Disease: Rocky Mountain Spotted Fever
Rocky Mountain spotted fever facts
Reported incidence of RMSF per million people in 2008; NN=not reported. SOURCE: CDC. What causes Rocky Mountain spotted fever? RMSF is caused by Rickettsia rickettsii, a bacterium that is transmitted to humans via the bite of an infected tick. In the United States, these ticks include the Rocky Mountain wood tick (Dermacentor andersoni), American dog tick (Dermacentor variabilis), and brown dog tick (Rhipicephalus sanguineus). The tick needs to bite humans and then attach itself for at least six to 10 hours for the transmission of the bacterium to occur, although transmission does not occur for up to 24 hours in some cases.What are Rocky Mountain spotted fever risk factors? Being outdoors in areas where the ticks carrying Rickettsia rickettsii are prevalent is the major risk factor for acquiring the disease. Although the name of the disease includes the Rocky Mountains, it is somewhat of a misnomer as RMSF is most commonly reported in the southeastern part of the United States (though the Rocky Mountain region was one of the first areas where the disease was identified). The incidence of RMSF increases when ticks are most active and people spend more time outdoors, which commonly occurs during the summer months.What are Rocky Mountain spotted fever symptoms and signs? Reader Stories
- Close to 2,000 cases of Rocky Mountain spotted fever (RMSF) are reported in the United States each year.
- RMSF is a potentially serious tick-borne disease that can cause fatalities, and it is the most common cause of fatal tick-borne diseases in the United States.
- The incident of RMSF has increased from less than two cases per million people in the year 2000, to over six cases per million people in 2010.
- Although RMSF cases have been reported throughout the United States, the highest incidence of cases in 2010 were in Arkansas, Delaware, Missouri, North Carolina, Oklahoma, and Tennessee.
- RMSF is treatable with antibiotics, but it can have serious long-term effects and lead to death if not treated quickly and properly.
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Reported incidence of RMSF per million people in 2008; NN=not reported. SOURCE: CDC. What causes Rocky Mountain spotted fever? RMSF is caused by Rickettsia rickettsii, a bacterium that is transmitted to humans via the bite of an infected tick. In the United States, these ticks include the Rocky Mountain wood tick (Dermacentor andersoni), American dog tick (Dermacentor variabilis), and brown dog tick (Rhipicephalus sanguineus). The tick needs to bite humans and then attach itself for at least six to 10 hours for the transmission of the bacterium to occur, although transmission does not occur for up to 24 hours in some cases.What are Rocky Mountain spotted fever risk factors? Being outdoors in areas where the ticks carrying Rickettsia rickettsii are prevalent is the major risk factor for acquiring the disease. Although the name of the disease includes the Rocky Mountains, it is somewhat of a misnomer as RMSF is most commonly reported in the southeastern part of the United States (though the Rocky Mountain region was one of the first areas where the disease was identified). The incidence of RMSF increases when ticks are most active and people spend more time outdoors, which commonly occurs during the summer months.What are Rocky Mountain spotted fever symptoms and signs? Reader Stories
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- Kidneys: Kidney failure may occur due to damage of the small blood vessels in the kidney.
- Extremities: Due to damage to the smallest blood vessels in the fingers or toes, blood flow can be disrupted, leading to gangrene, with amputation sometimes being necessary.
- Brain: Headaches, lethargy, confusion, and even seizures can occur due to damage to the blood vessels in the brain.
- Heart and lungs: Inflammation of heart tissue (myocarditis) or respiratory failure can lead to death.
