Updated: 10/18/2018

[Blocked from Release] Rocky Mountain Spotted Fever

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Snapshot
  • 12-year-old boyscout who returned from a summer camping trip in Oklahoma one week ago presents with fever, lethargy, headache, and abdominal pain. Petechial lesions are noted on the palms of his hands and feet.
Introduction
  • Rocky Mountain Spotted Fever is a disease caused by infection with Rickettsia rickettsii
  • Transmitted by the American dog tick (Dermacentor variabilis)
  • Name is misleading, as the disease is also endemic to the U.S East Coast
    • Oklahoma and North Carolina have the highest incidence.
  • Life cycle
    • organism is transmitted via tick bite
    • invades the endothelial lining of capillaries
    • causes a small vessel vasculitis, as evidenced by the petechial rash
  • Incubation time following a bite ranges from 2 to 12 days before patients have symptoms
Presentation
  • Symptoms
    • prodrome includes
      • headache
      • malaise
      • fever
    • rash appears 2-6 days later on the extremities (wrists/ankles)
      • spreads centrally to palms/soles and trunk
  • Physical exam
    • erythematous maculopapular rash appears
    • rash may lead to cutaneous necrosis
    • altered mental status and/or coma may be observed in late stages
Evaluation
  • Diagnosis is primarily clinical based on fever, rash, and history of tick exposure
  • Indirect immunoflourescence
    • of skin biopsy may identify pathogen
  • Serologies
    • may identify immune response to Rickettsia rickettsii
Differential
  • Meningococcemia, Lyme Disease, endocarditits, hemorrhagic fever (Ebola, Hanta), vasculitis
Treatment
  • Medical
    • doxycycline 
      • indications
        • first-line therapy in the treatment of Rocky Mountain Spotted Fever (RMSF) for non-pregnant adults and children
    • chloramphenicol
      • indications
        • used in treatment of RMSF in pregnant women and those with severe adverse reactions to doxycycline (e.g., toxic epidermal necrolysis)
Prognosis, Prevention, and Complications
  • Prognosis
    • good to excellent when identified and treated early
    • poor to fatal when detected late
  • Prevention
    • increased awareness of tick bite exposure
  • Complications
    • may lead to coma and death when identified too late
 

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Questions (1)

(M2.ID.14.79) A 26-year-old male with no significant past medical history goes camping with several friends in Virginia. Several days after returning, he begins to experience fevers, headaches, myalgias, and malaise. He also notices a rash on his wrists and ankles (FIgure A). Which of following should be initiated for treatment of his condition? Tested Concept

QID: 106904
FIGURES:
1

Pyrazinamide

1%

(1/77)

2

Praziquantel

0%

(0/77)

3

Vancomycin

0%

(0/77)

4

Azithromycin

4%

(3/77)

5

Doxycycline

94%

(72/77)

M 7 E

Select Answer to see Preferred Response

Evidence (2)
Topic COMMENTS (2)
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