ROCKY MOUNTAIN SPOTTED FEVER (RMSF)

EPIDEMIOLOGY: -

Caused by R. rickettsii, RMSF has the highest case-fatality rate of all rickettsial diseases.

• In the United States, the prevalence is highest in the south-central and southeastern states. Most cases occur between May and September.
• A rare presentation of fulminant RMSF is seen most often in male black pts with G6PD deficiency.
• RMSF is transmitted by different ticks in different geographic areas— e.g., the American dog tick (Dermacentor variabilis) transmits RMSF in the eastern two-thirds of the United States and in California, and the Rocky Mountain wood tick (D. andersoni) transmits RMSF in the western U.S.

PATHOGENESIS: -

Rickettsiae are inoculated by the tick after ≥6 h of feeding, spread lymphohematogenously, and infect numerous foci of contiguous endothelial cells.  Increased vascular permeability, with edema, hypovolemia, and ischemia, causes tissue and organ injury.

CLINICAL MANIFESTATIONS: -

The incubation period is ~1 week (range, 2–14 days). After 3 days of nonspecific symptoms, half of pts have a rash characterized by macules appearing on the wrists and ankles and subsequently spread

• Lesions ultimately become petechial in 41–59% of pts, appearing on or after day 6 of illness in ~74% of all cases that include a rash. The palms and soles become involved after day 5 in 43% of pts but do not become involved at all in 18–64%.
• Patients may develop hypovolemia, prerenal azotemia, hypotension, noncardiogenic pulmonary edema, renal failure, hepatic injury, and cardiac involvement with dysrhythmias. Bleeding is a rare but potentially lifethreatening consequence of severe vascular damage.
• CNS involvement—manifesting as encephalitis, focal neurologic deficits, or meningoencephalitis—is an important determinant of outcome. In meningoencephalitis, CSF is notable for pleocytosis with a mononuclear cell or neutrophil predominance, increased protein levels, and normal glucose levels.
• Laboratory findings may include increased plasma levels of acute-phase reactants such as C-reactive protein, hypoalbuminemia, hyponatremia, and elevated levels of creatine.

PROGNOSIS: -

Without treatment, the pt usually dies in 8–15 days; fulminant RMSF can result in death within 5 days. The mortality rate is 3–5% despite the availability of effective antibiotics, mostly because of delayed diagnosis. Survivors of RMSF usually return to their previous state of health.

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are:-

• Aconite
• Belladonna
• Bryonia
• Gelsemium
• Sulphur.