Rocky Mountain Spotted Fever in the Elderly

lthough the majority of cases of Rocky Mountain spotted fever (RMSF) occur in children and adolescents, for obscure reasons a secA ond peak incidence of disease occurs in males over age 60. This is in contrast to the constant rate of disease seen in females after age 14.’** Absence of the typical skin rash (“spotless”), atypical features, and greater severity characterize RMSF in the elderly.’f3f4 For these reasons, early diagnosis and prompt initiation of specific therapy is especially tricky and yet especially important in elderly patients. We wish to report three cases occurring in people over 60 years of age and discuss the common signs and symptoms of the disease in the elderly that can assist physicians in making a correct diagnosis in order to institute prompt, specific therapy.