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
CME Released: 9/13/2017
Valid for credit through: 9/13/2018, 11:59 PM EST
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Abstract and Introduction
Rocky Mountain spotted fever (RMSF) is an emerging public health concern near the US–Mexico border, where it has resulted in thousands of cases and hundreds of deaths in the past decade. We identified 4 patients who had acquired RMSF in northern Mexico and subsequently died at US healthcare facilities. Two patients sought care in Mexico before being admitted to US-based hospitals. All patients initially had several nonspecific signs and symptoms, including fever, headache, nausea, vomiting, or myalgia, but deteriorated rapidly without receipt of a tetracycline-class antimicrobial drug. Each patient experienced respiratory failure late in illness. Although transborder cases are not common, early recognition and prompt initiation of appropriate treatment are vital for averting severe illness and death. Clinicians on both sides of the US–Mexico border should consider a diagnosis of RMSF for patients with rapidly progressing febrile illness and recent exposure in northern Mexico.
Introduction
Rocky Mountain spotted fever (RMSF), a life-threatening and rapidly progressing tickborne disease, is caused by infection with the bacterium Rickettsia rickettsii. Onset of infection is characterized by nonspecific signs and symptoms that include fever, headache, and muscle pain. Progressing damage to the vascular endothelium can result in organ failure, cutaneous necrosis, and death. RMSF is frequently fatal for persons who do not receive appropriate therapy with a tetracycline-class drug during the first 5 days of illness; half of all deaths occur within the first 8 days.[1]
In the United States, RMSF is characteristically a rare and sporadically distributed disease: most cases are reported from mid-Atlantic states.[2]. Recently, however, epidemic levels of RMSF have been described for areas of eastern and southern Arizona and northern Mexico[3–6]. Transmission in these areas is perpetuated by large numbers of brown dog ticks (Rhipicephalus sanguineus sensu lato), which are responsible for unusually high incidence of disease in this region[3,5,7]. Rhipicephalus tick–transmitted RMSF was initially recognized in Mexico during the 1940s; yet during the past 12 years, the disease has rapidly reemerged in parts of Baja California and Sonora, Mexico[3,4,6,8,9] We describe 4 patients who acquired RMSF in Mexico and subsequently sought care in the United States. These cases highlight the need for increased healthcare provider awareness of this rapidly progressing disease in communities on both sides of the border.