Ver el código de «Rocky mountain spotted fever»

==Background==
[[File:American dog tick.jpeg|thumb|American dog tick]]
*Most frequent rickettsial disease reported in the US.<ref name="http://www.cdc.gov/rmsf/">http://www.cdc.gov/rmsf/</ref>
*Caused by Rickettsia rickettsii
**Obligate intracellular, gram negative bacteria
**Predilection for vascular endothelial cells 
*Spread by ticks
**American Dog Tick (Dermacentor variabilis) '''Most common vector'''
**Rocky Mountain Wood Tick (Dermacentor andersoni)
**Brown Dog Tick (Rhipicephalus sanquineus)
**Cayenne Tick (Amblyomma cajennense)
*Seasonal distribution with most infections occurring in the summer months
*Widely distributed in the US
**States with the highest incidence are Oklahoma, Nebraska, Arkansas, Tennessee and North Carolina
*Overall incidence is increasing while mortality is falling<ref>Columbia University Irving Medical Center. Rocky Mountain Spotted Fever. https://www.columbia-lyme.org/rocky-mountain-spotted-fever.</ref>
**Prior to the era of antibiotics, ~30% mortality
**Currently mortality is 3-5%

==Clinical Features==
[[File:Rocky Mountain Spotted Fever Rash.jpg|thumb|Rocky mountain spotted fever rash]]
[[File:Rr6502a1f21.gif|thumb|Maculopapular rash with central petechiae associated with Rocky Mountain spotted fever.]]
[[File:Rr6502a1f22.gif|thumb|Late-stage petechial purpuric rash involving the sole of the foot in a patient with Rocky Mountain spotted fever.]]
*Symptoms generally begin 2-14 days after inoculation from an infected tick<ref>http://www.mayoclinic.com/health/rocky-mountain-spotted-fever/DS00600</ref>

===Early symptoms===
*'''Non specific and highly variable'''
*[[Fever]]
*[[Nausea/Vomiting]]
*[[Abdominal pain]]
*[[Myalgia]]s (severe calf pain)
*[[Headache]]
*[[Fatigue]]
*[[Conjunctivitis]]

===Late symptoms===
*[[Rash]]
**Begins as a blanching maculopapular rash that evolves to become a petechial rash
**Usually 2-5 days after fever subsides
**Starts on extremities and spreads inward (centripetally)
**Can involve palms and soles (50% of cases)
*[[Arthralgia]]s
*Positive Rumpel-Leede test
**Development of petechiae at the site of blood pressure cuff and distally after compression

===Complications===
*Secondary to host response against infected endothelial cells
**[[Vasculitis]]
**[[Myocarditis]]
**Interstitial [[pneumonitis]]
**[[Encephalitis]]

==Differential Diagnosis==
*Other [[Tick Borne Illnesses]]
*Non-specific [[viral syndrome|viral illness]]

{{Lower respiratory zoonotic infections}}

{{Tick borne illnesses DDX}}

==Evaluation==
*PCR (initially)
*Serial serologic examinations by indirect fluorescent antibody confirm the diagnosis
*Titers

===Work-Up===
*[[ECG]] ([[Myocarditis]])
*Chem 7 ([[Hyponatremia]])
*CBC ([[Thrombocytopenia]])

==Management==
{{Rocky Mountain Spotted Fever antibiotics}}

==Disposition==

==See Also==
*[[Tick borne illnesses]]

==References==
<references/>

[[Category:ID]]