- Eyes: Damage to the eyes may occur, often due to inflammation of the vascular structures of the eye (uveitis or retinal vasculitis). How do physicians diagnose Rocky Mountain spotted fever? RMSF can be difficult to initially diagnose, as many of the early symptoms (such as headache and fever) are commonly seen with many other viral or bacterial infections. The presence of the classic rash usually helps in establishing the diagnosis, however, not all patients with RMSF will develop a rash. A tentative clinical diagnosis of RMSF can be made based on the patient's symptoms and their physical exam, in addition to a history of possible tick exposure. The prompt initiation of treatment in suspected RMSF is crucial, even before confirmatory test results are obtained. Specialized laboratory tests (such as immunofluorescent antibody tests, latex agglutination, or enzyme immunoassays) are available to confirm the diagnosis of RMSF. However, these tests are not readily available in all health-care facilities, and results of these tests may take days or weeks. During infection with RMSF, an individual's immune system will develop antibodies usually within the first seven to 10 days after illness onset (therefore the confirmatory lab tests might be negative during the first week). The indirect immunofluorescent assay needs to be performed on two samples to show a rise in antibody titers (the first sample is usually taken during the first week, and the second sample about two to four weeks later). Additional routine blood tests, such as a complete blood count, an electrolyte panel, liver function tests, and coagulation studies will be obtained. These blood tests can help monitor for any potential complications, such as kidney failure or problems with blood clotting. An electrocardiogram (ECG) or chest X-ray may also be obtained if there are any potential cardiac or pulmonary manifestations of the disease. In individuals who have confusion or seizures, a CT scan of the brain may also be ordered. What is the treatment for Rocky Mountain spotted fever? Antibiotics are the treatment for RMSF. Doxycycline is the antibiotic of choice in children and adults suspected of having RMSF. Antibiotic treatment is most effective if started within the first five days of symptom onset, so prompt treatment with antibiotics should be initiated in any individual suspected of having RMSF, even before confirmatory laboratory testing is obtained. The early initiation of antibiotics decreases the mortality rate of RMSF from 20% to about 5%. For individuals who are allergic to doxycycline, and in some pregnant patients, chloramphenicol is an alternative antibiotic that can be used. Although the disease responds well to treatment, it can become life-threatening if not treated promptly. Though certain patients with mild symptoms suspected of having RMSF can be treated as outpatients with antibiotics and close follow-up, other patients with suspected RMSF will require admission to the hospital for close monitoring and further evaluation.What is the prognosis of Rocky Mountain spotted fever? Reader Stories
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- Wear long pants and long sleeves when walking or working outside, especially in wooded areas.
- Use DEET-containing insect repellents.
- Check yourself, family members, and pets for ticks after you have been outside in a high-risk area.
- If a tick is found, proper removal of the tick is important. Removal of the tick should be performed with tweezers while wearing gloves. The tick should not be crushed, and care should be taken to ensure that the whole tick is removed while gently pulling the tick out.
- If possible, keep the tick so that identification of the tick species can be established if necessary.
Source: http://www.medicinenet.com
RMSF can be difficult to initially diagnose, as many of the early symptoms (such as headache and fever) are commonly seen with many other viral or bacterial infections. The presence of the classic rash usually helps in establishing the diagnosis, however, not all patients with RMSF will develop a rash. A tentative clinical diagnosis of RMSF can be made based on the patient's symptoms and their physical exam, in addition to a history of possible tick exposure. The prompt initiation of treatment in suspected RMSF is crucial, even before confirmatory test results are obtained. Specialized laboratory tests (such as immunofluorescent antibody tests, latex agglutination, or enzyme immunoassays) are available to confirm the diagnosis of RMSF. However, these tests are not readily available in all health-care facilities, and results of these tests may take days or weeks. During infection with RMSF, an individual's immune system will develop antibodies usually within the first seven to 10 days after illness onset (therefore the confirmatory lab tests might be negative during the first week). The indirect immunofluorescent assay needs to be performed on two samples to show a rise in antibody titers (the first sample is usually taken during the first week, and the second sample about two to four weeks later). Additional routine blood tests, such as a complete blood count, an electrolyte panel, liver function tests, and coagulation studies will be obtained. These blood tests can help monitor for any potential complications, such as kidney failure or problems with blood clotting. An electrocardiogram (ECG) or chest X-ray may also be obtained if there are any potential cardiac or pulmonary manifestations of the disease. In individuals who have confusion or seizures, a CT scan of the brain may also be ordered.
Source: http://www.medicinenet.com
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