The clinical evaluation of a patient who presents with Rocky Mountain Spotted Fever can be a challenge for physicians. The reason is the symptoms and signs which accompany this disease also occur in several other medical conditions. Since the clinical presentation is not specific for Rocky Mountain Spotted Fever, the doctor must make a decision about treatment despite the array of other diagnostic possibilities.
The signs and symptoms may include fever, headache, abdominal pain, vomiting, muscle pain, loss of appetite, and redness of the conjunctivae of the eye. Ninety percent of cases will develop a skin rash a few days after the tick bites the person. However, some patients with Rocky Mountain Spotted Fever will present to the physician’s office with few or none of these signs or symptoms (Centers for Disease Control, 2010).
Quick clinical decision
The management of Rocky Mountain Spotted Fever requires a quick decision on the part of the physician to initiate antibiotic therapy because it can lead to death of the patient in eight days if treatment does not begin early during the course of the infection.
If the physician prescribes a treatment for another medical condition which resembles Rocky Mountain Spotted Fever, the patient will likely return in a few days with the complaint that there has not been any improvement.
Moreover, the physician has to rely on the medical history and physical examination to make the diagnosis of this potentially fatal disease. If he or she orders laboratory tests, the physician must initiate antibiotic treatment for Rocky Mountain Spotted Fever before the results of the tests have returned. In other words, if the clinical evaluation suggests Rocky Mountain Spotted Fever, the physician has to immediately proceed with treatment regardless of the availability of laboratory test results.
The doctor also has to continue a full course of antibiotic therapy for Rocky Mountain Spotted Fever in these cases even if all of the laboratory tests are negative. This is because unremarkable laboratory tests do not exclude the possibility of this disease.
Nevertheless, if the physician believes the patient has the disease, he or she must proceed to order laboratory tests which are specific for Rocky Mountain Spotted Fever as well as any other relevant evaluation such as complete blood count and chemistry.
Antibiotic therapy
The Centers for Disease Control and the American Academy of Pediatrics recommend doxycycline as the first-line agent to treat adults and children of all ages who have Rocky Mountain Spotted Fever. There are several reasons for this despite the well-known contraindication to the use of tetracycline and similar drugs such as doxycycline in children less than eight years of age.
Pediatricians have known for more than a half century that the administration of tetracycline to children may lead to staining of the teeth and problems with the development of long bones. Hence, physicians in the United States will generally not prescribe it to a child under the age of eight. For the same reasons, medical doctors in the United Kingdom will not give it to children less than 12 years old.
The issues of the effects from tetracycline in a child less than eight years old or in the fetus when the mother takes tetracycline during pregnancy will probably not arise with a single short course of doxycycline during childhood. Furthermore, doxycycline is less likely to yield those effects than is tetracycline. Doxycycline is, to our knowledge, the most effective drug to achieve a microbiologic cure from Rocky Mountain Spotted Fever.
With a high index of clinical suspicion on the part of the physician, it is possible to easily treat this condition with very good results.
Sources
- Centers for Disease Control. (2010). Rocky Mountain Spotted Fever. Retrieved April 11, 2011.
- U.S. National Library of Medicine. (2010). Tick bites. Retrieved April 11, 2011.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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