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Biological Health Hazard – Fatal Rocky Mountain Spotted Fever (RMSF): Baja California, Mexico


Published Date: 2017-05-25 13:20:45
Subject: PRO/EDR> Rocky Mountain spotted fever – Mexico: (BC) fatalities
Archive Number: 20170525.5061586

Date: Wed 24 May 2017
Source: La Voz de la Frontera [in Spanish, machine trans., edited]

The Baja California State Health Secretariat has confirmed 3 new deaths from rickettsiosis. They are a girl of 1 year and 4 months, resident of Nuevo León in Mexicali, a young girl of 16, and a man of 59, both originating from Ensenada. Guillermo Trejo Dozal, head of the unit, also reported the case of another 55-year-old man living in Nuevo León, who remains at the General Hospital of Mexicali, where he is stable. With these, there are now 6 deaths due to rickettsiosis and 12 confirmed cases — 8 in Mexicali, 1 in Tijuana, 2 in Ensenada, and another in Vicente Guerrero.

Staff of the Department of Epidemiology of the Ministry of Health reported that preventive actions are being carried out in the community of Nuevo León where conditions of risk due to the presence of ticks have been located. Trejo Dozal said that the health sector has sufficient supply of medicines to treat the disease, which manifests with fever, headache, muscle pain, and general malaise. In advanced cases, diffuse abdominal pain, as well as red spots on the skin may occur.

Among the recommendations made by the health sector to prevent the spread of the disease are: keep the yards free of garbage, weeds, and debris; fumigate the home with appropriate insecticides; vaccinate, bathe, and treat pets; and go to the doctor in case of presenting any of the symptoms mentioned above.

The Secretary of Health warned that the increase in temperatures increases the proliferation of ticks, which is why it is essential to take preventive measures into account.

[Byline: Ericka Gallego]

Communicated by:

[The Rocky Mountain spotted fever (RMSF) rickettsia, _Rickettsia rickettsii_, is the cause of this illness, which is also referred to as febre maculosa, São Paulo exanthematic typhus, Minas Gerais exanthematic typhus, and Brazilian spotted fever. The organism, which is tickborne, is distributed through much of the USA, including the Rocky Mountains, and also in parts of southern Canada and Central and South America. It is vital to diagnose this rickettsial infection promptly to minimize morbidity and mortality.

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 a week after the tick exposure, long after the tick has detached. The presenting illness is generally nonspecific, with fever, muscle pains, and headache (but the headache is usually described as quite severe). The rash begins on day 3 of illness, initially maculopapular (a flat rash with small raised bumps) at the wrists and ankles before becoming petechial and purpuric (small and larger red or purple spots caused by bleeding under the skin), involving the palms and soles as well as spreading proximally to the trunk. Purpurae usually are 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 started in people with compatible symptoms inhabiting endemic areas during the spring and summer, even if no tick bite is known.

A picture of the rash in the source URL above appears to be that of varicella not RMSF. 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. – Mod.LL

Maps of Mexico can be seen at http://www.lib.utexas.edu/maps/americas/mexico_pol97.jpg and http://healthmap.org/promed/p/486. – Sr.Tech.Ed.MJ]

A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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