Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:20

1310 Rocky Mountain Spotted Fever

■Patients with mild disease can be followed as outpatients.

■Hospitalize moderately ill patients and those with multiple organ

involvement.

General Measures

■Hospitalized patients may require IV hydration and nutrition

➣May need pulmonary-arterial line for hemodynamic monitoring

➣Watch for increased vascular permeability leading to noncardio-

genic pulmonary edema.

➣Heparin not recommended

➣Steroids used by some; not proven to be useful

specific therapy

Indications

■All patients in whom the disease is suspected should be treated while

awaiting serologic confirmation – delay increases mortality.

Treatment Options

■Doxycycline or Tetracycline 7–10 days

■Contraindicated in children <9 or in pregnancy

■Severe disease is treated with same drugs given IV.

■Alternates: chloramphenicol in 4 divided doses for pregnant women

and children <9 yr Ciprofloxacin 7–10 days

follow-up

During Treatment

■Mild disease followed outpatient.

■Office visits every 2–3 days to follow symptoms

■Monitor electrolytes, renal function and CBC

complications and prognosis

Complications

■Managed with standard medical therapy. Thrombosis/vasculitis in

multiple organs leads to complications.

■Heparin not recommended.

➣Azotemia and renal failure

➣Encephalopathy

➣Seizure activity

➣Hepatitis and liver failure

➣Heart failure

➣Respiratory failure