Back to...

GET VISIBLE! Advertise Here. Find Out More




Share Our Stories! - Click Here






 

Tick Bite Kills 20 Yr Old
Woman - Tick Diseases Increasing
Rocky Mtn Spotted Fever Fatal TN, NE, LA  


From Patricia Doyle PhD
7-14-17

 
ROCKY MOUNTAIN SPOTTED FEVER (03) - USA: (TENNESSEE, NEBRASKA, LOUISIANA) FATAL
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1] Tennessee (Warren County)
Date: Wed 14 Jun 2017
Source: Macon County Times [edited]
http://www.maconcountytimes.com/news/12231/mcminnville-death-caused-by-rocky-mountain-spotted-tick-fever


Health officials have warned about the threat of tick-borne illnesses after a 20-year-old from McMinnville died from a bite. She died after a 5-week battle with Rocky Mountain Spotted Fever. According to the Southern Standard, the disease was first diagnosed as the flu.

The warm winter has meant more ticks, and officials with the Metro Public Health Department have tips to keep you and your family safe and sound. "For most people, it may cause an itchy red spot on the skin, which is fairly normal as far as tick bites go," Brian Todd, of the health department, said. "It's the more serious flu-like illness 2 to 5 days afterward, that's what we want people to be paying more particular attention to." Those symptoms might include a fever, rash, headache, nausea, abdominal and muscle pain and reddened eyes.

It's important to know very few people who come down with Rocky Mountain Spotted Fever develop all symptoms, and the number of symptoms varies from person to person. The illness is easily treated with antibacterials if detected early.

The best way to avoid tick-borne diseases is to prevent tick bites. Wear long shirts and pants in tall grass or treat your clothes with permethrin. Also, check for ticks on yourself and your pets after spending time outside.

In Tennessee, the most dangerous illnesses spread by ticks are Rocky Mountain spotted fever and ehrlichiosis. In 2016, there were 581 cases of Rocky Mountain spotted fever in Tennessee; between 2004 and 2014, there were 16 deaths attributed to Rocky Mountain spotted fever in the state. Rocky Mountain spotted fever and ehrlichiosis are preventable by avoiding tick bites, promptly removing ticks that do get on the skin and seeking medical care for a fever or rash after a possible tick bite.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Nebraska
Date: Wed 21 Jun 2017
Source: Nebraska TV, a KHGI report [edited]
http://nebraska.tv/news/local/rocky-mountain-spotted-fever-cases-confirmed-in-nebraska-from-ticks


Rocky Mountain Spotted Fever (RMSF) have been confirmed in the Southwest Nebraska Public Health Department district which includes: Chase, Dundy, Frontier, Furnas, Hayes, Hitchcock, Keith, Perkins and Red Willow counties. "RMSF is transmitted to humans by the bite of an infected tick," shares Melissa Propp, SWNPHD Public Health Nurse. "It can be severe or even fatal if not treated in the first few days of symptoms. See your doctor immediately if you have been bitten by a tick and experience sudden onset of high fever, deep muscle pain, severe headache and chills."

A rash may also develop but is often absent in the first few days. According to the Centers for Disease Control and Prevention (CDC) about 10 percent of people with RMSF never develop a rash. Most often, the rash begins within 5 days after the onset of fever as small, flat, pink, non-itchy spots on the wrists, forearms, and ankles and spreads to the trunk.

It is a good idea to take preventive measures against ticks year-round, but especially in warmer months when ticks are most active. Some suggestions include:
- Use repellents that contain 20-30 percent DEET [diethyltoluamide] on exposed skin and clothing for protection that lasts up to several hours.
- Parents should apply DEET products to their children, avoiding hands, eyes and mouth.
- Use products that contain permethrin on clothing, gear, and tents.
- Walk in the center of trails.
- Avoid wooded and brushy areas with high grass and leaf litter.
- Mow lawns regularly, remove leaf litter/brush and prune low-lying bushes to let in more sunlight.
- Keep woodpiles in sunny areas off the ground.

"If you are in areas with the potential for ticks, we recommend that you bathe or shower as soon as possible after coming indoors," explains Propp. "It will be easier to find and wash off ticks that are crawling instead of attached." Some suggestions:
- Conduct a full-body tick check on yourself and children as soon as you can.
- Look closely under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in their hair.
- Examine gear and pets. Ticks can ride into the home on clothing and pets, and then attach to a person later.
- Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Louisiana (Calcasieu Parish)
Date: Fri 16 Jun 2017, 7:33 PM EDT
Source: 7KPLC TV [edited]
http://www.kplctv.com/story/35685354/rocky-mountain-spotted-fever-cases-found-in-calcasieu-parish


A local doctor has seen 3 cases of Rocky Mountain spotted fever in Calcasieu Parish in the last several months. It's an illness that can be fatal if not treated promptly. Health officials say there's no cause for alarm, but suggest people be aware. It's the time of the year when there's more outdoor activity and more ticks, some of which carry Rocky Mountain spotted fever.

Dr. Tim Haman, an infectious disease specialist, says he has seen 3 cases in Calcasieu Parish in the last 2 to 3 months. One was in Moss Bluff. He says he's not sure where the other 2 cases were from. "It can be a very severe disease, especially in children. It can even be fatal. It typically presents with fever, at least 101 to 102 deg F [approx. 38 to 39 deg C], along with a rash that typically starts on the legs and spreads up toward the trunk," he said.

