CURRENT Essentials of Critical Care.pdf

Chapter 18 Dermatology 271■■■Rocky Mountain Spotted FeverEssentials of Diagnosis• Acute systemic illness with fever and purpuric eruption• Caused by Rickettsia rickettsii, transmitted by ticks in mid-Atlanticand Rocky Mountain states• Highest incidence in spring and summer; 1–14 day incubationperiod, followed by sudden onset of fever, headache, myalgia,nausea and vomiting• May be complicated by central nervous system, cardiac, pulmonaryand renal involvement• Disseminated intravascular coagulation may lead to shock anddeath• Diagnosis established by serologic tests, often retrospectively;tests are not reliable before second week of illnessDifferential Diagnosis• Viral or bacterial meningitis• Meningococcemia• Measles• Vasculitis• Thrombotic thrombocytopenic purpuraTreatment• Initiate treatment as soon as diagnosis is suspected with doxycyclineor chloramphenicol■ PearlRapidly progressive rash with bilateral symmetric petechiae of thepalms and soles are the hallmarks of Rocky Mountain spotted fever.ReferenceMasters EJ et al: Rocky Mountain spotted fever: a clinician’s dilemma. ArchIntern Med 2003;163:769. [PMID: 12695267]