Abdominal Pain Resembling Acute Appendicitis in Rocky Mountain Spotted Fever

Davis, Arthur E.; Bradford, W. David

doi:10.1001/jama.1982.03320450045032

Cited by 17 publications

(7 citation statements)

References 6 publications

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“…Abdominal pain is a symptom of RMSF that has led to misdiagnosis in other published reports [22, 23]. Diarrhea, often seen as an indicator of a benign process, such as viral gastroenteritis, was significantly correlated with late treatment and death in this study.…”

Section: Discussionmentioning

confidence: 48%

Risk Factors for Fatal Outcome From Rocky Mountain Spotted Fever in a Highly Endemic Area—Arizona, 2002–2011

Regan

Traeger

Humpherys

et al. 2015

Clinical Infectious Diseases

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Background Rocky Mountain spotted fever (RMSF) is a disease that now causes significant morbidity and mortality on several American Indian reservations in Arizona. Although the disease is treatable, reported RMSF case fatality rates from this region are high (7%) compared to the rest of the nation (<1%), suggesting a need to identify clinical points for intervention. Methods The first 205 cases from this region were reviewed and fatal RMSF cases were compared to nonfatal cases to determine clinical risk factors for fatal outcome. Results Doxycycline was initiated significantly later in fatal cases (median, day 7) than nonfatal cases (median, day 3), although both groups of case patients presented for care early (median, day 2). Multiple factors increased the risk of doxycycline delay and fatal outcome, such as early symptoms of nausea and diarrhea, history of alcoholism or chronic lung disease, and abnormal laboratory results such as elevated liver aminotransferases. Rash, history of tick bite, thrombocytopenia, and hyponatremia were often absent at initial presentation. Conclusions Earlier treatment with doxycycline can decrease morbidity and mortality from RMSF in this region. Recognition of risk factors associated with doxycycline delay and fatal outcome, such as early gastrointestinal symptoms and a history of alcoholism or chronic lung disease, may be useful in guiding early treatment decisions. Healthcare providers should have a low threshold for initiating doxycycline whenever treating febrile or potentially septic patients from tribal lands in Arizona, even if an alternative diagnosis seems more likely and classic findings of RMSF are absent.

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Section: Discussionmentioning

confidence: 48%

Risk Factors for Fatal Outcome From Rocky Mountain Spotted Fever in a Highly Endemic Area—Arizona, 2002–2011

Regan

Traeger

Humpherys

et al. 2015

Clinical Infectious Diseases

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“…The gastrointestinal symptoms often precede the appearance of a rash by more than 72 hours and often mimic other pathologies, leading to diagnostic delay [ 4 , 6 ]. Consideration of erroneous diagnoses such as acute abdomen secondary to cholangitis or appendicitis, can lead to unnecessary workups that contribute to unnecessary risk and costs [ 2 , 5 , 8 , 9 ]. Liver involvement in RMSF is also common, most frequently manifesting as AST and ALT elevation [ 3 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Rocky Mountain Spotted Fever Masquerading as Gastroenteritis: A Common but Overlooked Clinical Presentation

Braun

Greenberg

Pagadala

2021

Cureus

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Rocky Mountain spotted fever (RMSF) is a tick-borne illness caused by Rickettsia rickettsii. The classic triad of fever, rash, and a recent tick bite is rarely present at diagnosis. Less known, but more common initial presentations include gastrointestinal symptoms such as anorexia, nausea, vomiting, and abdominal pain. In endemic areas, a persistent fever with gastrointestinal symptoms should prompt screening and early initiation of antibiotics to prevent the development of fulminant RMSF and its associated high mortality. This case aims to educate about the gastrointestinal and hepatic manifestations of this diagnostic enigma.

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“…The presence of gastrointestinal symptoms in RMSF correlates with infection of blood vessels in the stomach, intestines, pancreas, and liver (1,111). The occurrence of nausea or vomiting (38 to 56%), abdominal pain (30 to 34%), and diarrhea (9 to 20%) early in the course before the onset of rash may lead to a misdiagnosis of gastroenteritis or acute surgical abdomen (37,62,65,67,87). Patients with RMSF have undergone exploratory abdominal surgery for suspected appendicitis, acute cholecystitis, and perforated diverticulitis (14,37,65,87,136,151,153).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Only 3% of patients with RMSF have the classic triad of fever, rash, and history of tick bite during the first 3 days of illness, the time during which the patient usually seeks medical care (62). Gastrointestinal, pulmonary, or central nervous system signs and symptoms may mislead the clinician to an erroneous initial diagnosis of nonspecific viral syndrome, gastroenteritis, acute surgical abdomen, bronchitis, pneumonia, meningoencephalitis, or other misdiagnoses (37,39,54,63,65,67,87,136,151,153). A reliance upon classic textbook manifestations of the disease often delays the diagnosis and appropriate lifesaving treatment.…”

Section: Clinical Diagnosismentioning

confidence: 99%

“…Resurgence in the incidence, difficulty of clinical diagnosis, defined populations at higher risk of a fatal outcome, and increased general use of antimicrobial agents that lack antirickettsial activity are persistent factors leading to misdiagnosis and death. Failure of vaccines to confer protective immunity and the lack of a generally available laboratory diagnostic test during the acute stage of illness provide overwhelming evidence that the old problems of prevention and diagnosis of RMSF still need attention (14,34,37,39,40,53,54,63,65,67,87,136,139,149,151,153,156,164).…”

Section: Introductionmentioning

confidence: 99%

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