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Lisa G. Kaplowitz, MD; James V. Lange, PhD; Janet J. Fischer; David H. Walker, MD

Arch Intern Med. 1983;143(6):1149-1151.

Abstract
• Blood rickettsial titers, skin biopsy results, and circulating endotoxin measurements were correlated with the clinical course of disease in patients with Rocky Mountain spotted fever (RMSF). Nine of 11 patients with documented RMSF had Rickettsia rickettsii isolated from plasma samples. Of the eight patients in whom rickettsial titers were measured, seven had 10^0.7 to 10^1.2 median tissue culture infective doses (TCID₅₀) per milliliter; all seven had mild to moderately severe disease. One patient with fulminant, fatal untreated RMSF had 10³ TCID₅₀/mL of postmortem plasma. Two patients from whom rickettsiae were not isolated had positive direct immunofluorescent stains of skin biopsy material for R rickettsii. Circulating endotoxin was present in two patients, one with documented rickettsemia and one with a positive skin biopsy alone. Only low levels of circulating rickettsiae are present in patients with moderately severe disease. Measurement of plasma endotoxin is not useful in the early diagnosis of RMSF.

(Arch Intern Med 1983;143:1149-1151)

Author Affiliations
From the Division of Infectious Diseases, Departments of Medicine (Drs Kaplowitz and Fischer) and Pathology (Drs Lange and Walker), University of North Carolina, Chapel Hill. Dr Kaplowitz is currently with the Medical College of Virginia, Richmond, and Dr Lange is now with the Centers for Disease Control, Atlanta.

Footnotes
Accepted for publication Feb 11, 1983.

Presented in part at the meeting of the American Society for Rickettsiology and Rickettsial Diseases, Atlanta, March 14, 1982.

Reprint requests to Division of General Medicine and Primary Care, Department of Medicine, Medical College of Virginia, Box 102, MCV Station, Richmond, VA 23298 (Dr Kaplowitz).

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