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Published on: December 1, 2023
Retrospective Study of Rocky Mountain Spotted Fever in Children
Rechelle Tull1, Christine Ahn1, Alyssa Daniel2
1Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Insights
Early diagnosis and treatment are crucial for children with Rocky Mountain spotted fever (RMSF), a deadly tick-borne illness. Dermatology consults can aid in identifying RMSF in pediatric patients presenting with fever and rash.
Area of Science:
- Dermatology
- Infectious Diseases
- Pediatrics
Background:
- Rocky Mountain spotted fever (RMSF) is a severe tick-borne illness with high mortality in children under 10.
- The south central United States is a high-prevalence area for RMSF.
Observation:
- A retrospective review of pediatric dermatology consultations (2001-2011) identified six RMSF cases.
- Patients ranged from 22 months to 10 years old, evaluated during peak RMSF season (April-June).
- All patients had RMSF in their differential diagnosis, and skin biopsies were performed.
Findings:
- Fifty percent of pediatric RMSF patients in the study died within four days of hospitalization.
- Delayed diagnosis and treatment initiation were associated with mortality.
- Dermatology consultation proved valuable in diagnosing RMSF based on clinical and skin findings.
Implications:
- Physicians should consider RMSF in pediatric patients with fever and rash, especially during summer months.
- Prompt antirickettsial therapy is essential to improve outcomes for RMSF.
- Dermatology plays a key role in the early diagnosis and management of RMSF in children.
Background/Objectives:
Rocky Mountain spotted fever (RMSF), a lethal tick-borne illness, is prevalent in the south central United States. Children younger than 10 years old have the greatest risk of fatal outcome from RMSF. The objective of the current study was to review pediatric cases of RMSF seen in the dermatology consult service and to evaluate dermatology's role in the diagnosis and management of this disease.
Methods:
A retrospective review was performed of inpatient dermatology consultations at a tertiary care center in North Carolina from 2001 to 2011. Data collected included patient demographic characteristics, symptoms, pre- and postconsultation diagnoses, diagnostic procedures, length of hospital stay, and outcome.
Results:
A total of 3,912 consultations were conducted in the dermatology service over 10 years. Six patients with RMSF, ranging in age from 22 months to 10 years (mean 5.1 years), were evaluated during April, May, and June. All preconsultation diagnoses included RMSF in the differential diagnosis. All patients underwent skin biopsies, and a culture was obtained in one case. Fifty percent of patients died within 4 days of hospitalization.
Conclusions:
Variables associated with mortality from RMSF are delayed diagnosis and initiation of antirickettsial therapy. Physicians should consider RMSF in children presenting with fever and rash during the summer months. Dermatology consultation is useful in evaluating patients with suspicious clinical features of RMSF with skin findings.
