CD-ROM Today (UK) (Spanish) 15/CDRT.iso/dp/0419/04194.txt

Text File | 1994-01-18 | 16.5 KB | 334 lines

$Unique_ID{BRK04194}
$Pretitle{}
$Title{Rocky Mountain Spotted Fever}
$Subject{Rocky Mountain Spotted Fever Black Fever Blue Fever Mexican Spotted
Fever Sao Paulo Fever Tobia Fever Blue Disease Black Measles Measles
Meningococcemia Rubella Schonlein-Henoch Purpura Thrombotic Thrombocytopenic
Purpura Typhus Typhoid Fever Q Fever Boutonneuse Fever Colorado Tick Fever
North Queensland Tick Fever South African Tick-bite Fever Israeli Rickettsial
Spotted Fever Lyme Disease}
$Volume{}
$Log{}

Copyright (C) 1989 National Organization for Rare Disorders, Inc.

600:
Rocky Mountain Spotted Fever

** IMPORTANT **
It is possible that the main title of the article (Rocky Mountain Spotted
Fever) is not the name you expected.  Please check the SYNONYM listing to
find the alternate names and disorder subdivisions covered by this article.

Synonyms

     Black Fever
     Blue Fever
     Mexican Spotted Fever
     Sao Paulo Fever
     Tobia Fever
     Blue Disease
     Black Measles

Information on the following diseases can be found in the Related
Disorders section of this report:

     Measles
     Meningococcemia
     Rubella
     Schonlein-Henoch Purpura
     Thrombotic Thrombocytopenic Purpura
     Typhus
     Typhoid Fever
     Q Fever
     Boutonneuse Fever
     Colorado Tick Fever
     North Queensland Tick Fever
     South African Tick-bite Fever
     Israeli Rickettsial Spotted Fever

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Rocky Mountain Spotted Fever is an acute infectious disorder.  This
disorder is transmitted to humans through the bite of an infected tick,
usually in wooded areas of the midwest, eastern and southeastern U.S.  The
illness can occur in other areas of the world where ticks are infected with
the rickettsial parasite.  Fever, rash and gastrointestinal problems are
among major symptoms.  Early diagnosis and treatment are vital in avoiding
serious complications of this disease.

Symptoms

Rocky Mountain Spotted Fever begins with an incubation period of from two to
twelve days.  A gradually or abruptly beginning fever may be followed after
three to five days by a pink or purplish colored rash on the wrists and
ankles.  The fever and rash usually become more severe for seven to fourteen
days.  The rash may not develop in all cases, possibly making diagnosis
difficult.  A blood test is necessary to confirm the diagnosis.  In other
cases, the rash may become widespread or develop into small bleeding spots
(petechiae, ecchymoses, or purpura) under the skin after about five days of
illness.  Swelling (edema), headache, chills, weakness and muscle pains may
also occur.  Eye infections (conjunctivitis) or light-sensitivity
(photophobia) may be present.  Skin deterioration or gangrene in the
extremities may develop.

Gastrointestinal symptoms such as nausea, vomiting, diarrhea and/or
abdominal pain occurs in approximately two thirds of patients early in the
course of the disorder.

Blood vessels, air vesicles (alveoli) and interstitial tissue in the
lungs often become infiltrated by the rickettsial parasite which causes
coughing and swelling (edema) in severe cases.

Severe headaches, lethargy, confusion, delirium, focal neurological
deficits, increased intracranial pressure leading to pressure on the optic
disk (papilledema), seizures and/or coma may occur in untreated cases as the
nervous system is progressively affected.  Some patients may have a stiffened
neck due to muscle pain (myalgia) or irritation of membranes surrounding the
brain and spinal cord tissue (meningismus).

As the untreated disease progresses, widespread swelling (edema) develops
in many patients because of leakage of blood plasma from damaged blood
vessels (vasculitis).  Kidney failure occurs in approximately fifteen percent
of patients due to diminished total quantity of blood in the circulation
(hypovolemia or oligemia).

Causes

Rocky Mountain Spotted Fever is caused by the bacteria known as Rickettsia
rickettsii which is transmitted to humans through the bite of infected ticks.
These ticks must be attached to the body for many hours in order to transmit
the infection.  Infected rodents can be hosts that transmit this disorder to
humans, but this is very seldom the case.  Symptoms arise when the
rickettsial parasites spread via the blood stream.  The parasites multiply in
large numbers and damage blood vessels causing leakage, swelling (edema), and
diminished total quantity of blood in circulation which can lead to kidney
failure.  Any organ in the body can be affected, most notably the skin, lungs
and/or brain.

Affected Population

Rocky Mountain Spotted Fever characteristically occurs in outbreaks in
various areas of the Midwest, East and Southeastern United States.
Statistically, young people between the ages of ten and twenty residing in
suburban or rural areas are most often affected during the early spring
through fall months.  Outbreaks have occurred in Long Island, New York and
four cases were identified recently in New York City.  Cabarus and Rowan
counties in North Carolina have reported epidemic numbers of cases as have
Georgia, Arkansas, Oklahoma and Texas.  The western mountain region of the
United States, for which the disease was named in 1906, currently reports
very few cases.  A total of 4,141 cases were reported to the Centers for
Disease Control (CDC) in Atlanta, GA, between the years of 1981-1984.  By
law, all cases of Rocky Mountain Spotted Fever must be reported to the CDC.
(For the address of the CDC, please see the Resources section of this
report.)

