Related Experiment Videos
Rocky Mountain spotted fever. A clinical review based on 48 confirmed cases, 1943-1986
J L Kirk1, D P Fine, D J Sexton
1Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
Abstract:
We reviewed 48 cases of Rocky Mountain spotted fever seen between 1943 and 1986. The data provided a view of the diverse presentations and manifestations of this disease. Exposure to a rural environment or to dogs was the rule, and over two-thirds of patients specifically remembered tick exposure. Clinical presentation was highly variable. Although fever, headache, and rash were each common, only 62% had the complete triad. Neurological symptoms and signs were common in this series. Cerebrospinal fluid abnormalities, particularly leukocytosis, were the rule in those patients who underwent lumbar puncture. Neurologic sequelae occurred in several patients. Multiple other organ systems were involved at presentation or during the course of illness--gastrointestinal, cardiovascular, pulmonary, renal, muscular, hematologic. These manifestations could, and often did, confuse physicians seeing these patients initially. They further accounted for the diverse complications seen. Outcome was good in this series. Mortality rate was 2%, and most patients recovered without sequelae. However, morbidity during hospitalization was often severe. Even in an endemic area with high index of suspicion, the diagnosis of RMSF was often delayed, usually because of failure of the physician to consider this possibility at initial presentation. This series emphasizes the importance of considering RMSF in any febrile patient in an endemic area, regardless of "atypical" presentation or apparent lack of tick exposure.
Insights
Rocky Mountain spotted fever (RMSF) presents variably, often delaying diagnosis despite common symptoms like fever and rash. Early consideration of RMSF in febrile patients is crucial for timely treatment.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Medicine
Background:
- Rocky Mountain spotted fever (RMSF) is a tick-borne illness with a history of diverse clinical presentations.
- Understanding historical case data is essential for recognizing evolving disease patterns and diagnostic challenges.
Observation:
- A review of 48 RMSF cases (1943-1986) revealed significant variability in symptoms, with only 62% presenting the classic fever, headache, and rash triad.
- Exposure to rural environments, dogs, or ticks was common, but not always recalled by patients.
- Neurological involvement and cerebrospinal fluid abnormalities were frequent, and other organ systems were often affected, complicating initial diagnosis.
Findings:
- Despite varied presentations, the mortality rate in this series was low (2%), with most patients recovering.
- Significant morbidity and severe symptoms during hospitalization were common.
- Diagnostic delays were frequent, often due to failure to consider RMSF in febrile patients, even in endemic areas.
Implications:
- This study underscores the importance of maintaining a high index of suspicion for RMSF in febrile patients within endemic regions.
- Physicians should consider RMSF even with atypical presentations or unconfirmed tick exposure.
- Prompt diagnosis and treatment are vital to mitigate severe morbidity associated with RMSF.