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오늘은 ' 록키산 홍반열 [ Rocky MountaIn Spotted Fever ] '에 대해 알아보고 정리하겠습니다!
록키산 홍반열
[ Rocky MountaIn Spotted Fever ]
정의
사람과 개에 영향을 미치는 Rickettsia rickettsii 에 의해서 일어나는 진드기 매개 리켓치아성 질병.
원인
Rickettsia rickettsii 라는 진드기에 물려 걸림
발병기전
출처 입력→ 진드기의 타액이 침입 → 혈관 내피세포에서 증식함.
발병 및 역학
• 3월 후반에서 9월말까지가 진드기의 계절임.
• 잠복기는 2일에서 2주 정도임.
• 저먼 셰퍼드가 다른 견종보다 감수성이 있음.
주요증상
간, 비장 종대, 비장종대, 간종대; 거리감각불능, 거리감각 과대 및 과소; 결막, 공막 부종; 결막, 공막의 발적; 결막, 공막의 충혈, 혈관의 이상; 구강점막의궤양, 수포, 플라크(반), 농포, 미란, 절창; 구토; 기립불능, 다우너; 기침; 난청, 귀머거리; 눈물흘림, 장액성 분비물, 축축한 눈; 눈의 화농성 분비물; 다뇨증; 다음, 많이 마심, 지나친 갈증; 다호흡, 빠른호흡(빈호흡), 과호흡; 단백뇨; 뒷다리 반사 이상(증가나 감소); 뒷다리 양쪽 부전마비, 무기력, 마비; 뒷다리 종창, 종괴(관절부/비관절부 포함); 뒷다리 통증; 뒷다리 파행, 경직, 절름발이; 뒷발, 발가락 종창, 종괴; 림프절 종대, 림프절 병증, 종창, 종괴; 망막출혈; 망막혈관 크기 이상; 머리 기울기; 목, 경부, 목구멍 통증; 목의 경직, 뻣뻣한 목; 무기력, 침울, 졸림, 생기없음; 발열, 고열; 실신, 경련, 간질발작, 허탈; 복강 외부 압박에 따른 통증; 부정맥, 불규칙한 심박 및 맥박; 비정상의 폐포음, 흉강음, 랏셀음, 염발음, 천명음, 마찰음; 비정상적 또는 공격적 행동, 습성이 바뀜; 비정상적인 자세; 비출혈, 코피; 빈맥, 빠른 맥박, 심박; 사지마비, 무기력; 산통, 복통; 선회운동; 설사, 하리; 수척, 건강상태 불량, 증체율 불량; 식욕부진, 식욕감소, 식욕절폐, 젖을 안먹임, 먹이 공급 중단; 실명, 시력상실; 심음의 감소; 안구 전방출혈, "블랙 아이"; 안구진탕, 안구불수의적운동; 앞다리 종창, 종괴(관절부/비관절부위 포함); 앞다리 통증; 앞다리 파행, 경직, 절름발이; 앞발, 발가락 종창, 종괴; 요통, 허리 통증; 운동실조, 협조불능, 절뚝거림, 넘어짐; 유착증, 유착; 음경, 포피, 고환, 음낭의 종대, 종괴; 음낭 통증; 이동거부; 전신파행, 경직, 절름발이; 점막, 피부 창백, 빈혈; 점상 또는 반상출혈, 타박상; 점액양 비강 분비물, 장액성, 수양성; 지각과민, 예민함, 과다운동; 진전; 체중감소; 탈수; 피부 괴사, 가피, 괴저; 피부 부종; 피부 통증; 피부, 털, 깃털에 기생충; 피부, 털, 깃털이 축축함; 피부의 궤양, 미란, 찰과상; 피부홍반, 염증, 발적; 핍뇨, 무뇨증, 요 정체; 혈뇨; 혈변; 혈변, 분변내 잠혈; 혈색소뇨, 근색소뇨; 호흡곤란, 개구호흡, 그르렁거림, 가쁜호흡; 혼수, 혼미; 화농성 비강 분비물; 황달; 흉부 종창, 흉부, 가슴, 늑골, 흉골의 종괴
감별진단
• 에르리히증(Canine ehrlichiosis).