Related Disorders

Symptoms of the following disorders can be similar to those of Rocky Mountain
Spotted Fever.  Comparisons may be useful for a differential diagnosis:

Lyme Disease is a tick-transmitted inflammatory disorder characterized by
an early focal skin lesion, and subsequently a growing red area on the skin
(erythema chronicum migrans or ECM).  The disorder may be followed weeks
later by neurological, heart or joint abnormalities.  (For more information
on this disorder, choose "Lyme" as your search term in the Rare Disease
Database).

Measles is a highly contagious disease occurring primarily in children.
This disease is characterized by fever, cough, acute nasal mucous membrane
discharge (coryza), inflammation of the lining of the eyelids
(conjunctivitis), a spreading rash, and eruption of small, irregular, bright
red spots (Koplik's spots) on the inner cheeks in the mouth with a minute
bluish or white speck in the center of each.  Vaccination can prevent measles
in children.  (For more information on this disorder, choose "Measles" as
your search term in the Rare Disease Database).

Meningococcemia is an infectious disorder which begins abruptly with a
sparse rash on the wrists, underarms (axillae), flanks and ankles.  The rash
may be preceded by mottled redness of the skin resembling discoloration
typical of Typhoid Fever.  Chills, joint and muscle pains (especially of the
back and legs), tenderness of the soles of the feet, headache, sore throat,
vomiting, diarrhea, and severe weakness may also occur.  Skin spots may
spread and join to form large areas, and may affect the palms of the hands
and soles of the feet.

Rubella is a contagious viral disease characterized by swelling of lymph
glands and a rash.  If a pregnant woman becomes infected with Rubella during
the early months of pregnancy, a spontaneous abortion, stillbirth, or fetal
abnormalities may result.  The rash may resemble that of Measles and occurs
after a fourteen to twenty-one day incubation period and a one to five day
preliminary phase in children.  The rash begins on the face and neck and
quickly spreads to the trunk and extremities.  At the onset of the eruption,
a reddening similar to that of scarlet fever may appear.  A slight fever
usually accompanies the rash.  Headache, loss of appetite, sore throat, and
general discomfort (malaise) are more common in affected adults and teenagers
than children.  The disease can be prevented through vaccination.   (For more
information on this disorder, choose "Rubella" as your search term in the
Rare Disease Database).

Schonlein-Henoch Purpura is one of a group of blood vessel disorders
characterized by purplish or brownish-red discolorations on the skin.  These
spots may be large or small.  Internal bleeding may occur in various areas of
the body.  This disorder may affect the skin, joints, gastrointestinal
system, kidneys, and in a very few cases, the central nervous system.  Little
is known about the cause of this form of purpura although it may be an
allergic reaction which more often occurs in children than in adults.  Some
cases of Schoenlein-Henoch are characterized by joint disease without
gastrointestinal problems and are termed Schoenlein's Purpura.  Another form
characterized by acute abdominal symptoms but without joint disease is known
as Henoch's Purpura.  This disorder runs a limited course with a good
prognosis in most cases.  (For more information on this disorder, choose
"Schonlein" as your search term in the Rare Disease Database).

Thrombotic Thrombocytopenic Purpura (also known as TTP or Moschowitz
Disease) is a very severe disease of unknown cause.  In addition to
discolored bleeding spots under the skin (purpura), signs of central nervous
system involvement can occur.  This is due to abnormal formation of
filamented strands of protein (fibrin) or blood clots (thromboses) in the
arterioles and/or capillaries in many organs of the body.  Fever, hemolytic
anemia, and excess urea in the blood (azotemia) also may occur.  For more
information on this disease, choose "TTP" as your search term in the Rare
Disease Database.)

Q Fever is an infectious disease caused by a rickettisial organism
(Coxiella burnettii) first identified in Queensland, Australia in 1935, which
also occurs in the U.S.  Symptoms do not include damage to blood vessel cells
typical of Rocky Mountain Spotted Fever.  Fever, pneumonia, granulomatous
hepatitis, and occasionally vegetative inflammation of the membrane lining
the heart (endocarditis) occurs.  This disorder may be transmitted by a tick
bite, but is most often acquired by farm workers or meat handlers who inhale
the organism from infected meat products or livestock.  Sheep, goats or
cattle may carry the infection without symptoms.  (For more information on
this disorder, choose "Q Fever" as your search term in the Rare Disease
Database.

Boutonneuse Fever is a rickettsial infection usually transmitted by
inhalation rather than by insects.  This disorder is characterized by a
sloughing of skin (eschar) at the site of a bite by an Ixodes tick, with an
associated disease of the lymph nodes (lymphadenopathy) in approximately
fifty percent of diagnosed cases.  It is followed a few days later by fever
and generalized rash.  This fever occurs most often in Africa, Asia, and in
the Mediterranean basin.

