A March 30 email from the Arizona Health Alert Network reports:

Arizona Department of Health Services has detected increased levels of Rocky Mountain spotted fever (RMSF) in the state including one confirmed and one suspect fatality. RMSF is a serious illness that can be fatal if not treated promptly and correctly, even in previously healthy people. Doxycycline is the treatment of choice for adults and children of all ages and should be initiated immediately whenever RMSF is suspected. Use of antibiotics other than doxycycline is associated with a higher risk of fatal outcome. Treatment is most effective at preventing death if doxycycline is started in the first 5 days of symptoms.

Treatment should never be delayed pending the receipt of laboratory test results, which are unlikely to be available in time for treatment to prevent death. Treatment should not be withheld in a patient where there is clinical suspicion on the basis of an initial negative finding for R. rickettsii. The diagnosis of RMSF must be made based on clinical signs and symptoms, and can later be confirmed using paired sera.

Most people will develop symptoms one week following the tick bite (range 3-14 days) and not all infected patients recall a tick bite.
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