title: Rocky Mountain spotted fever: a clinician's dilemma.
abstract: Rocky Mountain spotted fever is still the most lethal tick-vectored illness in the United States. We examine the dilemmas facing the clinician who is evaluating the patient with possible Rocky Mountain spotted fever, with particular attention to the following 8 pitfalls in diagnosis and treatment: (1) waiting for a petechial rash to develop before diagnosis; (2) misdiagnosing as gastroenteritis; (3) discounting a diagnosis when there is no history of a tick bite; (4) using an inappropriate geographic exclusion; (5) using an inappropriate seasonal exclusion; (6) failing to treat on clinical suspicion; (7) failing to elicit an appropriate history; and (8) failing to treat with doxycycline. Early diagnosis and proper treatment save lives.
authors.affiliation: Department of Pediatrics, St Francis Medical Center and Southeast Missouri Hospital, Cape Girardeau, MO, USA. EMAST7456@AOL.com
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Masters
authors.forename: Gary S
authors.initials: GS
authors.lastname: Olson
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weiner
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004318:Doxycycline / Q000008:administration & dosage; D005260:Female; D006801:Humans; D012373:Rocky Mountain Spotted Fever / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline