title: Retrospective Study of Rocky Mountain Spotted Fever in Children.
abstract: OBJECTIVE
  Rocky Mountain spotted fever (RMSF), a lethal tick-borne illness, is prevalent in the south central United States. Children younger than 10 years old have the greatest risk of fatal outcome from RMSF. The objective of the current study was to review pediatric cases of RMSF seen in the dermatology consult service and to evaluate dermatology's role in the diagnosis and management of this disease.
  
  
  METHODS
  A retrospective review was performed of inpatient dermatology consultations at a tertiary care center in North Carolina from 2001 to 2011. Data collected included patient demographic characteristics, symptoms, pre- and postconsultation diagnoses, diagnostic procedures, length of hospital stay, and outcome.
  
  
  RESULTS
  A total of 3,912 consultations were conducted in the dermatology service over 10 years. Six patients with RMSF, ranging in age from 22 months to 10 years (mean 5.1 years), were evaluated during April, May, and June. All preconsultation diagnoses included RMSF in the differential diagnosis. All patients underwent skin biopsies, and a culture was obtained in one case. Fifty percent of patients died within 4 days of hospitalization.
  
  
  CONCLUSIONS
  Variables associated with mortality from RMSF are delayed diagnosis and initiation of antirickettsial therapy. Physicians should consider RMSF in children presenting with fever and rash during the summer months. Dermatology consultation is useful in evaluating patients with suspicious clinical features of RMSF with skin findings.
authors.affiliation: Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Rechelle
authors.initials: R
authors.lastname: Tull
authors.affiliation: Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Christine
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Mecklenburg Medical Group-Southpark, Charlotte, North Carolina.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Daniel
authors.affiliation: Department of Dermatology, School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Gil
authors.initials: G
authors.lastname: Yosipovitch
authors.affiliation: Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Strowd
mesh_terms: D002648:Child; D003880:Dermatology; D017809:Fatal Outcome; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009657:North Carolina; D012017:Referral and Consultation; D012189:Retrospective Studies; D012373:Rocky Mountain Spotted Fever / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy