Rocky Mountain Spotted Fever: The Daily PANCE Blueprint
During your assessment of a patient with Rocky Mountain Spotted Fever, which of the following is most likely to be seen?
A. Fever every three days
B. Rash spreads from head to toe
C. Slapped cheek rash in children
D. Erythema marginatum
E. Rash migrates towards the trunk
Answer and topic summary
The answer is E. Rash migrates towards the trunk
Rocky Mountain Spotted Fever (RMSF) is a life-threatening tick-borne illness caused by Rickettsia rickettsii. The hallmark rash starts on the wrists and ankles, then spreads centrally toward the trunk, typically appearing 2-5 days after fever onset. It is often petechial and can become hemorrhagic.
Clinical Presentation: Fever, headache, myalgias, and a maculopapular rash that progresses to petechiae. Late-stage complications include vasculitis, multi-organ failure, and shock.
Diagnosis: Primarily clinical—do not delay treatment for lab confirmation. Serologic tests (IFA for IgG) are supportive but take days to return.
Treatment: Doxycycline is the first-line treatment, even in children, as delay increases mortality risk.
| Condition |
Cause |
Rash Characteristics |
Clinical Presentation |
Diagnosis |
Treatment |
| Rocky Mountain Spotted Fever (RMSF) |
Rickettsia rickettsii |
Starts on wrists and ankles, spreads to trunk, petechial, can become hemorrhagic |
Fever, headache, myalgias, maculopapular rash, late-stage complications: vasculitis, multi-organ failure, shock |
Primarily clinical, serologic tests (IFA for IgG) supportive |
Doxycycline, even in children |
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