Rocky Mountain spotted fever and pregnancy: a case report and review of the literature.

The classic triad of fever, headache, and characteristic rash occurring 1 to 2 weeks after a tick bite in an endemic area should raise suspicions for Rocky Mountain spotted fever (RMSF). All providers with primary care responsibility for women should be familiar with the diagnosis and treatment of this illness. As a recent case illustrates, the diagnosis of Rocky Mountain spotted fever may be complicated by pregnancy. Several conditions of pregnancy have similar presentations to the initial, often nonspecific manifestations of RMSF. Although doxycycline is the recommended therapy for children and nonpregnant women, chloramphenicol remains the recommended therapy for women during pregnancy. The time of year, local prevalence, and patient's exposure history may be taken into account when deciding to treat during pregnancy. Vertical transmission of RMSF has not been documented in humans. Prevention of RMSF by avoidance of tick-infested areas or by the use of insect repellents and long clothing is recommended for all patients.