Presentation
A family of 3 (husband, wife, and their son) presented with symptoms compatible with SFG rickettsiosis. For 2 patients, serum samples presented increased levels of IgM and IgG for SFG Rickettsia. [ncbi.nlm.nih.gov]
Swollen preauricular and submandibular lymph nodes were present on the same side of the affected eye (Parinaud's oculoglandular syndrome). Three days later she presented with fever and maculopapular rash. [medsci.org]
Case counts in this table are presented as they were published in the MMWR issues. Therefore, numbers listed in later MMWR weeks may reflect changes made to these counts as additional information becomes available. [healthdata.gov]
Gastrointestinal
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Abdominal Pain
The following symptoms are commonly seen with this disease; fever, rash (occurs 2-5 days after fever, may be absent in some cases; see below), headache, nausea, vomiting, abdominal pain (may mimic appendicitis or other causes of acute abdominal pain), [health.ri.gov]
Typical symptoms of RMSF/SFR include fever, headache, abdominal pain, vomiting, and muscle pain. A rash may also develop but is often absent in the first few days; some patients never develop a rash. [epi.publichealth.nc.gov]
Other symptoms are general symptoms common with other types of infections such as vomiting, diarrhea, and abdominal pain. [web.uconn.edu]
Eyes can become red, muscles may feel tender, and there may be abdominal pain, nausea, vomiting, poor appetite, and fatigue. [kidshealth.org]
Other symptoms that may be present include: Gastrointestinal involvement producing abdominal pain, nausea, and vomiting. Central nervous system involvement which may cause confusion, lethargy, seizures, blindness, deafness, or coma. [dermnetnz.org]
Liver, Gall & Pancreas
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Hepatosplenomegaly
Systemic examination of abdomen revealed mild hepatosplenomegaly in all. Routine blood testing revealed Hemoglobin (Hb) varied from 8-10 gm%, total white cell count between 11,000–13,500/cu mm. Serology for typhoid, malaria and dengue were negative. [omicsonline.org]
Eyes
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Red Eye
If untreated, RMSF can lead to serious health problems, so it's important to call your doctor promptly if you notice any symptoms of RMSF, such as: high fever headache chills muscle aches red eyes rash Without antibiotic treatment, RMSF can lead to health [kidshealth.org]
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Chemosis
She had eyelid edema, discharge, conjunctival hyperemia, chemosis, a granulomatous nodule on the lower half of the bulbar conjunctiva, and a marginal corneal ulcer at the 4 o'clock position. [medsci.org]
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Conjunctival Hyperemia
She had eyelid edema, discharge, conjunctival hyperemia, chemosis, a granulomatous nodule on the lower half of the bulbar conjunctiva, and a marginal corneal ulcer at the 4 o'clock position. [medsci.org]
Workup
Microbiology
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Rickettsia Conorii
The clinical findings, severity, and fatal outcome are most consistent with Rickettsia conorii infection. [ncbi.nlm.nih.gov]
Blood samples were tested for Rickettsia conorii IgM by ELISA and were positive. Rickettsia conorii IgG was negative for all patients. [omicsonline.org]
Presence of Rickettsia conorii subsp. israelensis, the causative agent of Israeli spotted fever, in Sicily, Italy, ascertained in a retrospective study.. J Clin Microbiol 43 :, 6027– – 6031. [jmm.microbiologyresearch.org]
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Toxoplasma Gondii
TPHA test and tests for the detection of serum IgM and IgG to Toxoplasma gondii and Borrelia burgdorferi were negative. [medsci.org]
Toxoplasma gondii 280. Giardia lamblia 281. Trichomonas vaginalis 282. Babesia Specii 283. Cryptosporidium Specii 284. Isospora belli, Sarcocystis Specii, Blastocystis hominis și Cyclospora Secțiunea I. Boli Datorită Toxic Alge 285. [euro-libris.ro]
Treatment
Abstract The emergence and reemergence of a serious infectious disease are often associated with a high case-fatality rate because of misdiagnosis and inappropriate or delayed treatment. [ncbi.nlm.nih.gov]
