Gastrointestinal symptoms in Rocky Mountain Spotted Fever. Histopathologic finding of ulcerative enteritis with vascular

Rocky Mountain spotted fever

Rocky Mountain spotted fever (RMSF) is a life-threatening disease caused by Rickettsia rickettsii, an obligately intracellular bacterium that is spread to human beings by ticks. More than a century after its first clinical description, this disease is still among the most virulent human infections identified, being potentially fatal even in previously healthy young people. The diagnosis of RMSF is based on the patient's history and a physical examination, and often presents a dilemma for clinicians because of the non-specific presentation of the disease in its early course. Early empirical treatment is essential to prevent severe complications or a fatal outcome, and treatment should be initiated even in unconfirmed cases. Because there is no vaccine available against RMSF, avoidance of tick-infested areas is still the best way to prevent the infection.

Rocky Mountain spotted fever: a disease in need of microbiological concern

Rocky Mountain spotted fever, a life-threatening tick-transmitted infection, is the most prevalent rickettsiosis in the United States. This zoonosis is firmly entrenched in the tick host, which maintains the rickettsiae in nature by transovarian transmission. Although the incidence of disease fluctuates in various regions and nationwide, the problems of a deceptively difficult clinical diagnosis and little microbiologic diagnostic effort persist. Many empiric antibiotic regimens lack antirickettsial activity. There is neither an effective vaccine nor a generally available assay that is diagnostic during the early stages of illness, when treatment is most effective. Microbiology laboratories that offer only the archaic retrospective Weil-Felix serologic tests should review the needs of their patients. Research microbiologists who tackle these challenging organisms have an array of questions to address regarding rickettsial surface composition, structure-function analysis, and pathogenic and immune mechanisms, as well as laboratory diagnosis.

Rickettsioses of the spotted fever group around the world

Spotted fever group rickettsioses comprise Rocky Mountain spotted fever (Rickettsia rickettsii), boutonneuse fever (R. conorii), North Asian tick typhus (R. sibirica), Queensland tick typhus (R. australis), rickettsialpox (R. akari), and Oriental spotted fever (R. japonica). Ticks or mites serve as the vector and reservoir hosts of the rickettsiae. These obligate intracellular bacteria invade vascular endothelial cells, which are damaged directly, causing increased vascular permeability. The rash usually appears in Rocky Mountain spotted fever on the third day of illness and later evolves to become petechial maculopapules in 50% of cases with involvement of the palms and soles in a similar proportion of patients. Eschar occurs in some SFG rickettsioses at the site of tick bite, but rarely in Rocky Mountain spotted fever. Diagnosis often proves difficult, and laboratory assays for antibodies to SFG rickettsiae are generally useful only in convalescence. Rickettsiae are demonstrable by diagnostic immunohistology in biopsies of rash or eschar. Empiric treatment with doxycycline, tetracycline, or chloramphenicol should be given early in the course on the basis of clinical suspicion of the diagnosis of a SFG rickettsiosis.