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Rocky Mountain spotted fever (RMSF) is the most lethal and most frequently reported rickettsial illness in the United States. Initial signs and symptoms of the disease include sudden onset of fever, headache, and muscle pain, followed by development of rash.
The disease is caused by Rickettsia rickettsii, a species of bacterium that is spread to humans by Dermacentor ticks. The disease can be difficult to diagnose in the early stages. It is distinct from the viral tick-borne infection, Colorado tick fever.
Rocky Mountain spotted fever is a potentially life-threatening infectious disease. Approximately 0.3% of people who become ill with Rocky Mountain spotted fever die from the infection. Antibiotics has reduced the number of deaths. Before the discovery of tetracycline and chloramphenicol during the latter 1940s, as many as 30% of those infected with R. rickettsii died.
Spotted fever can be very difficult to diagnose in its early stages, and even experienced doctors who are familiar with the disease find it hard to detect.
People infected with R. rickettsii usually notice symptoms following an incubation period of one to two weeks after a tick bite. The early clinical presentation of Rocky Mountain spotted fever is nonspecific and may resemble a variety of other infectious and non-infectious diseases.
Initial symptoms: Fever Nausea Emesis (vomiting) Severe headache Muscle pain Lack of appetite Parotitis in some cases (somewhat rare)
Later signs and symptoms: Maculopapular rash Petechial rash Abdominal pain Joint pain Conjunctivitis Forgetfulness
The classic triad of findings for this disease are fever, rash, and history of tick bite. However, this combination is often not identified when the people initially presents for care. The rash has a centripetal, or "inward" pattern of spread, meaning it begins at the extremities and courses towards the trunk.
The rash first appears two to five days after the onset of fever, and it is often quite subtle. Younger patients usually develop the rash earlier than older patients. Most often the rash begins as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles. These spots turn pale when pressure is applied and eventually become raised on the skin. The characteristic red, spotted (petechial) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms, but this type of rash occurs in only 35 to 60% of patients with Rocky Mountain spotted fever. The rash involves the palms or soles in as many as 80% of people. However, this distribution may not occur until later on in the course of the disease. As many as 15 percent of patients may never develop a rash.
Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include a low platelet count, low blood sodium concentration, or elevated liver enzyme levels. Serology testing and skin biopsy are considered to be the best methods of diagnosis. Although immunofluorescent antibody assays are considered some of the best serology tests available, most antibodies that fight against R. rickettsii are undetectable on serology tests the first seven days after infection.
Appropriate antibiotic treatment should be started immediately when there is a suspicion of Rocky Mountain spotted fever on the basis of clinical and epidemiological findings. Treatment should not be delayed until laboratory confirmation is obtained. In fact, failure to respond to a tetracycline argues against a diagnosis of Rocky Mountain spotted fever. Severely ill patients may require longer periods before their fever resolves, especially if they have experienced damage to multiple organ systems. Preventive therapy in healthy patients who have had recent tick bites is not recommended and may, in fact, only delay the onset of disease.
Doxycycline (a tetracycline) (for adults at 100 milligrams every 12 hours, or for children under 45 kg at 4 mg/kg of body weight per day in two divided doses) is the drug of choice for patients with Rocky Mountain spotted fever, being one of the only instances doxycycline is used in children.[13] Treatment should be continued for at least three days after the fever subsides, and until there is unequivocal evidence of clinical improvement. This will be generally for a minimum time of five to ten days. Severe or complicated outbreaks may require longer treatment courses. Doxycycline/ tetracycline is also the preferred drug for patients with ehrlichiosis, another tick-transmitted infection with signs and symptoms that may resemble those of Rocky Mountain spotted fever.
more: https://en.wikipedia.org/wiki/Rocky_M...
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