In the United States of America, the Rocky Mountain spotted fever (RMSF) is the most severe rickettsial disease. It has an alarmingly high mortality rate with death often occurring between days 9 and 15 of illness. Recently, a more severe form of RMSF was described. This peculiar form of RMSF is known as the Fulminant Rocky Mountain spotted fever and is not associated with any rickettsial infection. It is set apart from the classic RMSF in its accelerated clinical course, often with the absence of a rash and rapid death occurring within days 3 and 5 of illness. Whenever a rash is present, it often appears on the day of death and rapidly progressed to extensive purpura, a lesion on the skin. 4. 26.
Both the classic RMSF and Fulminant RMSF show similar symptoms which include nausea, vomiting, fever, myalgia, jaundice and weakness. Due to the rather common symptoms which are shared by many other illnesses, a high suspicion index is usually required for the correct diagnosis of RMSF. Other possible symptoms include tachypnea, tachycardia, generalised seizure, shock, cardiorespiratory arrest, coma, fixed dilated pupils and oliguria. Unfortunately, the differentiation between the classical and the more severe form is rather difficult, often leading to misdiagnosis and a delay in appropriate treatment. On closer scrutiny however, it came to the awareness of medical professionals that those who suffer from Fulminant RMSF are often males of African ethnicity with African type glucose-6-phosphate dehydrogenase deficiency. This sparked the suspicion that Fulminant RMSF and glucose-6-phosphate dehydrogenase deficiency are linked. The relationship between the occurrence of Fulminant RMSF and glucose-6-phosphate dehydrogenase deficiency was later found to be statistically significant. 4. 26.
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Prepared on 01 Jan 2008 by teekoonhien |
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