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A Clinician's Dilemma

Edwin J. Masters, MD; Gary S. Olson, MD; Scott J. Weiner, MD, PhD; Christopher D. Paddock, MD

Arch Intern Med. 2003;163:769-774.

Rocky Mountain spotted fever is still the most lethal tick-vectored illness in the United States. We examine the dilemmas facing the clinician who is evaluating the patient with possible Rocky Mountain spotted fever, with particular attention to the following 8 pitfalls in diagnosis and treatment: (1) waiting for a petechial rash to develop before diagnosis; (2) misdiagnosing as gastroenteritis; (3) discounting a diagnosis when there is no history of a tick bite; (4) using an inappropriate geographic exclusion; (5) using an inappropriate seasonal exclusion; (6) failing to treat on clinical suspicion; (7) failing to elicit an appropriate history; and (8) failing to treat with doxycycline. Early diagnosis and proper treatment save lives.

From the Department of Pediatrics, St Francis Medical Center and Southeast Missouri Hospital, Cape Girardeau, Mo (Dr Weiner), and the Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Paddock). Drs Masters and Olson are in private practice, Cape Girardeau. Dr Weiner is now with the Department of Pediatrics, Austin Medical Education Programs and Children's Hospital of Austin, Austin, Tex.

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