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{{Rocky Mountain spotted fever}}
{{Rocky Mountain spotted fever}}
{{CMG}} {{AE}} {{IMD}}
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==Overview==
==Overview==


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. Early onset symptoms typically associated with Rocky Mountain Spotted Fever include fever, nausea, vomiting, and headache.  
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. Early onset symptoms typically associated with Rocky Mountain spotted fever include fever, nausea, vomiting, and headache.  
Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include [[thrombocytopenia]], [[hyponatremia]], or elevated [[liver enzyme]] levels.
Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include [[thrombocytopenia]], [[hyponatremia]], or elevated [[liver enzyme]] levels.


 
==Symptoms==
==Signs and symptoms==
[[Image:Foot.jpg|left|thumb|200px|Early ([[macular]]) rash on sole of foot caused by Rocky Mountain spotted fever on the arm]]
[[Image:Foot.jpg|right|thumb|200px|Early ([[macular]]) rash on sole of foot caused by Rocky Mountain spotted fever on the arm]]
[[Image:Rocky mountian spotted fever.jpg|left|thumb|200px|Late [[petechial]] rash caused by Rocky Mountain spotted fever on the arm]]
[[Image:Rocky mountian spotted fever.jpg|right|thumb|200px|Late [[petechial]] rash caused by Rocky Mountain spotted fever on the arm]]


Rocky Mountain spotted fever can be very difficult to diagnose in its early stages, even among experienced physicians who are familiar with the disease.   
Rocky Mountain spotted fever can be very difficult to diagnose in its early stages, even among experienced physicians who are familiar with the disease.   


Patients infected with ''R. rickettsii'' generally visit a physician in the first week of their illness, following an incubation period of about 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.  
Patients infected with ''R. rickettsii'' generally visit a physician in the first week of their illness, following an incubation period of about 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. <ref name="RMSF Symptoms CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref>
 
Initial symptoms may include:


*[[fever]]  
''Initial symptoms may include:''
*[[nausea]]  
*[[Fever]]  
*[[vomiting|emesis]]  
*[[Nausea]]  
*[[headache|severe headache]]  
*[[Vomiting|Emesis]]  
*[[myalgia|muscle pain]]  
*[[Headache|Severe headache]]  
*[[lack of appetite]]   
*[[Myalgia|Muscle pain]]  
*[[Lack of appetite]] <ref name="RMSF Symptoms CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref>


Later signs and symptoms include:
*It should be noted that initial symptoms occur within the first 3 days of illness. Only 3% of patients with RMSF will display a rash within the first 3 days of infection.


*[[maculopapular rash]]
''Later signs and symptoms include:''
*[[petechiae|petechial rash]]  
*[[Maculopapular rash]]
*[[abdominal pain]]  
*[[Petechiae|Petechial rash]]  
*[[joint pain]]  
*[[Abdominal pain]]  
   
*[[Joint pain]] <ref name="RMSF Symptoms CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref>


==Illness Severity==
[[Image:RMSF incidence.jpg|left|500px|Epidemiology Graph 3 - Comparison between RMSF cases and their fatality.]]
*Rocky Mountain spotted fever can be a very severe illness and patients often require hospitalization. Because ''R. rickettsii'' infects the cells lining [[blood vessel]]s throughout the body, severe manifestations of this disease may involve the [[respiratory system]], [[central nervous system]], [[gastrointestinal system]], or [[renal system]].
*Host factors associated with severe or fatal Rocky Mountain spotted fever include advanced age, male sex, African-American race, chronic alcohol abuse, and
[[glucose-6-phosphate dehydrogenase]] (G6PD) deficiency.
*Deficiency of G6PD is a sex-linked genetic condition affecting approximately 12% of the U.S.
*African-American male population; deficiency of this enzyme is associated with a high proportion of severe cases of Rocky Mountain spotted fever. This is a rare clinical course that is often fatal within 5 days of onset of illness.


*Long-term health problems following acute Rocky Mountain spotted fever infection include partial [[paralysis]] of the lower extremities, [[gangrene]] requiring amputation of fingers, toes, or arms or legs, hearing loss, loss of bowel or bladder control, movement disorders, and language disorders.  
<br>
*These complications are most frequent in persons recovering from severe, life-threatening disease, often following lengthy hospitalizations.
<br>
<br>
==Rocky Mountain spotted fever rash==
*The rash first appears 2-5 days after the onset of fever and is often not present or may be very subtle when the patient is initially seen by a physician. 
*Younger patients usually develop the rash earlier than older patients. 
*Most often it 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|petechial]]) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms, and this type of rash occurs in only 35% to 60% of patients with Rocky Mountain spotted fever.
*The rash involves the palms or soles in as many as 50% to 80% of patients; however, this distribution may not occur until later in the course of the disease. <ref name="RMSF Symptoms CDC”">Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015</ref> 
*As many as 10% to 15% of patients may never develop a rash.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Bacterial diseases]]
[[Category:Rickettsiales]]
[[Category:Zoonoses]]
[[Category:Dermatology]]

Latest revision as of 18:39, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

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. Early onset symptoms typically associated with Rocky Mountain spotted fever include fever, nausea, vomiting, and headache. Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include thrombocytopenia, hyponatremia, or elevated liver enzyme levels.

Symptoms

Early (macular) rash on sole of foot caused by Rocky Mountain spotted fever on the arm
Late petechial rash caused by Rocky Mountain spotted fever on the arm

Rocky Mountain spotted fever can be very difficult to diagnose in its early stages, even among experienced physicians who are familiar with the disease.

Patients infected with R. rickettsii generally visit a physician in the first week of their illness, following an incubation period of about 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. [1]

Initial symptoms may include:

  • It should be noted that initial symptoms occur within the first 3 days of illness. Only 3% of patients with RMSF will display a rash within the first 3 days of infection.

Later signs and symptoms include:





Rocky Mountain spotted fever rash

  • The rash first appears 2-5 days after the onset of fever and is often not present or may be very subtle when the patient is initially seen by a physician.
  • Younger patients usually develop the rash earlier than older patients.
  • Most often it 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, and this type of rash occurs in only 35% to 60% of patients with Rocky Mountain spotted fever.
  • The rash involves the palms or soles in as many as 50% to 80% of patients; however, this distribution may not occur until later in the course of the disease. [1]
  • As many as 10% to 15% of patients may never develop a rash.

References

  1. 1.0 1.1 1.2 1.3 Rocky Mountain Spotted Fever Symptoms. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/symptoms/index.html Accessed on December 30, 2015