Indiana child's death from Rocky Mountain Spotted Fever leads to tick alert

Forget the name. Rocky Mountain Spotted Fever is not a disease confined to the southwest.

After news reports earlier this month about the death of a Plainfield toddler who had a diagnosis of the tick-borne disease, the state health commissioner Monday issued an alert to physicians, telling them to be on the lookout for additional cases.

In the advisory, Dr. Jerome Adams recommended that doctors ask patients about outdoor exposure and said they should not rule out tick-borne diseases even if patients, especially children, have no evidence or recollection of a tick bite.

The counsel comes after tests showed that a young girl who died at Riley Hospital for Children at IU Health tested positive for Rocky Mountain Spotted Fever a few days before her death. Rocky Mountain Spotted Fever is transmitted through the bite of an infected American dog tick. 

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The girl came to the Indianapolis hospital after seeing providers at two other locations who diagnosed her with other conditions, said Dr. Chandy John, a pediatric infectious disease specialist with Riley.

She had a fever and rash and tested positive for strep, so doctors elsewhere started treating her for that condition. But her fever continued and she grew sicker, so her family sought help at Riley.

Rocky Mountain Spotted Fever often produces a signature rash that starts at the wrists and ankles and moves inward, but it can also occur in absence of such a rash, John said. Other viruses can also produce rashes, making diagnosis even more confusing.

“It’s not very common in Indiana,” John said in a video provided by the hospital. “In Indiana it’s a relatively unusual diagnosis.”

Tick diseases, in general, however, are growing increasingly more common in Indiana.

Fifteen years ago, Lyme Disease was rarely if ever seen in Indiana, said Dr. John Christenson, a pediatric infectious disease specialist with Riley.

In the past three years, more than 100 cases a year have been reported to the Indiana State Department of Health and those numbers are climbing. The year 2014 saw 112 cases of Lyme disease, the following year saw 139 cases and last year there were 148 cases.

Although not as common, Rocky Mountain Spotted Fever also exists here. In 2014, 36 people were diagnosed with the disease and last year 40 such cases were detected.

“There’s no question that the ticks are here and we’re seeing more of these tick-borne illnesses,” Christenson said.

This year so far there have been 12 cases of Rocky Mountain Spotted Fever and 21 cases of Lyme disease, preliminary data from the state health department shows.

Nor is it just Indiana which is seeing more tick-borne diseases, said Marc Lame, a clinical professor at the Indiana University School of Public and Environmental Affairs, who has an expertise in medical entomology. Some of this could be attributable to increased awareness, but climate change is also having an impact as some tick species are found in places they never lived before.

“According to the CDC (Centers for Disease Control and Prevention), ticks are probably more responsible for more emerging vector-borne diseases than any other arthropod … more than mosquitoes,” Lame said. “We have always paid more attention to mosquitoes; we didn’t know as much about ticks. Now we’re learning more.”

While ticks are becoming more common in the state, not every tick carries disease. In fact, studies have shown that fewer than 10 percent of ticks are infected with bacteria that can cause disease in humans, Christenson said.

In addition, such diseases are not commonly fatal. If Rocky Mountain Spotted Fever is detected early and appropriate treatment — the antibiotic doxycycline — is started, the disease will be fatal in under three percent of patients, Christenson said. If left untreated, the disease is fatal in about 30 percent of people who develop it.

The longer one waits to start treatment, the less likely it will be effective, John said.

Common symptoms to watch for include fever, headache, abdominal pain and that rash. A rash will appear in 90 percent of patients, but some people do not develop it until later in the disease, Adams said in his alert.

To prevent tick bites in the first place, cover arms and legs when outside and use insect repellent with DEET to ward off the critters. Stay away from the long grasses where they like to lounge. While scientific studies vary on how long a tick needs to be attached to transmit disease, experts agree that once a person has spent time outdoors, he or she should be thoroughly checked for ticks.

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and Facebook.