MMWR - Dx and Mfmt of Tickborne Rickettsial Diseases

[Guest guest]

My Dr handed me the hard copy of this kind of morbid report today.

MMWR is Morbidity and Mortality Weekly Report from the publishers of

the New England Journal of Medicine

My Lyme is active at the moment and I am having a hard time

comprehending things, so I am looking for comments and feedback on

this.

The introduction is copied below. The link to the full article is

here :

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm

Thanks,

*S*

Introduction

Tickborne rickettsial diseases (TBRD) are clinically similar, yet

epidemiologically and etiologically distinct illnesses. In the United

States, these diseases include 1) Rocky Mountain spotted fever

(RMSF), 2) human monocytotropic (or monocytic) ehrlichiosis (HME), 3)

human granulocytotropic (or granulocytic) anaplasmosis (HGA, formerly

known as human granulocytotropic ehrlichiosis or HGE) (1), 4)

Ehrlichia ewingii infection, and 5) other emerging TBRD. The reported

incidence of these diseases has increased during the previous decade.

Despite the availability of low-cost and effective antibiotic

therapy, which may be used empirically for suspected cases, TBRD

continue to cause severe illness and death in otherwise healthy

adults and children. The greatest challenge to clinicians is

diagnosing these infections early in their clinical course, when

antibiotic therapy is most effective (2,3). The majority of patients

with TBRD seek medical care within 2--4 days of onset of illness (4--

7). In general, these patients are first evaluated by family

practitioners, pediatricians, internists, emergency department (ED)

physicians, or physician extenders. Early signs and symptoms of these

illnesses are notoriously nonspecific, or they might mimic benign

viral illnesses, making diagnosis difficult. For example, even in

areas where awareness of RMSF is high, approximately 60%--75% of

patients with this TBRD receive an alternate diagnosis on their first

visit for medical care (8,9). Moreover, the earlier patients seek

care in the course of their illness, the more likely an alternate

diagnosis will be made (4). The lack of a specific initial syndrome,

however, does not imply that the course of these diseases will be

benign.

In October 2004, to address the need for a consolidated resource for

the diagnosis and management of TBRD, CDC's Viral and Rickettsial

Zoonoses Branch collaborated with 11 clinical and academic

specialists of RMSF, HGA, and HME. These external contributors were

invited by CDC subject matter specialists to participate among

clinicians and researchers in the field of TBRD, based on direct

working interactions related to case consultation and recognized

expertise from peer-reviewed publications. In December 2004, the

framework of this report was developed by CDC's Viral and Rickettsial

Zoonoses Branch, based on a summary of the peer-reviewed published

reports on the epidemiology and clinical aspects of TBRD. External

contributors further developed recommendations for the diagnosis and

treatment of TBRD based on their clinical research and experience.

All work group collaborators reviewed and provided input and approved

the final content of this report.

The primary goal of this report is to provide primary care physicians

and physician extenders with practical information to assist with the

diagnosis and care of patients with TBRD. This report provides a

framework for recognizing suggestive symptoms, considering likely

alternative diagnoses, eliciting relevant history, requesting

appropriate diagnostic tests, and initiating prompt, effective

treatment. Information in this guide is designed to assist clinicians

to

recognize common epidemiologic situations and clinical manifestations

of TBRD;

obtain appropriate history and diagnostic tests for TBRD;

develop a differential diagnosis that includes and ranks TBRD;

make treatment decisions based on epidemiologic and clinical

evidence;

recognize that doxycycline is the treatment of choice for both adults

and children;

recognize that early and empiric antibiotic therapy can prevent

severe morbidity or death;

identify the availability, limitations, and utility of confirmatory

laboratory assays;

recognize potential severe manifestations of TBRD; and

report suspected and confirmed cases to appropriate public health

authorities to assist with control measures and public health

education efforts.

This report also provides resources on TBRD for health-care and

public health professionals. Clinical cases are included for self-

evaluation and to reinforce the information presented in this guide.

Additional information concerning TBRD in this report is available

from medical specialists, various medical societies, CDC, and state

and local health authorities.