Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Secretaría de Salud de Baja California, Mexicali, Baja California, México.
Am J Trop Med Hyg. 2022 Aug 22;107(4):773-779. doi: 10.4269/ajtmh.21-1017. Print 2022 Oct 12.
Rocky Mountain spotted fever (RMSF) is a potentially fatal tickborne disease caused by the bacterium, Rickettsia rickettsii and transmitted primarily by the brown dog tick (Rhipicephalus sanguineus) in the southwestern United States and Mexico. RMSF can be rapidly fatal if not treated early with doxycycline, making healthcare worker awareness and education critical to reduce morbidity and mortality. During 2008-2019, Mexicali experienced a RMSF epidemic with 779 confirmed cases, and an 11-year case-fatality rate of 18% (N = 140). A cross-sectional study was conducted with 290 physicians and physicians-in-training across 12 medical facilities in Mexicali. They were asked to complete a 23-item questionnaire to assess knowledge, attitudes, and practices for clinical, epidemiologic, and preventive aspects of RMSF. Half of participants were female, the largest age group was aged 25 to 44 (47%), and median time in practice was 6 years (interquartile rate: 1-21.5). Less than half (48%) surveyed were confident where diagnostic testing could be performed, and two-thirds did not regularly order serology (67%) or molecular diagnostic (66%) tests for RMSF when a patient presented with fever. Sixty-four percent knew doxycycline as first-line treatment of children < 8 years with suspected RMSF. When comparing healthcare workers with < 6 years of experience to those with ≥ 6 years, more experience was associated with greater confidence in where to have diagnostic testing performed (prevalence odds ratio [prevalence odds ratios [pOR]] = 2.3; P = 0.004), and frequency of ordering laboratory tests (serology, pOR = 3.3; P = 0.002; polymerase chain reaction, pOR = 3.9; P = 0.001). Continued education, including information on diagnostic testing is key to reducing morbidity and mortality from RMSF.
落矶山斑疹热（RMSF）是一种潜在致命的蜱传疾病，由细菌立克次体引起，主要通过美国西南部和墨西哥的棕色狗蜱（Rhipicephalus sanguineus）传播。如果不早期用强力霉素治疗，RMSF 可能迅速致命，因此，医护人员的意识和教育对于降低发病率和死亡率至关重要。2008 年至 2019 年，墨西卡利经历了一场 RMSF 疫情，确诊病例 779 例，11 年病死率为 18%（N=140）。在墨西卡利的 12 家医疗设施中，对 290 名医生和医学生进行了一项横断面研究。他们被要求完成一份 23 项的调查问卷，以评估对 RMSF 的临床、流行病学和预防方面的知识、态度和实践。一半的参与者为女性，最大的年龄组为 25 至 44 岁（47%），行医中位数为 6 年（四分位间距：1-21.5）。不到一半（48%）的被调查者对可以进行诊断检测的地方有信心，三分之二的人在患者出现发热时不经常订购血清学（67%）或分子诊断（66%）检测 RMSF。64%的人知道强力霉素是治疗疑似 RMSF 的 8 岁以下儿童的一线药物。在比较经验少于 6 年和经验超过 6 年的医护人员时，更多的经验与对在哪里进行诊断检测更有信心有关（患病率优势比[患病率优势比[POR]]=2.3；P=0.004），以及订购实验室检测的频率（血清学，POR=3.3；P=0.002；聚合酶链反应，POR=3.9；P=0.001）。持续的教育，包括关于诊断检测的信息，是降低 RMSF 发病率和死亡率的关键。
