https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091339/

. 2018; 19: 917–919.
Published online 2018 Aug 4. doi: 10.12659/AJCR.909636
PMCID: PMC6091339
PMID: 30076285

Septic Shock Caused by Rocky Mountain Spotted Fever in a Suburban Texas Patient with Pet Dog Exposure: A Case Report

Abstract

Patient: Female, 45

Final Diagnosis: Rocky mountain spotted fever

Symptoms: Altered mental state • ataxia • dyspnea • fever • headache

Objective:

Unusual clinical course

Background:

Rocky Mountain spotted fever (RMSF) is associated with high mortality and requires prompt identification and treatment to ensure better outcomes.

Case Report:

We describe an advanced case of RMSF in a 45-year-old female patient with pet dog exposure who presented with altered mental status, dyspnea, and ataxia progressing to septic shock and acute hypoxic respiratory failure requiring intubation and mechanical ventilation.

Conclusions:

This case illustrates the importance of keeping RMSF in the differential diagnosis in patient populations outside of the usual geographic areas of incidence in the appropriate clinical setting.

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**Comment**

This is what can happen when diagnosis is delayed.

This woman that lived in the suburbs had a 7-day history of fevers associated with headache, arthralgias, nausea, fatigue, and neck pain, but did NOT have the tell-tale blotchy RMSF rash.

Two days later, she worsened with confusion, combativeness, dyspnea, and ataxia. She got multiple recent bug bites from her pet dogs sleeping in her bed. The dogs were not up to date on flea and tick medication but were healthy and showed no sign of illness.
  • Rule #1:  Do NOT sleep with pets.  The risk is too great.
  • Rule #2:  If you choose to have pets, make sure you treat them if they go outdoors.  The risk is too great.
  • Rule #3:  Doctors need to start treating this plague with the respect it deserves and frankly should keep it in the back of their minds AT ALL TIMES.
Positive findings were R. typhi IgM 1: 1024 (normal <1: 64), R. Rickettsii IgM 1: 1024 (normal <1: 64), IgG 1: 128 (normal <1: 64), and echovirus Ab 1: 80 titer (normal <1: 80). The Rickettsial titers were repeated for possible cross-reactivity and R. typhi antibodies were noted to be negative (<1: 64).
Although R.typhi was ruled out due to cross-reactivity, I believe we will start seeing more of this strain in the future.
The patient improved on doxycycline, the drug of choice for RMSF and was discharged.
Why isn’t there a full-out media blitz on this like there was on Zika?