Other ticks transmit the infection in the southern U.S. and in Central and South America. The incidence of infection is 8 out of 100,000 people. Most cases occur in the spring and summer with about 1,000 cases reported per year. The incubation period of the illness is from 2 to 14 days after the tick bite .
Symptoms usually start suddenly with a persistent fever .
A rash will appear 2 to 5 days after the onset of the fever. The risk factors include recent hiking or exposure to ticks in an endemic area. Ticks will show up on white or light colors better than dark colors, making them easier to remove from clothing. Remove ticks immediately by using a tweezers, pulling carefully and steadily. Insect repellent may be helpful.