Clinical and Laboratory Features, Hospital Course, and Outcome of Rocky Mountain Spotted Fever in Children

Buckingham, Steven C.; Marshall, Gary S.; Schutze, Gordon E.; Woods, Charles R.; Jackson, Mary Anne; Patterson, Lori E.R.; Jacobs, Richard F.; Tick-borne Infections in Children Study Group,

doi:10.1016/j.jpeds.2006.11.023

« Previous Next »The Journal of Pediatrics
Volume 150, Issue 2 , Pages 180-184.e1, February 2007

Clinical and Laboratory Features, Hospital Course, and Outcome of Rocky Mountain Spotted Fever in Children

Presented in part at the Pediatric Academic Societies’ meeting, Washington, DC, May 14-17, 2005.

Departments of Pediatrics, University of Tennessee Health Science Center and Children’s Foundation Research Center at Le Bonheur Children’s Medical Center, Memphis, Tennessee; University of Louisville and Kosair Children’s Hospital, Louisville, Kentucky; University of Arkansas for Medical Sciences, College of Medicine and Arkansas Children’s Hospital, Little Rock, Arkansas; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Children’s Mercy Hospital, Kansas City, Missouri; and East Tennessee Children’s Hospital, Knoxville, Tennessee.

Received 27 February 2006; received in revised form 19 August 2006; accepted 1 November 2006.

Objectives

To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits.

Study design

Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression.

Results

Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm³ in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes.

Conclusions

Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.

Abbreviations: AOR, Adjusted odds ratio, CI, Confidence interval, RMSF, Rocky Mountain spotted fever