Thursday, July 12, 2018

PRO/EDR> Rocky Mountain spotted fever - USA (02): (WI) fatal

ROCKY MOUNTAIN SPOTTED FEVER - USA (02): (WISCONSIN) FATAL
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Date: Tue 10 Jul 2018 02:22 PM CDT
Source: Channel 3000 [edited]
<https://www.channel3000.com/health/dhs-wisconsinite-dies-from-rocky-mountain-spotted-fever/766125761>


A La Crosse woman has died of a disease that is considered rare in the
Midwest, health officials said. The Wisconsin Department of Health
Services and the La Crosse County Health Department said [Tue 10 Jul
2018], that the death is the 1st documented from Rocky Mountain
spotted fever in Wisconsin.

Jo Foellimi, a La Crosse County public health nurse, says a tick bit
the woman while she was camping in western Wisconsin in early May
[2018]. The woman was diagnosed with RMSF in mid-June and died days
later. Foellimi says the woman was in her late 50s but declined to
identify her.

RMSF most commonly occurs in the central and southeastern regions of
the USA, according to a news release. Most tickborne diseases
transmitted in Wisconsin are spread by the blacklegged (or deer) tick.
RMSF, however, is spread by the bite of the American dog (or wood)
tick. Early symptoms of RMSF can be mild and typically include fever,
headache, nausea, vomiting, rash and stomach pain, DHS said. If left
untreated, an RMSF infection can rapidly develop into a serious
illness.

DHS encouraged Wisconsin residents to take the following steps to
protect themselves and their families from tick bites while enjoying
the outdoors:
- Use an insect repellent with at least 20-percent DEET or another
EPA-registered repellent according to the label instructions.
- Use 0.5-percent permethrin products on clothing, socks and shoes
according to label instructions.
- Stay on trails and avoid walking through tall grasses and brush.
- Wear long sleeves and pants, and tuck pants into socks and shirts
into pants to avoid ticks crawling under clothing.
- Check your entire body for ticks after being outdoors.
- Take a shower as soon as possible after coming in from outdoors.
- Place clothes in the dryer on high heat for 10 minutes to kill any
ticks on clothing.
- Use a veterinarian-prescribed tick prevention treatment on pets.

DHS said that of the illnesses spread by ticks in Wisconsin, Lyme
disease is the most common, but ticks can also spread anaplasmosis,
ehrlichiosis and, more rarely, RMSF and Powassan virus.

Many people who contract a tickborne disease do not recall a tick
bite, so it is also important to be aware of the common symptoms of
tickborne disease, such as fever, rash, headache, body aches and
fatigue. Most diseases spread by ticks in Wisconsin can be effectively
treated with antimicrobials, making early diagnosis critical, health
officials said. If symptoms develop after a tick bite or after
possible tick exposure, see a health care provider.

--
Communicated by:
ProMED-mail
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[When a female _Dermacentor_ 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 timing in this report is strange as the incubation period of the
disease is about a week after the tick exposure, long after the tick
has detached but not a month. It is unclear when the illness actually
began and the actual exposure may not have been the one reported. 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 as it
may have here. A tetracycline represent the best drug for treatment,
even in children, Practicing infectious diseases in western Wisconsin
as I do, we see many cases of tickborne disease this time of year and
although RMSF is uncommon, tetracycline is also used for borreliosis,
anaplasmosis and ehrlichiosis and is often begun empirically before
diagnostics are available.

According to the state of Wisconsin
(<https://www.dhs.wisconsin.gov/tickborne/rmsf.htm>) between 2013 and
2017, only 69 cases were reported in the state. The majority of these
reported cases were acquired outside of Wisconsin. - Mod.LL

HealthMap/ProMED map available at:
Wisconsin, United States: <http://healthmap.org/promed/p/250>]

[See Also:
Rocky Mountain spotted fever - USA: (IN)
http://promedmail.org/post/20180622.5869412
2017
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Rocky Mountain spotted fever - USA (04): (MI) susp
http://promedmail.org/post/20170904.5293271
Rocky Mountain spotted fever - USA (03): (TN,NE,LA) fatal
http://promedmail.org/post/20170629.5137067
Rocky Mountain spotted fever - USA (02): (IN) fatal
http://promedmail.org/post/20170608.5092709
Rocky Mountain spotted fever - USA: (TN)
http://promedmail.org/post/20170505.5014084
2016
----
Rocky Mountain spotted fever - USA (02): (NE)
http://promedmail.org/post/20160630.4317127
Rocky Mountain spotted fever - USA: (MI)
http://promedmail.org/post/20160617.4294109
2015
----
Rocky mountain spotted fever - USA: (OK) severe complication
http://promedmail.org/post/20150814.3578711
2014
----
Rocky mountain spotted fever - USA (03): (PA) fatal
http://promedmail.org/post/20140908.2757657
Rocky Mountain spotted fever - USA (02): (TN) increased incidence
http://promedmail.org/post/20140802.2653237
Rocky Mountain spotted fever - USA: (CA) fatality
http://promedmail.org/post/20140627.2568871
2013
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Rocky Mountain spotted fever - USA: (IL,NC)
http://promedmail.org/post/20130817.1886026
2012
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Rocky Mountain spotted fever - USA (05): (TN) increase
http://promedmail.org/post/20120802.1225293
Rocky Mountain spotted fever - USA (04): (KS, IL, AR)
http://promedmail.org/post/20120719.1206256
Rocky Mountain spotted fever - USA (03): (TN)
http://promedmail.org/post/20120606.1157629
Rocky Mountain spotted fever - USA (02): (AZ)
http://promedmail.org/post/20120411.1097210
Rocky Mountain spotted fever - USA: (MO), early susp. cases
http://promedmail.org/post/20120404.1090349]
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