From 1965 to 1971, 42 patients with Rocky Mountain spotted fever were hospitalized in Memphis. The correct diagnosis often was missed initially, with an average delay of 10.6 days between symptom onset and initiation of appropriate antimicrobial therapy. In addition to rash and fever, central nervous system and hematologic abnormalities were prominent clinical features. Ten patients had multiple coagulation defects compatible with a diagnosis of disseminated intravascular coagulation; there was a markedly increased mortality in this group.
These findings suggest the following: (1) greater physician awareness of the epidemiologic and clinical features of this disease is required; (2) the clinical appearance is often confusing, particularly when dominated by neurologic or hematologic abnormalities; and (3) prompt recognition and treatment of associated disseminated intravascular coagulation may be crucial in the management of severe disease.
Torres J, Humphreys E, Bisno AL. Rocky Mountain Spotted Fever in the Mid-South. Arch Intern Med. 1973;132(3):340–347. doi:10.1001/archinte.1973.03650090022005
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