Rocky mountain spotted fever - Revision history

Rossdonaldson1: /* Clinical Features */

2025-07-30T18:17:04Z

Clinical Features

← Older revision		Revision as of 18:17, 30 July 2025
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	[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|Rocky mountain spotted fever rash]]		[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|Rocky mountain spotted fever rash]]
	[[File:Rr6502a1f21.gif\|thumb\|Maculopapular rash with central petechiae associated with Rocky Mountain spotted fever.]]		[[File:Rr6502a1f21.gif\|thumb\|Maculopapular rash with central petechiae associated with Rocky Mountain spotted fever.]]
			[[File:Rr6502a1f22.gif\|thumb\|Late-stage petechial purpuric rash involving the sole of the foot in a patient with Rocky Mountain spotted fever.]]
	*Symptoms generally begin 2-14 days after inoculation from an infected tick<ref>http://www.mayoclinic.com/health/rocky-mountain-spotted-fever/DS00600</ref>		*Symptoms generally begin 2-14 days after inoculation from an infected tick<ref>http://www.mayoclinic.com/health/rocky-mountain-spotted-fever/DS00600</ref>

Rossdonaldson1 at 18:15, 30 July 2025

2025-07-30T18:15:33Z

← Older revision		Revision as of 18:15, 30 July 2025
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	==Clinical Features==		==Clinical Features==
			[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|Rocky mountain spotted fever rash]]
			[[File:Rr6502a1f21.gif\|thumb\|Maculopapular rash with central petechiae associated with Rocky Mountain spotted fever.]]
	*Symptoms generally begin 2-14 days after inoculation from an infected tick<ref>http://www.mayoclinic.com/health/rocky-mountain-spotted-fever/DS00600</ref>		*Symptoms generally begin 2-14 days after inoculation from an infected tick<ref>http://www.mayoclinic.com/health/rocky-mountain-spotted-fever/DS00600</ref>

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	===Late symptoms===		===Late symptoms===
	~~[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|Rocky mountain spotted fever rash]]~~
	*[[Rash]]		*[[Rash]]
	**Begins as a blanching maculopapular rash that evolves to become a petechial rash		**Begins as a blanching maculopapular rash that evolves to become a petechial rash

Rossdonaldson1: /* Clinical Features */

2019-11-27T03:51:43Z

Clinical Features

← Older revision		Revision as of 03:51, 27 November 2019
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	===Late symptoms===		===Late symptoms===
	[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|]]		[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|Rocky mountain spotted fever rash]]
	*[[Rash]]		*[[Rash]]
	**Begins as a blanching maculopapular rash that evolves to become a petechial rash		**Begins as a blanching maculopapular rash that evolves to become a petechial rash

ClaireLewis at 15:59, 14 September 2019

2019-09-14T15:59:25Z

← Older revision		Revision as of 15:59, 14 September 2019
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	==Background==		==Background==
			[[File:American dog tick.jpeg\|thumb\|American dog tick]]
	*Most frequent rickettsial disease reported in the US.<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>		*Most frequent rickettsial disease reported in the US.<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>
	*Caused by Rickettsia rickettsii		*Caused by Rickettsia rickettsii
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	===Early symptoms===		===Early symptoms===
	*'''Non specific and highly variable'''		*'''Non specific and highly variable'''
	*Fever		*[[Fever]]
	*Nausea/Vomiting		*[[Nausea/Vomiting]]
	*Abdominal pain		*[[Abdominal pain]]
	*~~Myalgias~~ (severe calf pain)		*[[Myalgia]]s (severe calf pain)
	*Headache		*[[Headache]]
	*Fatigue		*[[Fatigue]]
	*Conjunctivitis		*[[Conjunctivitis]]

	===Late symptoms===		===Late symptoms===
	*Arthralgias		[[File:Rocky Mountain Spotted Fever Rash.jpg\|thumb\|]]
	*Rash		*[[Rash]]
	**Begins as a blanching maculopapular rash that evolves to become a petechial rash		**Begins as a blanching maculopapular rash that evolves to become a petechial rash
	**Usually 2-5 days after fever subsides		**Usually 2-5 days after fever subsides
	**Starts on extremities and spreads inward (centripetally)		**Starts on extremities and spreads inward (centripetally)
	**Can involve palms and soles (50% of cases)		**Can involve palms and soles (50% of cases)
			*[[Arthralgia]]s
	*Positive Rumpel-Leede test		*Positive Rumpel-Leede test
	**Development of petechiae at the site of blood pressure cuff and distally after compression		**Development of petechiae at the site of blood pressure cuff and distally after compression
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	===Complications===		===Complications===
	*Secondary to host response against infected endothelial cells		*Secondary to host response against infected endothelial cells
	**Vasculitis		**[[Vasculitis]]
	**[[Myocarditis]]		**[[Myocarditis]]
	**Interstitial pneumonitis		**Interstitial [[pneumonitis]]
	**[[Encephalitis]]		**[[Encephalitis]]

	==Differential Diagnosis==		==Differential Diagnosis==
	*Other [[Tick Borne Illnesses]]		*Other [[Tick Borne Illnesses]]
	*Non-specific viral illness		*Non-specific [[viral syndrome\|viral illness]]

	{{Lower respiratory zoonotic infections}}		{{Lower respiratory zoonotic infections}}
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	===Work-Up===		===Work-Up===
	*[[ECG]] (Myocarditis)		*[[ECG]] ([[Myocarditis]])
	*Chem 7 ([[Hyponatremia]])		*Chem 7 ([[Hyponatremia]])
	*CBC (Thrombocytopenia)		*CBC ([[Thrombocytopenia]])

	==Management==		==Management==

Ostermayer: /* Management */

2019-01-18T23:00:45Z

Management

← Older revision		Revision as of 23:00, 18 January 2019
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	==Management==		==Management==
	*[[Doxycycline]] 100 mg BID for 5-7 days<ref>Shandera WX, Roig IL: Viral & Rickettsial Infections, in Papadakis MA, McPhee SJ (eds): Current Medical Diagnosis and Treatment, ed 52. USA, McGraw-Hill, 2013, (Ch) 32: p 1412-1413.</ref>		{{Rocky Mountain Spotted Fever antibiotics}}
	**Indicated also in children at 2.2mg/kg BID
	*[[Chloramphenicol]] (CAM) 50-100 mg/kg/day div Q6hr (Max dose = 4g/day)
	**Preferred agent in pregnancy. May cause [[aplastic anemia]] and [[Grey baby syndrome]], more common in near term or 3rd trimester<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>
	**Consideration should be made for doxycycline over CAM in the 3rd trimester

	==Disposition==		==Disposition==

Kxl328: /* Background */

2018-10-23T04:35:21Z

Background

← Older revision		Revision as of 04:35, 23 October 2018
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	*Widely distributed in the US		*Widely distributed in the US
	**States with the highest incidence are Oklahoma, Nebraska, Arkansas, Tennessee and North Carolina		**States with the highest incidence are Oklahoma, Nebraska, Arkansas, Tennessee and North Carolina
	*Overall incidence is increasing while mortality is falling		*Overall incidence is increasing while mortality is falling<ref>Columbia University Irving Medical Center. Rocky Mountain Spotted Fever. https://www.columbia-lyme.org/rocky-mountain-spotted-fever.</ref>
			**Prior to the era of antibiotics, ~30% mortality
			**Currently mortality is 3-5%

	==Clinical Features==		==Clinical Features==

Kxl328: /* Management */

2018-10-07T00:25:31Z

Management

← Older revision		Revision as of 00:25, 7 October 2018
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	==Management==		==Management==
	*[[Doxycycline]] ~~100mg~~ BID for 5-7 days<ref>Shandera WX, Roig IL: Viral & Rickettsial Infections, in Papadakis MA, McPhee SJ (eds): Current Medical Diagnosis and Treatment, ed 52. USA, McGraw-Hill, 2013, (Ch) 32: p 1412-1413.</ref>		*[[Doxycycline]] 100 mg BID for 5-7 days<ref>Shandera WX, Roig IL: Viral & Rickettsial Infections, in Papadakis MA, McPhee SJ (eds): Current Medical Diagnosis and Treatment, ed 52. USA, McGraw-Hill, 2013, (Ch) 32: p 1412-1413.</ref>
	**Indicated also in children at 2.2mg/kg BID		**Indicated also in children at 2.2mg/kg BID
	*[[Chloramphenicol]] 50-~~100mg~~/kg/day div Q6hr (Max dose = 4g/day)		*[[Chloramphenicol]] (CAM) 50-100 mg/kg/day div Q6hr (Max dose = 4g/day)
	**Preferred agent in pregnancy. May cause [[aplastic anemia]] and [[Grey baby syndrome]]<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>		**Preferred agent in pregnancy. May cause [[aplastic anemia]] and [[Grey baby syndrome]], more common in near term or 3rd trimester<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>
			**Consideration should be made for doxycycline over CAM in the 3rd trimester

	==Disposition==		==Disposition==

DrKarb: /* Early symptoms */

2018-02-16T21:19:42Z

Early symptoms

← Older revision		Revision as of 21:19, 16 February 2018
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	*Nausea/Vomiting		*Nausea/Vomiting
	*Abdominal pain		*Abdominal pain
	*Myalgias		*Myalgias (severe calf pain)
	*Headache		*Headache
	*Fatigue		*Fatigue

Rossdonaldson1 at 16:09, 17 September 2017

2017-09-17T16:09:42Z

← Older revision		Revision as of 16:09, 17 September 2017
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	**Interstitial pneumonitis		**Interstitial pneumonitis
	**[[Encephalitis]]		**[[Encephalitis]]

			==Differential Diagnosis==
			*Other [[Tick Borne Illnesses]]
			*Non-specific viral illness

			{{Lower respiratory zoonotic infections}}

			{{Tick borne illnesses DDX}}

	==Evaluation==		==Evaluation==
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	*Titers		*Titers

	==Work-Up==		===Work-Up===
	*[[ECG]] (Myocarditis)		*[[ECG]] (Myocarditis)
	*Chem 7 ([[Hyponatremia]])		*Chem 7 ([[Hyponatremia]])
	*CBC (Thrombocytopenia)		*CBC (Thrombocytopenia)

	~~==Differential Diagnosis==~~
	*Other [[Tick Borne Illnesses]]
	*Non-specific viral illness

	~~{{Lower respiratory zoonotic infections}}~~

	~~{{Tick borne illnesses DDX}}~~

	==Management==		==Management==
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	*[[Chloramphenicol]] 50-100mg/kg/day div Q6hr (Max dose = 4g/day)		*[[Chloramphenicol]] 50-100mg/kg/day div Q6hr (Max dose = 4g/day)
	**Preferred agent in pregnancy. May cause [[aplastic anemia]] and [[Grey baby syndrome]]<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>		**Preferred agent in pregnancy. May cause [[aplastic anemia]] and [[Grey baby syndrome]]<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>

			==Disposition==

	==See Also==		==See Also==

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T13:56:39Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 13:56, 9 September 2016
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	==Work-Up==		==Work-Up==
	*ECG (Myocarditis)		*[[ECG]] (Myocarditis)
	*Chem 7 ([[Hyponatremia]])		*Chem 7 ([[Hyponatremia]])
	*CBC (Thrombocytopenia)		*CBC (Thrombocytopenia)

Rocky mountain spotted fever - Revision history

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1 at 18:15, 30 July 2025

Rossdonaldson1: /* Clinical Features */

ClaireLewis at 15:59, 14 September 2019

Ostermayer: /* Management */

Kxl328: /* Background */

Kxl328: /* Management */

DrKarb: /* Early symptoms */

Rossdonaldson1 at 16:09, 17 September 2017

Rossdonaldson1: Text replacement - "*ECG" to "*ECG"

Rossdonaldson1: Text replacement - "ECG" to "ECG"