Rocky Mountain Spotted Fever

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Table of Contents

Overview of the Disease
Discussion
Conclusion
References

Rocky Mountain Spotted Fever (“RMSF”) is considered as the most common rickettsial infection in the United States of America (Cash & Glass,2011, p.390). In 2-8 days the fever can rage. If not treated immediately, the complications can lead to cardiac involvement with congestive heart failure and arrhythmia (Avner & Harmon,2009, p.1246). Therefore, RMSF must not be taken lightly. The only problem is that it is not easy to diagnose. Symptoms began to appear between 2 to 8 days after the bite of an infected tick. If not treated immediately the patient can die from multiple organ failure. It is important to learn more about RMSF in order to deal with it more effectively.

Overview of the Disease

In the year 1873, Idaho physicians described a form of “black measles “ in the Snake River Valley (Evans & Brachman, 1999, p.597). In the latter part of the 19^th century, doctors began to document an illness that causes delirium as well as blotchy-skin, red-purple-black rash that appeared on the ankles, wrists and forehead and then all of a sudden it spreads to the whole body (Evans & Brachman,1999, p.597). It was later called the spotted fever of Idaho. At first they thought that it was the result of infection from drinking melted snow. It was only in 1908 when the medical world fully comprehended that it was due to a tick vector.

It has to be reiterated that RMSF is the most sever of the rickettsial diseases (Avner & Harmon, 2009, p.1246). Even though it is called rocky mountain spotted fever, this disease has been reported all over the United States. However, it is most common in Oklahoma, Kansas, Missouri, Arkansas, North Carolina, and Tennessee. It seems that the occurrence of the disease is linked to regions located in the Western part of the US. It is also important to point out that report of RMSF usually increases during late spring through fall (Bernstein & Shelove, year, p.205).

The root cause of the medical problem is an “intracellular, gram-negative coccobacillary bacteria (Bernstein & Shelov, 2012, p.205). The infectious agent is Rickettsia rickettsii and transmitted through a tick vector (Cash & Glass, 2011, p.390). The only good thing about this terrible illness is that it cannot be transmitted through human-to-human contact.

The most common symptom is the presence of a rash. A more technical description is that the infection is associated with a characteristic rash. The first sign of RMSF is high fever. But most people will never know that this is not an ordinary fever. However, on the sixth day of the illness rashes are evident. There is a need to pay careful attention to the symptoms because most of the patients exhibit nonspecific signs. For example children may complain of prominent abdominal pain and parents may make the hasty judgment that this is caused by acute appendicitis. Health professionals may also misdiagnose and say that it is due to cholecystitis or bowel obstruction.

The most problematic aspect of early detection is due to the fact that the bite of the tick is painless (Elston, 2009, p.28). Thus, a person is bitten by the vector but notices nothing out of the ordinary. More importantly, high fever which is a symptom of the disease is not detected until one week later. Thus, in the initial round of medical tests the possible contact with the tick vector may not be considered by the patient.

Aside from headache it can be observed that the patient exhibits some form of restlessness. At the same time meningism and confusion may occur. These symptoms can manifest together with other neurolgic signs (Avner & Harmon, year, p.1246). In some cases it has been reported that pulmonary involvement is also one of the symptoms for RMSF. It must also be noted that “infection is associated with an initial leucopenia, followed by neutrophil leukocytosis” (Avner & Harmon, year, p.1246). But in most cases thrombocytopenia or a relative decrease of blood platelet is one of the symptoms of RMSF (Avner & Harmon, 2009, p.1246). In some cases the central nervous sytem is affected and this is manifested by delirium, coma and shock (Evans & Brachman, 1999, p.597).

The pathophysiology of the RMSF can be summarized through the following statements:

Inoculation of the R. rickettsii into the dermis, with subsequent infection of endothelial cells, occurs via a tick bite. The incubation period is 2 to 14 days. After replication and dissemination of bacteria, vascular inflammation is assocatied with a petechial or maculopapular rash. Unrecognized and untreated infection results in multisystem organ involvement, vascular obstruction, disseminated intravascular coagulation and occasional death (Bernstein & Shelov, 2012, p.206).

It is important to take note if the people in an area have a history of tick exposure in an endemic area. Parents, local officials, and even teachers must be aware of the history of tick exposure in their locale. They have to be mindful of the health of the people under their care and protection. Knowledge about the history of an area will help them identify symptoms that other people may ignore. Consider for instance that “prodromal symptoms are nonspecific and include headache, fever and malaise” at the same time “nausea, vomiting, abdominal pain, and diarrhea may be present” (Bernstein & Shelov, 2012, p.206).

Taken separately symptoms like fever and diarrhea may not cause alarm for many parents, teachers and even health professionals. But a detailed understanding of tick problems in an area should be enough to alert guardians, parents, teachers, and government officials of the possibility of RMSF infection. It has to be pointed out that up to one-third of patients with RMSF cannot recall if they were bitten by a tick or if they came in contact with a tick (Cash & Glass, 2011, p.390).

