Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States

Biggs, Holly M.; Behravesh, Casey Barton; Bradley, Kristy; Dahlgren, F. Scott; Drexler, Naomi A.; Dumler, J. Stephen; Folk, Scott M.; Kato, Cecilia Y.; Lash, R. Ryan; Levin, Michael; Massung, Robert F.; Nadelman, Robert B.; Nicholson, William L.; Paddock, Christopher D.; Pritt, Bobbi S.; Traeger, Marc

doi:10.15585/mmwr.rr6502a1

Cited by 409 publications

(590 citation statements)

References 298 publications

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“…Persons suffering from intolerance for doxycycline or those in whom the drug is contraindicated may be treated with rifampicin for 5-10 days. Its effectiveness has been confirmed, among others, in the treatment of HGA in children under 8 years of age as well as in women in the third trimester of pregnancy [24,25,26].…”

Section: Human Granulocytic Anaplasmosis (Hga)mentioning

confidence: 78%

“…Approximately, 80% of the patients experience neck stiffness, which indicates that the central nervous system has been affected. A characteristic tache noire with localized lymphadenitis occur in 50-100% of the patients, and maculopapular rash in less than half [24].…”

Section: R Africae Infectionsmentioning

confidence: 99%

“…The recommended dose of doxycycline is 100 mg twice daily (orally or intravenously) for adults and 2.2 mg / kg twice daily (orally or intravenously) for children up to 45 kg. The treatment should be implemented immediately, as delay can lead to serious consequences or death [24].…”

Section: R Africae Infectionsmentioning

confidence: 99%

“…It is more important for the physician to inform the person about the possible symptoms, the time of their appearance as well as observe the spot [24].…”

Section: Prevention Of Tick-borne Diseasesmentioning

confidence: 99%

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Part I. Zoonozis – Tick-Borne Diseases Tick-Borne Bacterial Diseases in Poland

Tylewska-Wierzbanowska

Chmielewski

2017

hpc

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Section: Human Granulocytic Anaplasmosis (Hga)mentioning

confidence: 78%

Section: R Africae Infectionsmentioning

confidence: 99%

Section: R Africae Infectionsmentioning

confidence: 99%

“…It is more important for the physician to inform the person about the possible symptoms, the time of their appearance as well as observe the spot [24].…”

Section: Prevention Of Tick-borne Diseasesmentioning

confidence: 99%

See 2 more Smart Citations

Part I. Zoonozis – Tick-Borne Diseases Tick-Borne Bacterial Diseases in Poland

Tylewska-Wierzbanowska

Chmielewski

2017

hpc

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“…1 El cuadro clínico de esta enfermedad deriva de la infección del endotelio vascular, que produce una vasculitis evidenciable como exantema petequial, asociada a fiebre y dolor en el sistema músculo-esquelético.…”

Section: Introductionunclassified

Caso fulminante de rickettsiosis (Rickettsia rickettsii) en una lactante del sureste de México

et al. 2017

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Presentación de casos clínicos RESUMENLa fiebre manchada de las Montañas Rocosas es una enfermedad ocasionada por Rickettsia rickettsii, una bacteria transmitida por garrapatas infectadas, y que se caracteriza por fiebre, exantema, artralgias y mialgias, aunque, ocasionalmente, su presentación es inespecífica. Debido a que su evolución asemeja otras enfermedades exantemáticas, como dengue o chikungunya, su diagnóstico no es de primera intención, a pesar de que países como México tienen las características ecológicas y socioeconómicas propicias para su transmisión, con índices de mortalidad hasta de 30% en pacientes pediátricos. Esta elevada mortalidad se asocia a diagnósticos y terapia retrasados debido al desconocimiento médico acerca de la enfermedad, lo que propicia la aparición de formas atípicas y fulminantes de fiebre manchada de las Montañas Rocosas. El objetivo del presente trabajo es describir un caso clínico fulminante de fiebre manchada de las Montañas Rocosas para que sea considerada en el diagnóstico diferencial, lo cual impactaría directamente en los índices de mortalidad. Palabras clave: rickettsiosis, fiebre maculosa de las Montañas Rocosas, pediatría, enfermedades transmitidas por garrapatas. ABSTRACT Rocky Mountain spotted fever is a disease caused byRickettsia rickettsii, a bacteria transmitted by infected ticks. It is characterized by fever, exanthema, arthralgias and myalgias; but sometimes its clinical presentation is non specific. Due to its similarities with other exanthematic diseases like dengue or chikungunya, Rocky Mountain spotted fever is not a first line diagnosis, even though countries like Mexico show the ecologic and socioeconomic characteristics that favor its transmission, with a 30% mortality rate among pediatric patients. This mortality rate has been associated to a delayed diagnosis Caso fulminante de rickettsiosis (Rickettsia rickettsii) en una lactante del sureste de MéxicoFatal case of rickettsiosis in a toddler from southeastern Mexico and therapy, due to a poor knowledge among physicians regarding this disease; this favors the occurrence of atypical and fulminant cases. The objective of this work is to describe a fulminant case of Rocky Mountain spotted fever, expecting that this disease could be later considered among the differential diagnosis which could directly impact its mortality rate.

