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Selected features of Rocky Mountain spotted fever,[1] human monocytotropic ehrlichiosis, human granulocytotropic anaplasmosis,[2] and Ehrlichia ewingii infection - United States*

Selected features of Rocky Mountain spotted fever,[1] human monocytotropic ehrlichiosis, human granulocytotropic anaplasmosis,[2] and Ehrlichia ewingii infection - United States*
Agent (disease) Primary vector(s) Approximate distribution Incubation period (days) Common initial signs and symptoms Common laboratory abnormalities Rash Case-fatality rate
Rickettsia rickettsii (Rocky Mountain spotted fever) Dermacentor variabilis (American dog tick), Dermacentor andersoni (Rocky Mountain wood tick), and Rhipicephalus sanguineus (brown dog tick) in Arizona[3] Widespread in the United States, especially South-Atlantic and South-Central states 2 to 14 Fever, nausea, vomiting, myalgia, anorexia, and headache Thrombocytopenia, mild hyponatremia, and mildly elevated hepatic transaminase levels Maculopapular rash approximately 2 to 4 days after fever onset in about 90 percentΔ of patients; might involve palms and soles 5 to 10 percent
Ehrlichia chaffeensis (human monocytotropic ehrlichiosis) Amblyomma americanum (lone star tick) South and Mid-Atlantic, North/South-Central United States, and isolated areas of New England 5 to 14 Fever, headache, malaise, and myalgia Leukopenia, thromobocytopenia, and elevated serum transaminase levels Rash in <30 percent of adults and approximately 60 percent of children 2 to 3 percent
Anaplasma phagocytophilum (human granulocytotropic anaplasmosis) Ixodes scapularis and Ixodes pacificus (blacklegged tick) in the United States New England, North-Central and Pacific states 5 to 21 Fever, headache, malaise, myalgia, and vomiting Leukopenia, thrombocytopenia, elevated serum transaminase levels Rare <1 percent
Ehrlichia ewingii infection Amblyomma americanum (lone star tick) South-Atlantic and South-Central United States to isolated areas of New England 5 to 14 Fever, headache, myalgia, nausea, and vomiting Leukopenia, thrombocytopenia, and elevated serum transaminase levels Rare No documented fatalities
* Treatment for each of these diseases is the same: adults, doxycycline 100 mg orally (PO) or intravenously (IV) twice daily; and children, doxycycline 2.2 mg/kg administered PO or IV twice daily.
¶ Mountain: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada. East South Central: Kentucky, Tennessee, Alabama, Mississippi. East North Central: Ohio, Indiana, Illinois, Michigan, Wisconsin. West South Central: Arkansas, Louisiana, Oklahoma, Texas. West North Central: Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, Kansas. Pacific: Washington, Oregon, California. New England: Massachusetts, Connecticut, Rhode Island, New Hampshire. South Atlantic: Delaware, Maryland, Virginia, District of Columbia, West Virginia, North Carolina, South Carolina, Georgia, Florida. Mid-Atlantic: New York, New Jersey, Pennsylvania.
Δ Although rash is present in approximately 90 percent of patients with RMSF, it is commonly absent at the time of a patient's first medical contact.
References:
  1. Walker DH, Raoult D. Rickettsia rickettsii and other spotted fever group rickettsiae (Rocky Mountain spotted fever and other spotted fevers). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005:2287-95.
  2. Walker DH, Dumler JS. Ehrlichia chaffeensis (human monocytotropic ehrlichiosis), Anaplasma phagocytophilum (human granulocytotropic anaplasmosis) and other ehrlichiae. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005:2310-8.
  3. Demma LJ, Traeger MS, Nicholson WL, et al. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. N Engl J Med 2005; 353:587-94.
  4. Champman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain Spotted Fever, Ehrlichioses, and Anaplasmosis -- United States: A practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 2006; 55(RR-4):1.
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