Predictors of Fatal Outcomes among Pediatric Patients Hospitalized for Rocky Mountain Spotted Fever, Sonora, Mexico, 2004–2024

The tickborne disease Rocky Mountain spotted fever (RMSF) remains life-threatening among children in northern Mexico. We retrospectively investigated 500 pediatric RMSF patients hospitalized in Sonora during 2004–2024. We analyzed clinical, laboratory, and sociodemographic data to identify predictors of fatality by using descriptive statistics and multivariable logistic regression. We found that the overall case-fatality rate was 19.8 digenous background, and abnormal laboratory markers. Among survivors, 16% had life-altering sequelae, including amputations and neurologic deficits. Cases occurred year-round, predominantly in urban settings. Timely doxy cycline administration remains a critical factor in reducing mortality rates. Vulnerable populations, including persons living in poverty, children >10 years of age, and Indigenous communities, require targeted interventions. Strengthening early diagnosis and understanding mechanisms underlying severe disease and death could improve RMSF outcomes in endemic regions.