1/73. Infectious disease emergencies in primary care. Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated. ( info) |
| Although acute disseminated encephalomyelitis has been observed after a variety of viral infections and an occasional bacterial infection, it has not been reported in association with rickettsial infections. Reported is a 7-year-old male with magnetic resonance images and clinical manifestations suggestive of acute disseminated encephalomyelitis after a tick bite and serologically proven rocky mountain spotted fever. ( info) |
3/73. Evidence of rickettsial spotted fever and ehrlichial infections in a subtropical territory of Jujuy, argentina. Between November 1993 and March 1994, a cluster 6 pediatric patients with acute febrile illnesses associated with rashes was identified in Jujuy Province, argentina. Immunohistochemical staining of tissues confirmed spotted fever group rickettsial infection in a patient with fatal disease, and testing of serum of a patient convalescing from the illness by using an indirect immunofluorescence assay (IFA) demonstrated antibodies reactive with spotted fever group rickettsiae. A serosurvey was conducted among 16 households in proximity to the index case. Of 105 healthy subjects evaluated by IFA, 19 (18%) demonstrated antibodies reactive with rickettsiae or ehrlichiae: 4 had antibodies reactive with rickettsia rickettsii, 15 with ehrlichia chaffeensis, and 1 with R. typhi. Amblyomma cajennense, a known vector of R. rickettsii in south america, was collected from pets and horses in the area. These results are the first to document rickettsial spotted fever and ehrlichial infections in argentina. ( info) |
| Soon after a patient from tennessee died of rocky mountain spotted fever (RMSF), several family members developed symptoms suggestive of the disease and were treated presumptively for RMSF. Fifty-four persons visiting the index patient's home were interviewed; serum samples were collected from 35. Three additional cases of RMSF were confirmed, all of which occurred in first-degree relatives. time spent at the family home and going into the surrounding woods were significantly associated with developing antibodies to rickettsia rickettsii. ticks were collected and examined for rickettsiae by polymerase chain reaction analysis. Because hyperendemic foci and family clusters of RMSF can occur, when a case is suspected clinicians should be vigilant for signs and symptoms consistent with R. rickettsii infection in other persons who may have been similarly exposed. ( info) |
5/73. Cutaneous (non-hiv) infections. Cutaneous infections continue to represent a large proportion of inpatient dermatology. Though most infectious skin diseases do not warrant hospitalization, some do and can rapidly become fatal if not treated promptly. A selected group of infections are reviewed--primary cutaneous infections, exotoxin-mediated syndromes, and systemic infections--that warrant hospitalization. Dermatologists play a critical role in the synthesis of patient history and appreciation of morphologic skin disease, which, when coupled with appropriate lab tests, may help to establish a diagnosis allowing for the timely implementation of effective and targeted therapy. ( info) |
| patients with rocky mountain spotted fever (RMSF), a tickborne infection caused by rickettsia rickettsii, respond quickly to tetracycline-class antibiotics (e.g., doxycycline) when therapy is started within the first few days of illness; however, untreated RMSF may result in severe illness and death. persons aged <10 years have the highest age-specific incidence of RMSF. This report summarizes the clinical course and outcome of RMSF in four children from four regions of the united states and underscores the need for clinicians throughout the united states to consider RMSF in children with rash and fever, particularly those with a history of tick bite or who present during April-September when approximately 90% of RMSF cases occur. ( info) |
| The classic triad of fever, headache, and characteristic rash occurring 1 to 2 weeks after a tick bite in an endemic area should raise suspicions for rocky mountain spotted fever (RMSF). All providers with primary care responsibility for women should be familiar with the diagnosis and treatment of this illness. As a recent case illustrates, the diagnosis of rocky mountain spotted fever may be complicated by pregnancy. Several conditions of pregnancy have similar presentations to the initial, often nonspecific manifestations of RMSF. Although doxycycline is the recommended therapy for children and nonpregnant women, chloramphenicol remains the recommended therapy for women during pregnancy. The time of year, local prevalence, and patient's exposure history may be taken into account when deciding to treat during pregnancy. Vertical transmission of RMSF has not been documented in humans. Prevention of RMSF by avoidance of tick-infested areas or by the use of insect repellents and long clothing is recommended for all patients. ( info) |
| A sequential occurrence of rocky mountain spotted fever (RMSF) in a dog and its owner is described. Diagnosis of RMSF in the animal guided subsequent testing for and diagnosis of the same disease in the human patient. Previous reports of concurrent RMSF in dogs and their owners are reviewed, and the epidemiologic significance of this occurrence is discussed. ( info) |
| Initial symptoms of rocky mountain spotted fever (RMSF), a tick-borne illness caused by rickettsia rickettsii, are nonspecific and include headache, gastrointestinal disturbances, malaise, and myalgias, followed by fever and rash. The classic triad of fever, rash, and history of tick exposure is uncommon at presentation. Clinical manifestations of RMSF range from virtually asymptomatic to severe. Because of the potentially fatal outcome of RMSF, presumptive clinical diagnosis and empiric antimicrobial therapy can be critical. We present the case of a 3-year-old girl from new york State who presented with fever and rash. ( info) |
10/73. Brazilian spotted fever: description of a fatal clinical case in the State of Rio de Janeiro. We describe a case of Brazilian spotted fever in a previously healthy young woman who died with petechial rash associated to acute renal and respiratory insufficiency 12 days following fever, headache, myalgia, and diarrhea. Serologic test in a serum sample, using an immunofluorescence assay, revealed reactive IgM/IgG. ( info) |