North Carolina presents with a febrile illness. He reports a 5-day history of fever, malaise, headache, and vomiting. Today, he has developed a nonpruritic rash that began on his extremities and has spread to his body.
On exam he has a fever of 38.3◦C with a pulse of 120 and otherwise normal vitals. The rash is maculopapular and generalized, involving his palms and soles. Oral mucosa is dry but intact, and the exam is otherwise nonspecific.
Basic investigations were done and CBC shows mild thrombocytopenia but is normal otherwise. BUN and creatinine are at the upper limits of normal, and the electrolytes are normal.
The rash on his hand and feet is shown below:
What is the most likely Diagnosis?
Rocky Mountain spotted fever (RMSF).
Case Discussion:
Rocky Mountain spotted fever RMSF is a tick-borne (dog or wood tick) disease caused by Rickettsia rickettsii. Despite its name, RMSF is endemic in the southeastern United States, the Atlantic states, and the northern Rocky Mountains.
Clinical features: It presents with a prodrome of fever and headache several days before the onset of the characteristic rash—a maculopapular eruption that begins at the wrists and ankles and spreads centrally. Eventually, the rash becomes petechial.
Laboratory manifestations of RMSF are generally nonspecific: mild thrombocytopenia (rarely becoming severe), hyponatremia, azotemia, elevated transaminases, and prolonged PTT and PT.
Management: Early treatment is essential. Individuals treated after 5 days of symptoms have worse outcomes than those treated earlier. Awaiting serologic studies is inappropriate and treatment should not be delayed. The drug of choice in the treatment of RMSF is doxycycline 100 mg PO BID for 14 days.
This is true for children as well! Pregnant women should be treated with chloramphenicol. Agents such as penicillin, fluoroquinolones, and cephalosporins are inappropriate in this situation.
Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.
ReplyDeleteNice blog
ReplyDeleteHave been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
Thanks so much for reading my article, you should share your testimony if you have cure as well
Dr.akpupowerherbscenter@gmail.com
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