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Ehrlichiosis clinically indistinguishable from Rocky Mountain spotted fever
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NEW YORK CITY – An overview of tickborne rickettsial infections including common symptoms, treatment options and prevention methods was recently presented at the 23rd Annual Infectious Diseases in Children Symposium.
Gordon E. Schutze, MD, professor of pediatrics at Baylor College of Medicine, Houston, presented this information during the meeting held in New York City. Schutze reported on common symptoms associated with Rocky Mountain spotted fever, human monocytic ehrlichiosis and human granulocytic ehrlichiosis and treatment options for children with rickettsial disease. In addition, Schutze discussed the use of insect repellants and prophylactic antimicrobial treatment in the prevention of tickborne disease in children.
Symptomatic presentations of Rocky Mountain spotted fever are characterized by an acute triad of fever, headache, and rash, which is only present in 58% of patients. The rash commonly seen with Rocky Mountain spotted fever starts on the extremities and works its way to the remainder of the body. However, a patient with Rocky Mountain spotted fever doesn’t always have spots, and this disease is clinically indistinguishable from ehrlichiosis.
“You can have spotless spotted fever,” he said. “But you can’t have Rocky Mountain spotted fever without the fever.”
An important thing to note, said Schutze, is that children appear to have the ability to clear the disease without pharmacologic intervention. This comes from serology testing of asymptomatic children.
Amblyomma americanum (Lone Star tick), Dermacentor variabilis (Dog tick) are the major tick vectors for human monocytic ehrlichiosis. Most reported cases occur during April-September mostly in the U.S. Individuals living in rural regions or who have history of outdoor activity are at highest risk, according to Schutze.
Human granulocytic anaplasmosis, formerly known as human granulocytic ehrlichiosis, is caused by Anaplasma phagocytophilum and has worldwide distribution.
Children with rickettsial disease should be treated with doxycycline, said Schutze. Failure to respond within 3 days usually means it is not a rickettsial illness. Therapy is continued for 3 afebrile days and when the patient has shown clinical improvement (usually 7-10 days).
“Don’t be afraid to give doxycycline to a child at any age. I can’t underline that enough, he said.
Schutze also included in the presentation what he called the “Don’ts” of rickettsial disease:
- Don’t wait for a petechial rash to develop before suspecting the diagnosis.
- Don’t exclude the diagnosis if there is no tick bite.
- Don’t exclude the diagnosis based solely on geographic or seasonal reasons.
- Don’t withhold therapy if clinically suspicious.
- Don’t be afraid to use doxycycline for treatment of patients at any age.
Finally, Schutze also included methods for proper tick removal, including using forceps by pulling straight out while close to the skin and cleaning the site after the tick has been removed.
Regarding tick removal, Schutze said he works hard to dispel the myth of having to remove a tick’s head. He also said not to use petroleum jelly or fingernail polish to try and smother the tick because it only becomes “angry and will vomit and defecate and make things worse.”
“If you just remove the body and keep the area clean, the body will take care of the rest,” he said. - by Cassandra Richards
For more information:
- Schutze GE. Tick borne Rickettsial disease in children. Presented at: the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21, 2010; New York City.