Tull Rechelle, Ahn Christine, Daniel Alyssa, Yosipovitch Gil, Strowd Lindsay C
Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Mecklenburg Medical Group-Southpark, Charlotte, North Carolina.
Pediatr Dermatol. 2017 Mar;34(2):119-123. doi: 10.1111/pde.13053. Epub 2016 Dec 19.
BACKGROUND/OBJECTIVES: Rocky Mountain spotted fever (RMSF), a lethal tick-borne illness, is prevalent in the south central United States. Children younger than 10 years old have the greatest risk of fatal outcome from RMSF. The objective of the current study was to review pediatric cases of RMSF seen in the dermatology consult service and to evaluate dermatology's role in the diagnosis and management of this disease.
A retrospective review was performed of inpatient dermatology consultations at a tertiary care center in North Carolina from 2001 to 2011. Data collected included patient demographic characteristics, symptoms, pre- and postconsultation diagnoses, diagnostic procedures, length of hospital stay, and outcome.
A total of 3,912 consultations were conducted in the dermatology service over 10 years. Six patients with RMSF, ranging in age from 22 months to 10 years (mean 5.1 years), were evaluated during April, May, and June. All preconsultation diagnoses included RMSF in the differential diagnosis. All patients underwent skin biopsies, and a culture was obtained in one case. Fifty percent of patients died within 4 days of hospitalization.
Variables associated with mortality from RMSF are delayed diagnosis and initiation of antirickettsial therapy. Physicians should consider RMSF in children presenting with fever and rash during the summer months. Dermatology consultation is useful in evaluating patients with suspicious clinical features of RMSF with skin findings.
背景/目的：落基山斑疹热（RMSF）是一种由蜱传播的致命疾病，在美国中南部地区较为普遍。10岁以下儿童患RMSF导致致命后果的风险最高。本研究的目的是回顾皮肤科会诊服务中所见的小儿RMSF病例，并评估皮肤科在该疾病诊断和管理中的作用。
对北卡罗来纳州一家三级医疗中心2001年至2011年的住院皮肤科会诊进行回顾性研究。收集的数据包括患者人口统计学特征、症状、会诊前后诊断、诊断程序、住院时间和结局。
10年间皮肤科共进行了3912次会诊。4月、5月和6月期间对6例RMSF患者进行了评估，年龄从22个月至10岁（平均5.1岁）。所有会诊前诊断的鉴别诊断中均包括RMSF。所有患者均接受了皮肤活检，1例进行了培养。50%的患者在住院4天内死亡。
与RMSF死亡率相关的因素是诊断延迟和抗立克次体治疗的启动。医生应考虑到夏季出现发热和皮疹的儿童可能患有RMSF。皮肤科会诊有助于评估具有RMSF可疑临床特征及皮肤表现的患者。
