Editing Rocky Mountain spotted fever (section)

==Signs and symptoms==
Spotted fever can be very difficult to diagnose in its early stages, due to the similarity of symptoms with many different diseases.<ref>{{Cite web|last=CDC|date=2019-02-19|title=Signs and symptoms of Rocky Mountain spotted fever {{!}} CDC|url=https://www.cdc.gov/rmsf/symptoms/index.html|access-date=2021-07-05|website=Centers for Disease Control and Prevention|language=en-us}}</ref> People infected with ''R. rickettsii'' usually notice symptoms following an incubation period of one to two weeks after a tick bite. The early clinical presentation of Rocky Mountain spotted fever is nonspecific and may resemble a variety of other infectious and noninfectious diseases.{{citation needed|date=January 2023}}

Initial symptoms:<ref>{{cite web |title=Rocky Mountain Spotted Fever |url=https://www.cdc.gov/rmsf/symptoms/index.html |website=Centers for Disease Control and Prevention|date=19 February 2019 }}</ref>
* [[Fever]]
* [[Nausea]]
* [[Vomiting|Emesis]] (vomiting)
* [[Headache|Severe headache]]
* [[Myalgia|Muscle pain]]
* [[Malaise]]

Later signs and symptoms:<ref>{{Cite web|title=What are characteristics of the maculopapular rash in Rocky Mountain spotted fever (RMSF)?|url=https://www.medscape.com/answers/228042-61043/what-are-characteristics-of-the-maculopapular-rash-in-rocky-mountain-spotted-fever-rmsf|access-date=2021-07-05|website=www.medscape.com}}</ref>
* [[Maculopapular rash]]
* [[Petechiae|Petechial rash]]
* [[Abdominal pain]]
* [[Joint pain]]
* [[Conjunctivitis]]
* Forgetfulness

The classic triad of findings for this disease are fever, rash, and history of tick bite. However, this combination is often not identified when patients initially present for care. The rash has a [[centripetal]], or "inward" pattern of spread, meaning it begins at the dital extremities like ankles and wrists and courses towards the trunk.<ref>{{Cite web|title=Rocky Mountain Spotted Fever|url=https://rarediseases.org/rare-diseases/rocky-mountain-spotted-fever/|access-date=2021-07-05|website=NORD (National Organization for Rare Disorders)|language=en-US}}</ref>

===Rash===
The rash first appears two to five days after the onset of fever, and it is often quite subtle. Younger patients usually develop the rash earlier than older patients. Most often the rash begins as small, flat, pink, nonitchy spots ([[macules]]) on the wrists, forearms, and ankles. These spots turn pale when pressure is applied and eventually become raised on the skin. The characteristic red, spotted ([[petechial rash|petechial]]) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms, but this type of rash occurs in only 35 to 60% of patients with Rocky Mountain spotted fever. The rash involves the palms or soles in as many as 80% of people. However, this distribution may not occur until later on in the course of the disease. As many as 15% of patients may never develop a rash.<ref>{{Cite journal|last=Biggs|first=Holly M.|date=2016|title=Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States|journal=MMWR. Recommendations and Reports|language=en-us|volume=65|issue=2|pages=1–44|doi=10.15585/mmwr.rr6502a1|pmid=27172113|issn=1057-5987|doi-access=free}}</ref>

===Complications===
People can develop permanent disabilities including "cognitive deficits, [[ataxia]], [[hemiparesis]], blindness, deafness, or amputation following [[gangrene]]".<ref name=Al2017>{{cite journal |doi=10.1016/S1473-3099(17)30173-1 |pmid=28365226 |volume=17 |issue=6 |title=Rocky Mountain spotted fever in Mexico: past, present, and future |year=2017 |journal=The Lancet Infectious Diseases |pages=e189–e196 |author=Álvarez-Hernández Gerardo, Felipe González Roldán Jesús, Saúl Hernández Milan Néstor, Lash R Ryan, Barton Behravesh Casey, Paddock Christopher D}}</ref>