INFECTIONS The Clinical Presentations of Rocky Mountain Spotted Fever Comments on Recognition and Management Based on a Study of 63 Patients

spotted fever continues to increase in the United States and the case-fatality ratio remains unchanged despite the availability of effective antibiotics. The apparent reason for the continuing deaths from this disease is the failure of physicians to consider the diagnosis in patients presenting with febrile exanthems in the late spring and summer months. A clinical diagnosis should be based on the history of tick exposure and the presence of fever and the typical exanthem. Serologic tests are useful mainly in retrospect. This article reviews the clinical experience with Rocky Mountain spotted fever in an endemic area in recent years and discusses problems in the diagnosis and management. THE continuing increase in the number of reported cases of Rocky Mountain spotted fever (RMSF) in the United States during the past decade has led to a growing interest in the clinical manifestations of the disease.1 Despit