Rocky Mountain spotted fever has received national attention this month since a toddler in Indiana died of the disease. It's on the rise in Louisiana. Still, Haman says there are only about 20 cases a year. "Even though we've seen the number of cases double it's still less than 20 a year," he said. But if left untreated it can kill. So, Haman says, it's important to be aware of the symptoms. "If it's not treated it can definitely be fatal," he said. However, the rash may not be present at the beginning. "You can have the fever for several days before the rash pops up," said Haman. And prompt treatment with a specific antimicrobial called doxycycline is crucial and should be initiated before lab results may have confirmed the disease. "You have to treat before the test is back. You can't wait for the test to treat," said Haman.

[Byline: Theresa Schmidt]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[When the female tick harboring the organism attaches to a passing human, she usually starts low on the body after transferring from grassy vegetation or even directly or indirectly from a dog. After crawling around on clothes seeking an appropriate cutaneous site (wearing white clothes makes a wandering tick easier to spot), she attaches and begins to feed.

If not already partially fed, after attaching, it generally takes 24 hours to activate and transmit the rickettsial organism. For this reason, daily or twice-daily tick checks with removal will minimize disease transmission. Ticks that attach in hairy areas such as the scalp or beard may be more difficult to find.

The incubation period of the disease is about 1 week after the tick exposure, long after the tick has detached. The presenting illness is generally nonspecific, fever, muscle pains, headache (but the headache is usually described as quite severe). The rash begins on day 3 of the illness, initially maculopapular at the wrists and ankles before becoming petechial and purpuric, involving the palms and soles as well as spreading proximally to the trunk. Purpura usually is not seen before the 6th day of illness. The mortality is indeed quite low if treatment (usually a tetracycline) is begun during the 1st 2 days of the rash or before.

Empiric treatment for this infection should always be begun in people with compatible symptoms inhabiting endemic areas during the spring and summer, even if no tick bite is known.

The early rash of this disease can be seen at http://upload.wikimedia.org/wikipedia/commons/d/d2/Rocky_Mountain_spotted_fever_PHIL_1962_lores.jpg.

Delayed diagnosis contributes to morbidity and mortality of RMSF. The tetracyclines represent the best drug for treatment, even in children, and the following is the CDC statement in this regard https://www.cdc.gov/rmsf/doxycycline/index.html [updated 16 Mar 2015]:

Background on doxycycline and older tetracycline antimicrobials
---------------------------------------------------------------
Tetracyclines are broad-spectrum antimicrobials in use since the 1940s. Older tetracycline-class drugs have been linked to cosmetic staining of permanent teeth when used in children before the age of 8 years. As a result, in 1970 a warning label was attached to all tetracycline-class antibiotics advising against the use in children under the age of 8 years.

In 1967 doxycycline was introduced as a newer tetracycline-class antibiotic. Doxycycline binds less readily to calcium and has not been shown to cause the same tooth staining. Several studies have previously been published showing the lack of staining of permanent teeth when doxycycline was used in children. The warning, currently present on all tetracycline-class antibiotics, including doxycycline, continues to mention the concern regarding dental staining.

Doxycycline and rickettsial diseases
------------------------------------
Doxycycline is the most effective treatment of all rickettsial diseases including RMSF, ehrlichiosis and anaplasmosis. It is the antimicrobial recommended by the American Academy of Pediatrics (AAP) and CDC for the treatment of suspected rickettsial diseases in patients of all ages. Studies have shown that other antimicrobials are less effective and are associated with a higher number of deaths (case fatality rate).

In a 2012 national survey, 80 per cent of clinicians correctly selected doxycycline as the treatment of choice for suspected RMSF in persons 8 years or older, however, only 35 per cent of clinicians correctly chose doxycycline as the treatment of choice for suspected RMSF in children under 8 years. This hesitation may contribute to the increased fatality rate among children. Children under the age of 10 years represent less than 6 per cent of RMSF cases, but they represent 22 per cent of deaths. The same disproportionate case fatality rate in children has been observed for ehrlichiosis and other serious rickettsial infections.

Doxycycline is most effective when given within the first 5 days of illness. Because there is no rapid test to diagnose rickettsial diseases, clinicians must diagnose and treat based on clinical suspicion alone. It is important that concern about dental staining [should] not cause providers to use other antibiotics, or delay the start of treatment in children.

The newest evidence
-------------------
In 2013, researchers from CDC and the Indian Health Service [IHS] began looking into the subject of dental staining following doxycycline usage, to better understand if this is an issue. This study was performed to look at whether or not doxycycline, in the dose and duration used to treat suspected RMSF, caused dental staining in children less than 8 years. The study took place in a community which has suffered from high rates of RMSF since 2003, where a large number of people, including children, were treated with doxycycline.

Dentists inspected the permanent teeth of children who had received doxycycline for suspected RMSF prior to their 8th birthday and those who had not. Blinded dentists (without knowing which children had received the drug) looked for tooth staining, evaluated tooth color, and looked for evidence of weakness in the tooth enamel for all children in the study. No differences were found between children who had received doxycycline and those who had not.

This study provides the largest sample size and best evidence to date that short courses of doxycycline (such as those used to treat rickettsial diseases) do not cause dental staining when given to children under the age of 8 years.

The current label allows for the use of doxycycline in pediatric rickettsial patients because other antimicrobials are not likely to be effective for treatment. However, clearer language on the drug label may help avoid hesitation in prescribing life-saving doxycycline to children, and reinforce CDC and AAP RMSF treatment recommendations. Despite the current label warning, it is important for healthcare providers to know that doxycycline has not been shown to cause tooth staining in the dose and duration used to treat rickettsial diseases. Early administration of doxycycline in adults and children can prevent severe illness and save lives. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/221.]