Identifying and Quickly Treating Rocky Mountain Spotted Fever in Children
Rocky Mountain Spotted Fever (RMSF) is prevalent in some southern states in the United States. Children are affected less frequently, but they have a higher mortality rate if infected.
Infection causes fever, headache, myalgia, abdominal pain, and rash. A recent article identified pediatric RMSF cases evaluated in the dermatology consult service at a tertiary academic center in North Carolina and described the clinical presentation, hospital course, and role of dermatology in RMSF management.
A total of 3,912 inpatient dermatology consultations were reviewed and using medical records, six pediatric cases of RMSF were found. Initially, none of the six cases were evaluated for RMSF and the average patient had three prior health care encounters before admission and thus started doxycycline after 6 days of symptoms. Half of the cases resulted in death within 4 days of hospitalization, and the necessary antirickettsial therapy was delayed in two fatal cases because of a misdiagnosis. Four of the six patients presented with rash and fever as the primary symptoms.
The authors highlight the difficulty of identifying RMSF as the source of infection because the presentation is often nonspecific. Acute RMSF can look like numerous pediatric infections, and in this study, diagnosis was delayed in two fatal RMSF cases because of positive rapid group A streptococcus (GAS) antigen detection tests. RMSF and GAS coinfection can occur and may have coexisted in the studied cases.
Knowledge of how RMSF manifests dermatologically is key to rapid treatment; 95% of children develop a rash within the first 2 days of illness. Providers should not rely on the presence of petechiae to make a clinical diagnosis because that typically develops after 5 days when the risk of death is much higher. In this study, all the cases had a dermatology consultation.
Because the delay in diagnosis and appropriate treatment is such a risk for mortality, the authors suggest that providers should consider RMSF in children presenting with fever and rash during the summer months and dermatology consultation should be used to evaluate patients with skin findings. They conclude that prompt treatment should be based on clinical history, examination, and laboratory abnormalities rather than RMSF laboratory testing which has poor sensitivity during acute disease.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: April 24, 2017
Source: Wiley Online Library
Adapted from the original article.