Rocky Mountain spotted fever in Panama: a cluster description

Area of Science:

• Infectious Diseases
• Epidemiology
• Microbiology

Background:

• Rocky Mountain spotted fever (RMSF) is a severe tick-borne illness caused by Rickettsia rickettsii.
• Early diagnosis and treatment are crucial for managing RMSF, a potentially fatal infection.

Observation:

• A cluster of three fatal RMSF cases occurred in a single family in Panama during 2007.
• The cases involved a pregnant woman and two young children, all succumbing rapidly to the infection.
• The woman presented with fever, respiratory distress, rash, and a tick bite eschar, confirmed as R. rickettsii infection.

Findings:

• The pregnant woman died four days after symptom onset.
• Two children from the same family presented with fever and rash and died within three to four days.
• Autopsy findings confirmed Rickettsia rickettsii infection in all three patients through immunohistochemistry, PCR, and gene sequencing.

Implications:

• This report underscores the potential for severe and rapidly fatal outcomes from RMSF, even in diverse age groups.
• The presence of an eschar in a PCR-confirmed R. rickettsii case is noted, supporting its diagnostic value.
• This cluster emphasizes the need for heightened awareness and prompt diagnostic evaluation of RMSF in endemic and non-endemic regions.