PEDIATRICSTREATMENT
■ Prevent tick exposure.
■ Prompt removal of ticks (RMSF unlikely if tick attached <12 hours)
■ Treatment of suspected RMSF should begin based on clinical suspicion
alone (prior to confirmatory testing). Doxycycline can be used in children
of all ages.
COMPLICATIONS
■ Mortality up to 25% if treatment delayed by >5 days after the onset of
symptoms
■ Severe cases can result in gangrene, with loss of digits or extremities.
MENINGOCOCCALDISEASE
■ Neisseria meningitidis:Gram-negative diplococcus that can cause menin-
gitis or bacteremia
■ Infections occur year round, with peak incidence in winter and spring.
■ Peak incidence < 4 years of age, with a second peak between the ages of
15 and 18 years.
■ Transmission is via airborne droplets.
SYMPTOMS/EXAM
■ Severe illness, with sudden onset and rapid progression of symptoms
■ Exanthem: Maculopapular rash typically progressing to petechiae
■ Fever
■ Hypotension
■ In patients with meningitis, nuchal rigidity and altered mental status are
usually present.
FIGURE 5.14. Rocky Mountain spotted fever.
(Reproduced, with permission, from Weinberg S, Prose NS, Kristal L., Color Atlas of Pediatric
Dermatology, 4th ed. New York: McGraw-Hill, 2008:56.)