Gottlieb Michael, Long Brit, Koyfman Alex
Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois.
Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
J Emerg Med. 2018 Jul;55(1):42-50. doi: 10.1016/j.jemermed.2018.02.043. Epub 2018 Apr 22.
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.
This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department.
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.
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.
落基山斑疹热（RMSF）有潜在致命风险，其体征和症状可能较为隐匿，与其他临床病症重叠。诊断延迟可能致命。
本综述基于循证医学对急诊科评估和管理RMSF的当前数据进行总结。
RMSF通过受感染蜱传播立氏立克次体而发病。在美国，感染暴露最常见于4月至9月，高危地点包括树木繁茂、灌木丛生或草木茂盛的地区。约半数感染患者回忆不起有蜱叮咬史。症状可包括发热、头痛、畏光、不适、肌痛，以及始于手腕和脚踝并蔓延至躯干的瘀点性皮疹。≤15%的患者可能不出现皮疹，发热、头痛和皮疹这一典型三联征也不具有确诊意义。实验室检查可能显示低钠血症、贫血、血小板减少、肝酶异常及凝血检查结果升高。抗体检测可能有帮助，但急诊医生通常无法及时获得这些结果。多西环素是成人、儿童及孕妇的首选治疗药物。应向患者告知预防策略及摘除蜱的有效方法。
RMSF是一种潜在致命疾病，需要及时识别和处理。详细的病史、体格检查及检测对该病的诊断很重要。了解临床特征、诊断工具及恰当治疗方法有助于急诊医生管理RMSF。