In order to enhance the capability to detect RMSF. Parents, teachers, and health professionals must be aware that in the onset of RMSF they will notice that the patient is febrile and appears very ill. The sign that the must look for is the unique type of rash that develops in the body of the patient. The rash is characteristic of RMSF because it appears after the third day. In addition, the rash begins peripherally on the wrists, ankles and lower legs and spreads centrally (Bernstein & Shelov,2012, p.206). In some cases the soles and palms can be affected by the rash.

The early detection strategy that must be implemented in hospitals can be enhanced with an increase in the knowledge regarding RMSF. One of the important pieces of information that must be disseminated to the general public is the predisposing factors that can increase the probability of infection. These are:

outdoor activities such as hunting, hiking and camping;
the tick vector must attach and feed for 4-6 hours before it can transmit the infectious agent;
age is not a predisposing factor but the illness is more common with children and young adults;
exposure to heavy brush areas;
contact with dogs and other animals with ticks; and
transmission has occurred on rare occasions by blood transfusion (Cash & Glass, 2011, p.390).

The insight that can be gleaned from this discourse is the fact that those who spend a great deal of time outdoors can have a greater chance of infection.

Health workers must be aware of the symptom. Those with suspected RMSF must be admitted to the hospital. The first thing that must be done is to administer antibiotics. It is imperative that the patient must be admitted to the hospital before day 5 of the illness. If the patient is not admitted to the hospital then he or she will experience multiple organ failure. The following explains why the body cannot function properly once this type of rickettsiae is allowed to develop unimpeded:

Histopathologically, the predominant lesions are in the vascular system. Rickettsiae multiply in the endothelial cells, which results in focal areas of endothelial cell proliferation, perivascular mononuclear cell infiltration, thrombosis, and leakage of red cells into the tissues. The renal lesions involve both blood vessels and interstitium, and acute tubular necrosis may occur. Bu tin most cases, the pathology appears to be a direct consequence of the invading organism on the renal vasculature (Avner & Harmon, 2009, p.1246).

It must be made clear that renal dysfunction is a major complication of RMSF. With the onset of renal dysfunction there is elevated levels of urea and creatinine. Acidosis is also common once the illness has progressed to this stage.

One of the best ways to confirm RMSF is through the detection of specific antibodies in convalescence (Avner & Harmon, 2009, p.1246). This process is made possible through the laboratory culture of Rickettsia rickettsii and the use of immunofluorescent staining and polymerase chain reaction testing of blood and skin biopsy specimens.

In the case of children, the usual antibiotics used to treat infections such as prenicillin, cephalosporins and macrolides are useless when it comes to RMSF. There are those who will use tetracyclines and doxycycline but this is not recommended because of the high risk of discoloration of tooth enamel (Bernstein & Shelov, 2012, p.206). The use of chloramphenicol is said to be an effective antibiotic medication.

Discussion

When the infectious agent is allowed to multiply in the body, the person will die from multiple organ failure. The best way to understand this is by looking at the lesions created by the multiplication of the said microorganism. Thus, it is important to administer antibiotics as well as to admit the patient to the nearest medical facility that can deal with the problem.

The importance of early detection cannot be overemphasized. In an ideal situation, the physician and other health professionals can immediately recognize that the patient is suffering from the symptoms related to RMSF. But in reality the symptoms appears in such a way that the physician are led to conclude something else. Consider for instance the effect if the person complains of headache. Even if there is nausea the physician will not immediately conclude that there is the presence of RMSF.

Another problematic aspect of the RMSF medical phenomenon is that the tick vector can attach to the victim and feed for many hours without the feeling of discomfort on the part of the human host. Even if it will require 4 to 6 hours of continuous feeding before the microorganism can be transmitted the process is completed without alarming the victim of a possible transference of the dreaded microbe.

The impact of the said illness can be devastating because onset can occur within 2 to 8 days. In many cases high fever set in only after one week. By the time the patient suffers from high fever the activity of the past few days becomes a distant memory. Thus, it is imperative that the areas usually hit with RMSF must institute an information dissemination drive to warn the residents of the effect of RMSF.

Conclusion

The residents in RMSF-prone areas must be made aware of the predisposing factors. It is also imperative to emphasize that the early symptoms may mislead parents, relatives and even health professionals. A casual observation of the patient may prompt a physician to deal with superficial symptoms like headache, nausea, and high fever. It is therefore important to inform the general public to the nature of the specific rash. The moment that this type of rash appears the patient must be immediately rushed to the nearest hospital. The general public must be made aware of the fact that RMSF can kill. The infectious agent can aggressively multiply and cause multiple organ failure.

References

Avner, E., & Harmon, W. (2009). Pediatric nephrology. New York: Springer.

Bernstein, D., & S. Shelov. (2012). Pediatrics for medical students. MD: Lippincott Williams & Wilkins.

Cash, J., & Glass, C. (2011). Family practice guidelines. New York: Springer.

Elston, D. (2009). Infectious diseases of the skin. UK: Manson Publishing.

Evans, A., & Brachman, P. (1999). Bacterial infections of humans: epidemiology and control. New York: Springer.

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Rocky Mountain Spotted Fever

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