A 25-year-old man from East Tennessee had been ill for 5 days with fever, chills, and headache when he noted a rash that developed on his palms and soles. In addition to macular lesions, petechiae are noted on the wrists and ankles. The patient has recently returned from a summer camping trip. Which of the following is the most important aspect of the history?A) Exposure to contaminated spring-water
The rash of Rocky Mountain spotted fever (RMSF) occurs about 5 days into an illness characterized by fever, malaise, and headache. The rash may be macular or petechial, but almost always spreads from the ankles and wrists to the trunk. The rash indicates endothelial infection, which in severe cases can lead to capillary leak and shock. North Carolina and East Tennessee have a relatively high incidence of disease. RMSF is a rickettsial disease with the tick as the vector, and the disease is more common in warm months when ticks are active. About 80% of patients will give a history of tick exposure. Doxycycline is considered the drug of choice, but chloramphenicol is preferred in pregnancy because of the effects of tetracycline on fetal bones and teeth. Overall mortality from the infection is now about 5%.