Colorado Tick Fever is a viral infection transmitted by ticks prevalent
in the western United States.  Fever, headaches, muscle aches, and
generalized discomfort characterize the illness, which resolves
spontaneously.  Onset occurs abruptly approximately five days after a tick
bite, which usually occurs at moderate altitudes during spring or early
summer.  Flu-like symptoms may include chills, headache, increased
sensitivity to light, muscle pains (especially in the back), fatigue, nausea,
vomiting and lack of appetite.  A slight reddish rash appears, and the spleen
can become enlarged.  Fever may rise sharply and require treatment.  (For
more information on this disorder, choose "Colorado Tick Fever" as your
search term in the Rare Disease Database).

North Queensland Tick Fever is a mild form of tick typhus.  It is caused
by the rickettsial parasite Rickettsia australis and is thought to be
transmitted by the Ixodes holocyclus tick.  Sloughing of skin (eschar) at the
site of the tick bite, lymph node disease (adenopathy), rash and fever occur.

South African Tick-bite Fever is a typhus-like fever of the South African
area bounded by Capetown, Southern Rhodesia, and Mozambique.  This disorder
is usually characterized primarily by sloughing of skin (eschar) at the site
of the tick bite, regional lymph node inflammation (adenitis), sudden chills
with severe shivering (rigors), and a rash on the fifth day, often with
severe central nervous system symptoms.

Israeli Rickettsial Spotted Fever is less severe than Rocky Mountain
Spotted Fever because typical complications may not occur.  Fever, rash on
the palms of the hands and soles of the feet which may extend to the torso,
muscle pain (myalgia), headache, enlarged spleen and liver occur in this
disorder.  Laboratory testing may reveal a left shift in the white cells, an
abnormally low number of white blood cells in circulation (leucopenia), a
reduction in the number of platelets in the blood, and/or impaired liver
function.

Enteroviral Infections, Hemorrhagic Fever Viruses, disseminated
Gonococcal infections, Staphylococcal Septicemia, or Pseudomonas Septicemia
are other conditions which may be mistaken for Rocky Mountain Spotted Fever.
Early diagnosis and treatment are vital to avoid complications in this
disorder.

Therapies:  Standard

There is no vaccination to protect people from Rocky Mountain Spotted Fever.
Public awareness of the signs and symptoms are very important.  The only
effective preventive measure is to search the body and remove ticks several
times daily when ticks are active.  This is because the tick has to be
attached to the body for many hours to transmit the infection.  The scalp,
underarms and pubic regions of the body should be given special attention.
Insect repellents can protect against tick bites, and should be used in
infested areas.

If the diagnosis is not clear, a blood test may be recommended to confirm
the presence of Rocky Mountain Spotted Fever.  According to the Centers for
Disease Control (CDC), the most effective tests for the diagnosis of this
disorder include the Indirect Fluorescent Antibody (IFA) test and the
Indirect Hemagglutination (IHA) test.  The antibiotic drug chloramphenicol is
often recommended for children under the age of eight, whereas tetracycline
hydrochloride may be more effective for older children or adults.

Therapies:  Investigational

Scientists are currently studying a vaccine for Rocky Mountain Spotted Fever
involving cloned genetic products.  More research is necessary to determine
long-term effectiveness of this proposed vaccine.

This disease entry is based upon medical information available through
October 1989.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Rocky Mountain Spotted Fever, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     NIH/National Institute of Allergy & Infectious Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Rd.  NE
     Atlanta, GA  30333
     [phone]

References

ROCKY MOUNTAIN SPOTTED FEVER PRESENTING AS THROMBOTIC THROMBOCYTOPENIC
PURPURA:  R.C. Turner, et al.; Am J Med (July 1986, issue 81 (1)).  Pp. 153-
157.

ROCKY MOUNTAIN SPOTTED FEVER:  C.A. Kamper, et al.; Clin Pharm (February
1988, issue 7 (2)).  Pp. 109-116.

STAPHYLOCOCCUS AUREUS SEPTICEMIA MIMICKING FULMINANT ROCKY MOUNTAIN
SPOTTED FEVER:  M.R. Milunski, et al.;  Am J Med (October 1987, issue 83
(4)).  Pp. 801-803.

THE SENSITIVITY OF VARIOUS SEROLOGIC TESTS IN THE DIAGNOSIS OF ROCKY
MOUNTAIN SPOTTED FEVER:  J.E. Kaplan, et al.; Am J Trop Med Hyg (July 1986,
issue 35 (4)).  Pp. 840-844.

CLONED GENE OF RICKETTSIA RICKETTSII SURFACE ANTIGEN:  CANDIDATE VACCINE
FOR ROCKY MOUNTAIN SPOTTED FEVER:  G.A. McDonald, et al.; Science (January 2,
1987, issue 235 (4784)).  Pp. 83-85.

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown
and Co., 1987.  Pp. 1629-1634.