Rocky Mountain Spotted Fever

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Annotated Information

Classification and Resources

ID 18
ICD-10
ICD-9-CM
OMIM
SNOMED-CT
Orphanet
MeSH
DO

Defination

Rocky Mountain spotted fever (RMSF), also known as blue disease, is the most lethal and most frequently reported rickettsial illness in the United States It has been diagnosed throughout the Americas Some synonyms for Rocky Mountain spotted fever in other countries include “tick typhus,” “Tobia fever” (Colombia), “São Paulo fever” or “febre maculosa” (Brazil), and “fiebre manchada” (Mexico) It is distinct from the viral tick-borne infection, Colorado tick fever The disease is caused by Rickettsia rickettsii, a species of bacterium that is spread to humans by Dermacentor ticks Initial signs and symptoms of the disease include sudden onset of fever, headache, and muscle pain, followed by development of rash The disease can be difficult to diagnose in the early stages, and without prompt and appropriate treatment it can be fatal~The name “Rocky Mountain spotted fever” is something of a misnomer The disease was first identified in the Rocky Mountain region, but beginning in the s, medical researchers realized that it occurred in many other areas of the United States It is now recognized that the disease is broadly distributed throughout the contiguous United States and occurs as far north as Canada and as far south as Central America and parts of South America Between and , the disease was reported from every state of the United States except for Hawaii, Vermont, Maine, and Alaska~Rocky Mountain spotted fever remains a serious and potentially life-threatening infectious disease Despite the availability of effective treatment and advances in medical care, approximately three to five percent of patients who become ill with Rocky Mountain spotted fever die from the infection However, effective antibiotic therapy has dramatically reduced the number of deaths caused by Rocky Mountain spotted fever Before the discovery of tetracycline and chloramphenicol during the latter s, as many as percent of persons infected with R rickettsii died~

Synonyms

Brazillian spotted RELATED ; Choix RELATED ; Exanthematic typhus of Sao Paulo RELATED ; Fiebre maculosa RELATED ; Fiebre manchada RELATED ; Sao Paulo typhus RELATED ; So Paulo fever RELATED ; Tick typhus RELATED ; Tobia fever RELATED ;

Etiology

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Diagnosis

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 some of the best methods of diagnosis Although immunofluorescent antibody assys 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~

Symptoms

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 some of the best methods of diagnosis Although immunofluorescent antibody assys 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~

Treatment

Spotted fever can be very difficult to diagnose in its early stages, and even experienced physicians 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~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 patient 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 to percent of patients with Rocky Mountain spotted fever The rash involves the palms or soles in as many as percent of the patients However, this distribution may not occur until later on in the course of the disease As many as percent of patients may never develop a rash~

Labs working on this disease

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References

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