0
Editor's Correspondence |

Rocky Mountain Spotted Fever Revisited

Burke A. Cunha, MD
Arch Intern Med. 2004;164(2):221-222. doi:10.1001/archinte.164.2.221.
Text Size: A A A
Published online

Extract

I read with interest the article on Rocky Mountain spotted fever (RMSF) by Masters et al1 that recently appeared in the ARCHIVES. The authors emphasized pitfalls in the diagnosis and treatment of RMSF, which are important for clinicians. As a review article, I believe several important clinical points were omitted.

The 2 cases presented in the article were not those of the authors and were of young children initially diagnosed as having a "viral syndrome." It is hard to understand how these cases could have been dismissed as viral. There are virtually no other infectious diseases that present initially with macules on the wrists and/or ankles and also involve the palms and/or soles. Enteroviral diseases of summer do not have the same distribution. Similarly, the mild increase in serum transaminases should have been another clue that the patients simply did not have a "viral syndrome," particularly when it occurs in summer in a febrile patient with a macular rash on the wrists and/or soles. Dismissing these patients as having viral gastroenteritis simply because they had diarrhea is also another pitfall. Excluding RMSF, no infection presenting with diarrhea is accompanied by a mild increase in serum transaminases, and the characteristic wrist and/or ankle rash of RMSF.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Pancytopenia in Lyme disease. BMJ Case Rep 2014;2014():.
Jobs
brightcove.createExperiences();