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Assessment of Risk Factors and Outcomes of Severe Ehrlichiosis Infection

et al. 2020

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IMPORTANCEEhrlichiosis cases in the US have increased more than 8-fold since 2000. Up to 57% of patients with ehrlichiosis require hospitalization and 11% develop a life-threatening complication; however, risk factors for serious disease are not well documented. OBJECTIVE To examine risk factors associated with severe ehrlichiosis. DESIGN, SETTING, AND PARTICIPANTS An analytic cross-sectional study of patients diagnosed with ehrlichiosis by polymerase chain reaction (PCR) between January 1, 2007, and December 31, 2017, was conducted in a single tertiary-care center in a region endemic for ehrlichiosis. Analysis was performed from February 27, 2018, to September 9, 2020. A total of 407 positive Ehrlichia PCR results were identified from 383 unique patients, with 155 unique patients meeting study criteria. Patients hospitalized at other institutions who had a positive Ehrlichia PCR performed as a reference test (n = 222) were excluded as no clinical data were available. Electronic medical record review was performed to collect demographic, clinical, laboratory, treatment, and outcomes data. Cases were excluded when there were insufficient clinical data to assess the severity of illness (n = 3) and when the clinical illness did not meet the case definition for ehrlichiosis (n = 3). EXPOSURES Date of presentation, onset of symptoms, date of PCR testing, date of treatment initiation, site of care, age, birth sex, race/ethnicity, Charlson Comorbidity Index, trimethoprim with sulfamethoxazole use within the prior 2 weeks, and immunosuppression. MAIN OUTCOMES AND MEASURES Requirement for intensive care unit (ICU) admission. RESULTSOf the 155 patients who met inclusion criteria, 99 patients (63.9%) were men, and 145 patients (93.5%) identified as non-Hispanic White; median age was 50 years (interquartile range, 23-64 years). Intensive care unit admission was indicated in 43 patients (27.7%), 94 patients (60.6%) were hospitalized on general medical floors, and 18 patients (11.6%) received care as outpatients. In adjusted analysis, time to treatment initiation was independently associated with an increased risk for ICU admission (adjusted prevalence ratio [aPR], 1.09; 95% CI, 1.04-1.14; P < .001). Documentation of tick exposure was independently associated with a decreased risk for ICU admission (aPR, 0.54; 95% CI, 0.34-0.86; P = .01). There appeared to be a nonsignificant change toward a decreased need for ICU care among immunosuppressed persons (aPR, 0.51; 95% CI, 0.26-1.00; P = .05). CONCLUSIONS AND RELEVANCEThis study suggests that delay in initiation of doxycycline therapy is a significant factor associated with severe ehrlichiosis. Increased recognition of infection by frontline clinicians to promote early treatment may improve outcomes associated with this increasingly common and life-threatening infection.

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Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States

Cited by 409 publications

References 298 publications

Part I. Zoonozis – Tick-Borne Diseases Tick-Borne Bacterial Diseases in Poland

Part I. Zoonozis – Tick-Borne Diseases Tick-Borne Bacterial Diseases in Poland

Caso fulminante de rickettsiosis (Rickettsia rickettsii) en una lactante del sureste de México

Assessment of Risk Factors and Outcomes of Severe Ehrlichiosis Infection

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