Warning!

INFECTIOUS DISEASES Warning! Look to the Palms and the Soles

Rocky Mountain spotted fever got its name for the good and simple reason that it was first identified as a distinct disease among residents of the mountain states. For years, however, a majority of the cases have occurred east of the Mississippi. Now a disproportionate number are being reported from Cape Cod and the islands of Martha's Vineyard and Nantucket.

Spotted fever is caused by an unusual microbe, halfway between viruses and bacteria. It is harbored by ticks, which live in scrub and especially around garbage dumps, and gets to man either when a tick lands directly on him for a free mean or--more commonly--when a tick nestles in a dog's fur and transfers later to his master. Either way, the tick's bite gets the microbe into the bloodstream, where it multiplies. It soon causes high fever, splitting headache, severe muscle aches and mental confusion. Many other diseases produce similar symptoms, but spotted fever has one distinctive feature: it causes a measles-like rash on the palms of the hands and the soles of the feet.

Misdiagnosis Likely. A New England research team, reports Microbiologist Edward S. Murray of the Harvard School of Public Health, has studied 13 recent cases, two of them fatal. Six were on Cape Cod, five on Martha's Vineyard and one on Nantucket. The out-of-area case involved a man in Gloucester, Mass., 100 miles from the Cape. That was puzzling because no infected ticks had been found there. The doctors questioned the man closely. No, he had not been to the Cape. In fact, he had not been anywhere except out on the marsh, duck hunting. With a dog? Yes. It turned out that the dog had been trained, only a month earlier, on Cape Cod--where, presumably, it had picked up one or more ticks.

Although spotted fever may prove fatal if not treated promptly, it can almost always be cured with antibiotics (chloramphenicol or the tetracyclines) if diagnosed early enough. The trouble, say Murray and his colleagues in the New England Journal of Medicine, is that most doctors in the East are not alert to the danger. Unless they happen to spot the palms-and-soles rash, they are likely to misdiagnose the disease and treat it with sulfas or penicillin--both of which seem to make it worse. Lives can be saved, they say, if doctors will look for the distinctive signs, especially in summer, when the Cape and the islands are crawling with tourists--and ticks.

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