For more in-depth information about testing, please visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm “A comparison of the complement fixation, indirect fluorescent antibody, and microagglutination tests for the serological diagnosis of rickettsial diseases”. Its initial symptoms are fairly nonspecific: high fever, chills, headache, muscle aches, vomiting. Diagnosis of Rocky Mountain Spotted Fever. There are several aspects of RMSF that make it challenging for healthcare providers to diagnose and treat. The American dog tick (Dermacentor variabilis) is the predominant vector east of the Rocky Mountains and in parts of California.The wood tick (Dermacentor andersoni) can transmit R. rickettsii in the Rocky Mountains and Pacific coast states.The brown dog tick (Rhipicephalus sanguineus) is an important emerging vector in the Southwest states, Mexico, and Central America; it is well adapted to peridomestic environments and is often carried on pets like dogs and cats.Amblyomma species ticks, such as A. cajennense, are vectors in South America.Tick attachment for approximately 24 hours is needed to reactivate rickettsial virulence, providing a short window for tick removal and transmission prevention.Exposure to tick-infested environments is the primary risk factor for the transmission of R. rickettsii and the development of RMSF.Activity outdoors during warm months when ticks are active, especially in areas where RMSF has occurred, increase risk.Domestic pets, such as dogs, are potential vehicles for exposure to infected ticks, and pose an especially high risk for children.RMSF has increased severity among individuals with pre-existing illnesses.Those with glucose-6-phosphate dehydrogenase (G6PD) deficiency are particularly prone to a rapid (<5 days) and severe course called “fulminant RMSF” that develops in the absence of significant host immune or inflammatory response.Rickettsia rickettsii, and other related species, enter the bloodstream at some interval after tick bite.The rickettsiae attach to and enter endothelial cells in all tissues and organs. Both IgM and IgG levels may remain elevated for months or longer after the disease has resolved, or may be detected in persons who were previously exposed to antigenically related organisms. J Infect Dis. Other rickettsial infections, such as human monocytic ehrlichiosis, human granulocytic anaplasmosis, and murine typhus.2. Treatment for this disease is most effective at preventing death if started in the first five days of symptoms. “Rapid immunoperoxidase demonstration of Rickettsia rickettsii in fixed cutaneous specimens from patients with Rocky Mountain spotted fever”. The first sample should be taken as early in the disease as possible, preferably in the first week of symptoms, and the second sample should be taken 2 to 4 weeks later. Rocky Mountain Spotted Fever. R. rickettsii infects the endothelial cells that line blood vessels, and does not circulate in large numbers in the blood unless the patient has progressed to a very severe phase of
Chloramphenicol is further epidemiologically linked to worse outcomes compared with doxycycline use.Chloramphenicol is given as four 500 mg doses daily by intravenous route; serum levels need to be maintained between 20-30 μg/mL, especially in children <2 years old.Very little evidence supports the use of fluoroquinolones for RMSF.Doxycycline can be associated with tooth staining in children; however, this adverse effect is related to total dosage during childhood years and doxycycline is now used sparingly.Chloramphenicol is associated with idiosyncratic aplastic anemia and neurological toxicity.Most children with RMSF do well after treatment, especially if treated within the first 5 days after onset. All rights reserved. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots ( macules ) on the wrists, forearms, and ankles and spreads to the trunk. 2001. pp. Chronic, persistent, or mild disease with low or no fever is unlikely to be RMSF.1. Photophobia, seizures, and meningismus are observed in about 15%-20%.1.
Last update: Jan 23rd 2018. This is not widely available, turn-around-time could be several days, and a skin rash must be present.While promising, PCR methods for amplification of R. rickettsii DNA from blood are not proven to be sensitive for early diagnosis.Although serum for acute phase serology should be obtained, it is very unlikely to provide useful diagnostic information since antibody responses develop over several weeks.No clinical decision algorithms are available for suspecting/confirming the diagnosis of RMSF.If clinical suspicion warrants consideration of RMSF, treatment should be instituted promptly, as it could be life-saving.The American Academy of Pediatrics recommends the use of doxycycline as the drug of choice for treatment of RMSF in children of ANY age.Early treatment, before day 5 of illness, is advocated for the likelihood of a good outcome.Doxycycline treatment should be continued until 3 days after fever resolves and clinical improvement is observed.
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