TY - JOUR
T1 - The Evaluation and Management of Rocky Mountain Spotted Fever in the Emergency Department
T2 - a Review of the Literature
AU - Gottlieb, Michael
AU - Long, Brit
AU - Koyfman, Alex
N1 - Publisher Copyright:
© 2018
PY - 2018/7
Y1 - 2018/7
N2 - Background: Rocky Mountain spotted fever (RMSF) is potentially deadly and can present subtly with signs and symptoms overlapping with other clinical conditions. Delayed diagnosis can be fatal. Objective: This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department. Discussion: RMSF occurs through transmission of Rickettsia rickettsii by an infected tick. Exposure in the United States occurs most commonly from April to September, and high-risk locations include wooded, shrubby, or grassy areas. Approximately half of patients with infection do not recall tick exposure. Symptoms can include fever, headache, photophobia, malaise, myalgias, and a petechial rash that begins on the wrists and ankles and spreads to the trunk. Rash may not occur in ≤15% of patients, and the classic triad of fever, headache, and rash is also not definitive. Laboratory evaluation may demonstrate hyponatremia, anemia, thrombocytopenia, abnormal liver enzymes, and elevated coagulation tests. Antibody testing can be helpful, but these results are not typically available to the emergency clinician. Doxycycline is the treatment of choice in adults, children, and pregnant patients. Patients should be advised about prevention strategies and effective techniques for removing ticks. Conclusions: RMSF is a potentially deadly disease that requires prompt recognition and management. Focused history, physical examination, and testing are important in the diagnosis of this disease. Understanding the clinical features, diagnostic tools, and proper treatment can assist emergency clinicians in the management of RMSF.
AB - Background: Rocky Mountain spotted fever (RMSF) is potentially deadly and can present subtly with signs and symptoms overlapping with other clinical conditions. Delayed diagnosis can be fatal. Objective: This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department. Discussion: RMSF occurs through transmission of Rickettsia rickettsii by an infected tick. Exposure in the United States occurs most commonly from April to September, and high-risk locations include wooded, shrubby, or grassy areas. Approximately half of patients with infection do not recall tick exposure. Symptoms can include fever, headache, photophobia, malaise, myalgias, and a petechial rash that begins on the wrists and ankles and spreads to the trunk. Rash may not occur in ≤15% of patients, and the classic triad of fever, headache, and rash is also not definitive. Laboratory evaluation may demonstrate hyponatremia, anemia, thrombocytopenia, abnormal liver enzymes, and elevated coagulation tests. Antibody testing can be helpful, but these results are not typically available to the emergency clinician. Doxycycline is the treatment of choice in adults, children, and pregnant patients. Patients should be advised about prevention strategies and effective techniques for removing ticks. Conclusions: RMSF is a potentially deadly disease that requires prompt recognition and management. Focused history, physical examination, and testing are important in the diagnosis of this disease. Understanding the clinical features, diagnostic tools, and proper treatment can assist emergency clinicians in the management of RMSF.
KW - Rocky Mountain spotted fever
KW - fever
KW - petechiae
KW - rash
KW - tick
KW - tick-borne
KW - vasculitis
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U2 - 10.1016/j.jemermed.2018.02.043
DO - 10.1016/j.jemermed.2018.02.043
M3 - Article
C2 - 29685474
AN - SCOPUS:85045896399
SN - 0736-4679
VL - 55
SP - 42
EP - 50
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 1
ER -