Thread by @IUIDfellowship

#idboardreview 40 M presents in summer w/fever, headache, myalagia later rash started on wrists, palms & soles and then diffuse. No hiking or travel. Multiple recent bug bites from her pet dogs who are not uptodate with flea/tick meds. Dx? #meded #idmeded #idtwitter

Rocky mountain spotted fever #RMSF ncbi.nlm.nih.gov/pmc/articles/P…

#RMSF @CDCgov cdc.gov/rmsf/healthcar…

#RMSF typically fever early in the course. OTher sx: HA, myalgias, N, V, abd pain. Rash is common but may not occur in first few days. Rash starts on wrists and ankles before spreading proximally. Palms/Soles 36-82% cases.

#RMSF Severe: skin necrosis, gangrenous digits, neurologic complications, azotemia, pulmonary edema, acute reps distress. Case fatality rate 23% without appropriate abx and upto 4% despite appropriate abx

#RMSF indirect immunofluorescence assage is serologic test of choice. 4fold increase in IgG titer from actue illness to convalescence confirms it. Dx: doxy 100bid x7-10d

#RMSF