Rocky Mountain spotted fever case study one

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.

The following case study involves a young girl, 4 years of age, in Panama. This is the first known fatal case of RMSF in the region since approximately the 1950s.

• 4 year old female
• History of:
  • Fever
  • Myalgia
  • Malaise
  • Intense headache
  • Arthralgia of lower extremities
  • 3 days of generalized rash

• Hypoalbuminemia
• Thrombocytopenia
• Elevated liver enzymes
• Increased immature neutrophils
• Hyponatremia
• CSF tests did show a protein elevation
• Serologic tests done for:
  • Dengue, hantavirus, calicivirus, equine encephalitis virus, and bacterial cultures
    • They were all negative

On the same day the patient was admitted, she had an episode of seizures, and the patient passed away shortly after, despite intense medical intervention. An autopsy was performed and some of the main findings of this procedure were interstitial pneumonitis, encephalitis, myocarditis, interstitial nephritis, and generalized lymphadenitis. After subsequent laboratory tests, the diagnosis of RMSF was made.

The death of this patient was due to a couple of reasons. The first is that it took too long to make a diagnosis. In turn, this caused there to be a delay in treating the patient with the correct antibiotic treatment. In order to prevent an outcome like this, treatment should begin even before the results from the diagnostic tests are available. Treatment should continue for 7 to 10 days or when the patient has been fever free for at least 3 days^[1].