Ravish Matthew E, Krowchuk Daniel P, Zapadka Michael, Shetty Avinash K
Department of Pediatrics, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston-Salem, North Carolina 27157, USA.
J Emerg Med. 2013 Aug;45(2):186-9. doi: 10.1016/j.jemermed.2012.11.038. Epub 2013 Feb 26.
Rocky Mountain spotted fever (RMSF) is a well-described, potentially lethal, tick-borne zoonotic infection and has very effective therapy. However, the diagnosis might not be made early enough, often leading to worse outcomes.
Our aim was to discuss the diagnostic dilemmas facing the physician when evaluating patients with suspected RMSF.
We report a case of RMSF in a 6-year-old girl who presented to our hospital with a 7-day history of fever, headache, and a petechial rash. After blood cultures were obtained, the patient was treated empirically with doxycycline, vancomycin, and ceftriaxone. During the next 24 h, her clinical status worsened, with acute onset of altered mental status, posturing, and fixed and dilated pupils. A computed tomography scan of the brain demonstrated diffuse cerebral edema with evidence of tonsillar herniation. She died 24 h after admission. A serum specimen tested positive for immunoglobulin G to Rickettsia rickettsii at a titer of 128 dilutions, confirming recent infection.
We present this case to raise awareness of RMSF in patients who present with a nonspecific febrile illness in tick-endemic areas in the United States. Early diagnosis and treatment with doxycycline before day 5 of illness is essential and can prevent morbidity and mortality.
落基山斑疹热（RMSF）是一种已被充分描述的、潜在致命的蜱传人畜共患病感染，且有非常有效的治疗方法。然而，诊断可能不够及时，常常导致更差的预后。
我们的目的是讨论医生在评估疑似RMSF患者时所面临的诊断困境。
我们报告一例6岁女孩的RMSF病例，该女孩因发热、头痛和瘀点性皮疹7天前来我院就诊。采集血培养标本后，患者接受了多西环素、万古霉素和头孢曲松的经验性治疗。在接下来的24小时内，她的临床状况恶化，出现急性精神状态改变、姿势异常以及瞳孔固定和散大。脑部计算机断层扫描显示弥漫性脑水肿并有小脑扁桃体疝的迹象。她入院24小时后死亡。一份血清标本检测到抗立氏立克次体免疫球蛋白G呈阳性，滴度为128稀释度，证实近期感染。
我们呈现此病例以提高对美国蜱虫流行地区出现非特异性发热疾病患者中RMSF的认识。在发病第5天前尽早用多西环素进行诊断和治疗至关重要，可预防发病和死亡。