Diagnosis Clinical features Biopsy of rash with fluorescent antibody staining to detect organisms Acute and convalescent serologic testing (serologic testing is not useful acutely) PCR Treatment Doxycycline or ciprofloxacin Treatment of spotted fever [merckmanuals.com]
Treatment Rocky Mountain Spotted Fever can be treated with antibiotics. [health.ri.gov]
Prognosis
What is the prognosis of Rocky Mountain spotted fever? If diagnosed early and treated promptly, RMSF has a very good prognosis. Most patients will fully recover without any long-term disabilities. [medicinenet.com]
Etiology
The etiologic agent is most related to Rickettsia parkeri, R. africae, and R. sibirica and probably widely distributed from Sao Paulo to Bahia in the Atlantic Forest. [ncbi.nlm.nih.gov]
In the Spotted fever group, R. rickettsii is the etiological agent of Rocky Mountain spotted fever, transmitted by the bite of a tick, whereas R. akari is the etiological agent of rickettsialpox, transmitted by the bite of a mite. [medsci.org]
J Immunol May 1, 1953, 70 (5) 461-472; Summary A toxic substance was demonstrated in yolk sac cultures of ten strains of the spotted fever rickettsia which were selected according to their virulence for guinea pigs, tick-host species, or etiologic relationship [jimmunol.org]
Howard Taylor Ricketts between 1906 and 1909 led to the isolation of the etiologic infective agent for Rocky Mountain spotted fever, Rickettsia rickettsii ( Ricketts 1906 ; Ricketts and Gomez 1908 ). [medlink.com]
Tickborne rickettsial diseases (TBRD) are clinically similar, yet epidemiologically and etiologically distinct illnesses. [babymed.com]
Epidemiology
Abstract Here, we report an epidemiological and entomological investigation of a cluster of cases of spotted fever group (SFG) rickettsiosis occurring in southern France. [ncbi.nlm.nih.gov]
The epidemiology of these tick-borne rickettsioses resembles that of Rocky Mountain spotted fever (RMSF) in the Western Hemisphere. Ixodid ticks and wild animals maintain the rickettsiae in nature. [merckmanuals.com]
Discuss the epidemiology of RMSF. Know when, if ever, to withhold therapy for RMSF if clinically suspicious of the diagnosis. Know the drug of choice for patients who have RMSF. [pedsinreview.aappublications.org]
Los Angeles County ACDC: A Manual of Departmental Rules, Regulations and Control Procedures (B73) Spotted Rickettsioses Disease Case Report (CDPH 8575) LA County Epidemiological Reporting Forms (web page) LAC: Reported Cases of Selected Diseases (2009 [publichealth.lacounty.gov]
Tickborne rickettsial diseases (TBRD) are clinically similar, yet epidemiologically and etiologically distinct illnesses. [babymed.com]
Pathophysiology
Host- and microbe-related risk factors for and pathophysiology of fatal Rickettsia conorii infection in Portuguese patients.. J Infect Dis 198 :, 576– – 585. [CrossRef] [PubMed] [Google Scholar] Stenos J., Graves S. R., Unsworth N. B.. ( 2005 ; ). [jmm.microbiologyresearch.org]
In this article, the author reviews the clinical manifestations, pathophysiology, diagnosis, and recommended treatment. The neurologic manifestations of the disease are emphasized. [medlink.com]
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Species of Rickettsia are small (0.3-0.5 mcm x 1-2 mcm) obligately intracellular bacteria (Proteobacteria). [mayomedicallaboratories.com]
Prevention
Thus, to prevent diagnostic errors, leptospirosis should be potentially considered with high suspicion in patients with acute undifferentiated fever, even in non-endemic areas of leptospirosis. [ncbi.nlm.nih.gov]
Prevention Reducing exposure to ticks is the best defense against Lyme disease, Rocky Mountain spotted fever, Babesiosis, Ehrliochiosis, and other tickborne infections. [health.ri.gov]
Healthdata.gov 2017 mmwr nedss netss nndss spotted-fever-ricke... syphilis-primary-an... wonder Additional Metadata Resource Type Dataset Metadata Created Date January 19, 2017 Metadata Updated Date August 20, 2018 Publisher Centers for Disease Control and Prevention [catalog.data.gov]
Antibiotics are not recommended for prevention. Approximately 0.5% of people who are infected die as a result. [en.wikipedia.org]
Prevention Travellers who participate in hiking, camping, or similar outdoor activities in wooded regions of endemic areas should take measures to prevent tick bites. There is no preventive medication or vaccine against rickettsial infections. [iamat.org]