1/3. Implications of presumptive fatal rocky mountain spotted fever in two dogs and their owner.A dog was examined because of petechiation, an inability to stand, pale mucous membranes, a possible seizure, and thrombocytopenia. Tick-borne illness was suspected, but despite treatment, the dog died. Eight days later, a second dog owned by the same individual also died. The dog was not examined by a veterinarian, but rocky mountain spotted fever (RMSF) was suspected on the basis of clinical signs. Two weeks after the second dog died, the owner was examined because of severe headache, fever, nausea, vomiting, decreased appetite, lethargy, and a fine rash on the body, face, and trunk. Despite intensive treatment for possible RMSF, the owner died. Although results of an assay for antibodies to rickettsia rickettsii were negative, results of polymerase chain reaction assays of liver, spleen, and kidney samples collected at autopsy were positive for spotted fever group Rickettsia spp. These cases illustrate how dogs may serve as sentinels for RMSF in humans and point out the need for better communication between physicians and veterinarians when cases of potentially zoonotic diseases are seen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. rocky mountain spotted fever. A clinical review based on 48 confirmed cases, 1943-1986.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.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/3. Rocky Mountain spotless fever: a dilemma for the clinician.Failure of the characteristic rash to develop during the course of illness in rocky mountain spotted fever may lead to the delay or failure of diagnosis and may result in fetal encephalopathic illness with disseminated vascular injury. Four patients are described herein in whom a rash failed to develop and the diagnosis was initially incorrect. Each patient was seen at least once before hospital admission by a physician and given ineffective antibiotic therapy, resulting in fatal complications. Besides the failure of the rash to develop, the lack of any specific diagnostic test that is useful during the acute illness represents a major difficulty for the physician in making the diagnosis before the patient's death. Any adult in an endemic geographic area who is initially seen with an undifferentiated acute febrile illness in which headache and myalgias are prominent should be considered for treatment with tetracycline unless otherwise contraindicated.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |