Rocky Mountain Spotted Fever

Tick-borne Diseases - Article

ABSTRACT: Tick-borne diseases are the most common vector-borne illnesses in the United States. Lyme disease is the most common, but several others also occur. The ehrlichioses have only been identified as agents of human disease in the United States in the past few decades, and knowledge about them is still evolving. Rocky Mountain spotted fever is relatively common and can be severe, especially in children, if the diagnosis is not made quickly. Tularemia has long been known to cause disease in humans, but there is renewed interest because of its potential as a biologic warfare agent. These diseases can be severe or even fatal. Most of them are easily treatable when identified early. These diseases result from a variety of infectious agents including bacteria, rickettsia, viruses and protozoa, or they may be caused by substances produced by the tick. Most of these diseases present initially with nonspecific symptoms and are often difficult to recognize. Few definitive diagnostic tests are available. Therefore, knowledge of the epidemiology and common presentations, as well as the diagnostic options and treatments available, are important issues for family physicians.

Rash and Fever in an Ill-Appearing Child - Photo Quiz

Dermatologic Emergencies - Article

ABSTRACT: Life-threatening dermatologic conditions include Rocky Mountain spotted fever; necrotizing fasciitis; toxic epidermal necrolysis; and Stevens-Johnson syndrome. Rocky Mountain spotted fever is the most common rickettsial disease in the United States, with an overall mortality rate of 5 to 10 percent. Classic symptoms include fever, headache, and rash in a patient with a history of tick bite or exposure. Doxycycline is the first-line treatment. Necrotizing fasciitis is a rapidly progressive infection of the deep fascia, with necrosis of the subcutaneous tissues. It usually occurs after surgery or trauma. Patients have erythema and pain out of proportion to the physical findings. Immediate surgical debridement and antibiotic therapy should be initiated. Stevens-Johnson syndrome and toxic epidermal necrolysis are acute hypersensitivity cutaneous reactions. Stevens-Johnson syndrome is characterized by target lesions with central dusky purpura or a central bulla. Toxic epidermal necrolysis is a more severe reaction with full-thickness epidermal necrosis and exfoliation. Most cases of Stevens-Johnson syndrome and toxic epidermal necrolysis are drug induced. The causative drug should be discontinued immediately, and the patient should be hospitalized for supportive care.

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