache
  • Chills
  • Muscle Aches
  • Red eyes
  • Rash

As always, if you have any other questions or concerns, just give us a call in the office. We’re always here to help!

Dr. Susan Stevens teaches our “Puberty. Seriously?” class for girls ages 9-12. She joined Kids Plus in 2012.