Rocky Mountain Spotted Fever

Ascent

Step 1: View clinicals

A 26 year old man presented with fever, cough, lightheadedness and generalised malaise for 36 hours. He had returned 2 days before from a hitch-hiking journey of 2 weeks in southwest Florida. An empirical course of Oseltamivir started 2 days before produced no improvement in symptoms. Seven hours into hospitalization, he develops profuse sweating and progressively worsening shortness of breath. His medical history is unremarkable. His psychiatric history is significant for bipolar disorder and chronic narcotic dependence. There is no history of allergies. He is a past tobacco smoker and former alcoholic, and occasionally uses marijuana.


Step 2: Order all relevant investigations

Chest X-Ray

There are bilateral diffuse hazy opacities in the lung fields consistent with the adult respiratory distress syndrome.

USS Abdomen + Liver Profile

The ultrasound scan of the abdomen reveals no abnormalities. AST: 717 U/l ALT: 759 U/l Direct Bilirubin: 1.32 mg/dl Albumin: 4.2 g/dL (3.5 - 5)

IFA for R. rickettsii

The Indirect Fluorescent Antibody Test for R. Rickettsii is negative.

Blood Cultures

Culture reports will be available in 2 days.


Step 3: Select appropriate management

Doxycyclin
Sulfadiazine
Intubation
Fluid Resuscitation


Score: ★★☆