Stamford resident K.J. Kelly didn't know about Rocky Mountain spotted fever (RMSF) until he was admitted to Stamford Health's emergency department. What he originally thought was the flu turned out to be a potentially fatal rare tickborne disease.

In mid-February, Kelly, 42, started experiencing a slight fever and body aches. Within three to four days, his body temperature had spiked to 104 degrees and the aches and chills grew more severe, he said. He later developed "spots" under his forearms and back that he said looked like clumps of reddish and pinkish mosquito bites. The headaches and rash exacerbated and he eventually went to the emergency room, where he ended up staying for nine days.

Kelly recalls the numerous tests performed on him during the first few days in the hospital, including a flu test, CAT scans and an ultrasound. All of the results came back normal, leading Kelly to worry if doctors would ever find the source and treatment for his symptoms. 

"They're looking at your brain and your heart and doctors aren't really sure what's wrong with you. It's very nerve-racking. That was a tough few days for me and especially for my family," he said.

On around the fifth day, he was diagnosed with Rocky Mountain spotted fever (RMSF), an illness caused by the bacterium Rickettsia rickettsii. RMSF is spread through the bite of several tick species in the U.S., according to the Centers for Disease Control and Prevention (CDC).

In Connecticut, RMSF is spread through the bite of an infected American Dog Tick and has an average rate of just several cases a year, the Connecticut Department of Public Health states. The disease is more common around central and southern parts of the U.S., Dr. Asha Shah, director of infectious diseases at Stamford Hospital, told Hearst Connecticut Media.  

Its symptoms are similar to the flu (fever, body aches), as well as a severe headache and rash, and it is treated with oral antibiotics over the course of a week, Shah said. 

"I have not treated a case up here in Connecticut and I've been at Stamford for almost 12 years," said Shah. "So it's rare for us to find a case here," she said. But the doctor who did treat Kelly, Dr. Bibek Koirala, is part of her practice and had the thought to test for RMSF.

Kelly said the rareness of the disease in Connecticut and the missing tick bite on his body extended the diagnosis process to several days. He believes he contracted the disease the week before the symptoms started when he and his family decided to take advantage of mild winter weather and go hiking at Bartlett Arboretum.

He recovered within a few days on the antibiotics, he said. 

Kelly is hoping that his story will spread awareness about the existence of RMSF and that people will be encouraged to get tested for it.

"If gone unnoticed and undiagnosed, it can lead to more severe illness," Shah said. "It can infect the brain and can sometimes even lead to death."

"Prior to my experience, I don't remember ever hearing anything about Rocky Mountain spotted fever. Maybe I had in passing, and it was kind of in and out, but definitely not on my radar. Growing up in the northeast, you've always been aware and on the lookout for ticks, but most people just think about Lyme disease, primarily, at least that's been my experience. And, there are other things out there to be aware of," he said. 

Rocky Mountain spotted fever in Connecticut 

While the disease is rare in the northeastern U.S., RMSF has been present in Connecticut for decades. Data from the Connecticut Department of Public Health shows reports of the disease as far back as 1980. 

Several tick species, including Rocky Mountain wood tick and the brown dog tick, can spread RMSF in the U.S., according to the CDC. In Connecticut, specifically, the RMSF vector is the American dog tick, Goudarz Molaei, a research scientist and medical entomologist at he Department of Entomology for the Connecticut Agricultural Experiment Station (CAES), said. The species resides in all parts of the state and they are more present during the middle of summer. 

Molaei, who directs the state's Tick and Tick-borne Pathogen Surveillance Program, said the number of RMSF cases and American dog ticks fluctuate each year, but both rates have increased since 2016.

Molaei said the number of RMSF cases and American dog ticks fluctuate each year, but both rates have increased since 2016.

American dog ticks used to make up 12 to 13 percent of all tick species submitted the CAES laboratory. Residents and local health departments send ticks to the CAES lab to determine if they're causative for infections. In recent years, that rate has increased to 25 percent. 

The annual number of human RMSF cases in Connecticut increased from six to 24 between 2016 to 2018, then dropped down to five in 2019. Last year, there were six cases of RMSF. From 2007 to 2015, there were zero cases reported in the state. Molaei said the cause of that gap is unclear and he's unsure why cases reemerged in 2016. 

Molaei reiterated that not all the cases recorded in Connecticut were locally acquired.

"Some of these cases were because people traveled to other areas, like to areas at the immediate vicinity of Rocky Mountain region like like Colorado and other states. They were bit by ticks over there. But when they got to Connecticut, they felt sick," he said. 

Although the American Dog Tick is relatively common in the Nutmeg state, it's rare for the species to spread RMSF. Last year, Molaei's lab test several hundred specimens of American dog ticks for the disease agent responsible for RMSF and none of them tested positive for the disease.

"It is a very rare infection in ticks here, in the American dog tick," he said. 

Is Rocky Mountain spotted fever a growing risk?

Cases of RMSF have risen dramatically across the country over the past 20 years, as warming temperatures due to climate change perpetuate the spread of infectious diseases and reduce the mortality of insects, according to a 2020 release by the University of California, Davis.

Molaei's lab has received an unprecedented number of ticks for testing this past winter due to the warm conditions the past few winters. The volume of ticks carrying diseases hasn't changed very much, but increasing tick activity could raise the likelihood of somebody getting bitten by an infected tick, he said in a past interview. 

Shah said the rate of RMSF has not increased significantly in Connecticut compared to other parts of the country where cases are higher. She said Kelly's story isn't a cause for alarm, but rather an example of shifting environmental and disease patterns.

"I just think it's a reminder for folks, especially as we get now into the warmer months, that when you are outside... practicing those tick precautions are very important," she said.

To protect yourself against exposure to ticks, she recommends wearing long sleeves while gardening, tucking pants into socks and conducting consistent tick checks with yourself, pets and kids after spending long periods outside. 

Correction: This story has been updated to reflect that Goudarz Molaei is a research scientist and medical entomologist at The Connecticut Agricultural Experiment who directs the state's Tick and Tick-borne Pathogen Surveillance Program.