Table 1.
| Element | Case-patient 1 | Case-patient 2 | Case-patient 3 | Case-patient 4 |
|---|---|---|---|---|
| Patient history | ||||
| Known exposure in RMSF-epidemic area of Mexico | + | + | + | |
| Evidence of receipt of medical care in Mexico | + | + | ||
| Prescribed nontetracycline antimicrobial drug | + | + | + | + |
| Signs and symptoms at initial presentation | ||||
| Fever | + | + | + | + |
| Headache | + | + | ||
| Nausea/vomiting/diarrhea | + | + | ||
| Rash | ||||
| Severe end-stage manifestations | ||||
| Skin necrosis | + | + | + | |
| Rash | + | + | + | + |
| Respiratory failure | + | + | + | + |
| Disseminated intravascular coagulation | + | |||
Table 1. Selected epidemiologic and clinical elements from patients with fatal cases of RMSF along the US–Mexico border, 2013–2016*
*RMSF, Rocky Mountain spotted fever; +, present; blank cells, absent.
CME
Fatal Rocky Mountain Spotted Fever along the United States– Mexico Border, 2013–2016
- Authors: Naomi A. Drexler, MPH; Hayley Yaglom, MS, MPH; Mariana Casal, MD, MPH; Maria Fierro, MD, MPH; Paula Kriner, MPH; Brian Murphy, DrPH; Anne Kjemtrup, DVM, MPVM, PhD; Christopher D. Paddock, MD, MPH
- CME Released: 9/13/2017
- THIS ACTIVITY HAS EXPIRED FOR CREDIT
- Valid for credit through: 9/13/2018, 11:59 PM EST
Target Audience and Goal Statement
This activity is intended for infectious disease practitioners, internists, intensivists, pulmonologists, public health officials, and other clinicians caring for patients with presumed or diagnosed Rocky Mountain spotted fever.
The goal of this activity is to describe clinical features and recommended management of Rocky Mountain spotted fever in patients with rapidly progressing febrile illness and recent exposure in northern Mexico, based on a series of 4 fatal cases.
Upon completion of this activity, participants will be able to:
- Identify clinical presentation and diagnosis of Rocky Mountain spotted fever (RMSF) in patients with rapidly progressing febrile illness and recent exposure in northern Mexico, based on a series of 4 fatal cases
- Interpret the clinical course and management of RMSF in patients with rapidly progressing febrile illness and recent exposure in northern Mexico
- Determine the clinical implications of analysis of this series of 4 fatal cases of RMSF in patients with rapidly progressing febrile illness and recent exposure in northern Mexico
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Fatal Rocky Mountain Spotted Fever along the United States– Mexico Border, 2013–2016: Methods
processing....
Methods
During 2013–2016, the Arizona Department of Health Services, the California Department of Public Health (CDPH), and the US Centers for Disease Control and Prevention (CDC) identified 4 cases of RMSF in persons who acquired the illness in Mexico and later died in the United States ( Table 1 ). The cases were identified during the course of routine surveillance and diagnostic testing for this disease at the respective state public health laboratories or CDC. To better characterize the epidemiologic risk factors, clinical progression, and treatment course associated with each of these deaths, we performed a retrospective review of clinical and epidemiologic data and, when available, medical charts. Because the CDC Human Subjects Review Committee determined that this evaluation was not research, this case series was exempt from institutional review board and human subjects review.