Answer the following questions: 2. Interpret the clinical course and management

Question

Answer the following questions:

2. Interpret the clinical course and management of RMSF in patients with rapidly progressing febrile illness and recent exposure in northern Mexico.

3. Determine the clinical implications of analysis of this series of 4 fatal cases of RMSF in patients with rapidly progressing febrile illness and recent exposure in northern Mexico.

Case 4 On 3 occasions in March 2016, an 18-year-old woman sought care in Nogales, Mexico, for fever, headache, myalgia, fatigue, and arthralgia. After each visit she was sent home with palliative treatment for fever, and after 1 of the visits, cephalexin was prescribed for an unspecified illness. Orn day 7 of illness, she sought care at an emergency department in Nogales, Mexico, for abdominal pain, rash, headache, and extreme fatigue. Laboratory testing detected leukocytosis, thrombocytopenia, and elevated levels of pancreatic enzymes and hepatic transaminases. The patient was transported across the border to Nogales, Arizona, for further medical care, but she died of cardiac arrest at arrival. An autopsy revealed a widespread petechial rash; perivascular inflammation of the heart, lungs, and liver; and petechial hemorrhages in the epicardium and lung pleura. Postmortem specimens of whole blood, urine, and vitreous humor were positive for DNA of R. rickettsii when tested by PCR at CDC immunohistochemical assay, also performed at CDC, demonstrated abundant intravascular antigens of SFGR in sections of lung, liver, heart, spleen, and central nervous system tissue (Figure, panels B and C)

Explanation / Answer

RMSF- Rocky Mountain Spotted Fever. The person starts suffering from RMSF within a week after getting bitten by a tick. The following signs and symptoms are the indication that the person is suffering from RMSF:

RMSF is experienced in person having unexplained febrile illness. The clinical experience of fever, rashes and headache is present in 5-6% of the patient in the first 2-3 days of tick exposure which increase upto 60-70% in the later stages.

Fever may rise upto 102?F or more-95% reported cases.

CNS symptoms are also seen-70% reported cases.

Some population of patients also experienced photophobia and insomnia.

PHYSICAL EXAMINATION

The spectrum of the person suffering from RMSF is broad. The person can experience mild fever, headache followed by myalgia, shock, hypotension, disseminated intravascular coagulation and ultimately resulting in death.

Rash is the major diagnostic signs and symptoms of RMSF reported in very low percent of the people on the very first day of tick bite. The maculopapular eruption on the ankles and wrist area is the first signs and symptoms of rash generation.

RMSF affects the cardiovascular system badly. Some percent of the patient experience the following cardiovascular threats-

DIAGNOSIS

The early stages of RMSF are usually characterized by having nonspecific symptoms like various viral and bacterial infections, which eventually delays the correct diagnosis and sometimes results in fatal outcome. The various conditions which are considered to be the diagnosis for RMSF includes-

RMSF diagnosis relies mainly of clinical criteria. The laboratory finding is very much important for the consideration of RMSF.

The various laboratory findings are-

Skin biopsy is also carried out for RMSF diagnosis.

MEDICATIONS

Early antibiotics initiation reduces the mortality rate of RMSF from 30-50%. The life-threatening RMSF patients are usually treated with doxycycline. Chloramphenicol also acts as an excellent alternative.

The identified 4 fatal cases of RMSF are reported in person travelled to northern Mexico. The epidemic RMSF has roused and emerging public health care concern in Mexico. Loads of cases are reported for the same of which almost 50% of the cases are reported to be fatal or life-threatening. The four cases reported by the patients generally experienced the symptoms of fever, headache vomiting, and thrombocytopenia in the early stages of the disease. The common symptom reported in all the four patients was rash. The patients sought care within 2-3 days of the disease onset. Death occurred with 28 days of the disease onset and several patients were also on life support. Non-Tetracycline class of antibiotics were given in all the reported cases of RMSF followed by Doxycycline.

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