• 면역 매개성 혈소판감소증(Immune-mediated thrombocytopenia).
• 전신성 홍반성 낭창(systemic lupus erythematosus).
• 부루셀라증(brucellosis).
치료
• Doxycycline : 10㎎/㎏을 10일 동안 하루 두 번 경구투여하거나 만약 구토가 있을시에는 5일 동안 정맥주사함.
• Prednisolone, Tetracycline, Oxytetracycline : 22㎎/㎏을 14일 동안 8시간마다 경구투여함.
• Chloramphenicol : 6개월 이하의 강아지에서 20㎎/㎏을 14일 동안 8시간마다 경구투여하고 혈소판 감소증 시에는 사용을 피함.
• Enrofloxacin : 3㎎/㎏을 7일 동안 8시간마다 경구투여함.
문제
A 24-year-old man presents to the office complaining of fatigue, nausea, fevers, and a rash on his hands and feet. The symptoms started after a camping trip with his family in North Carolina, but he denies any contact with sick individuals. The rash began a few days after he started to feel sick. He reports unprotected sex with a single female partner for the past 3 years. Vital signs include: temperature 38.5°C (101.3°F), blood pressure 100/60 mm Hg, heart rate 82/min, respiratory rate 14/min, and O2 saturation 99% on room air. The patient appears unwell. He has a maculopapular rash on his upper and lower extremities, including the palms of his hands and soles of his feet. What is the most likely cause of this patient’s condition?
| A. A sexually transmitted spirochete B. A protozoan transmitted via the Ixodes tick C. A gram-negative bacteria transmitted via the Dermacentor tick D. A gram-negative bacterium transmitted via the Ixodes tick E. A positive-sense, single-stranded RNA virus that is non-enveloped |
| Explanation: Correct answer C: Rocky Mountain spotted fever (RMSF) is an infection caused by the Gram-negative, intracellular, coccobacillus bacterium Rickettsia rickettsii and is transmitted to humans most often by the American dog tick (Dermacentor variabilis, also called the "Rocky Mountain wood tick"). The disease presents with systemic symptoms, such as fever and headache, as well as a rash that starts at the wrists or ankles and spreads to the rest of the body, including the palms of the hands and soles of the feet. Disease presentation and progression may be variable, including the appearance of the rash. The rash usually presents a few days to a week after the fever begins. The infection can progress to be life-threatening. Although the name suggests geography, RMSF can be found anywhere in the United States, as well as throughout Central and South America. This patient’s presentation and history make RMSF the most likely diagnosis. Option A: Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. Syphilis involves 3 stages of progression after exposure. Primary syphilis occurs right after exposure and presents as a painless chancre on the genitalia that disappears spontaneously. Secondary syphilis is the 1st step in the dissemination of the disease and presents with flu-like symptoms, as well as a maculopapular rash that includes the palms of the hands and soles of the feet. Tertiary syphilis is very dangerous and can lead to aortitis, neurosyphilis (tabes dorsalis), blindness, and chronic granulomas. The rash in secondary syphilis is similar to that seen in this patient – and this patient is sexually active. However, this patient’s monogamous relationship paired with a lack of genitourinary symptoms makes this diagnosis unlikely. Option B: Babesiosis is a disease caused by the protozoan of the genus Babesia that is transmitted via the Ixodes scapularis tick, also known as the black-legged or deer tick, the same vector that transmits the bacterium that causes Lyme disease (Borrelia burgdorferi) as well as the bacterium that causes human granulocytic anaplasmosis (Anaplasma phagocytophilum); coinfections are common and need to be excluded if the patient does not respond to standard antibiotic therapy. Symptoms of babesiosis include fever, fatigue, and myalgias. Babesiosis can cause hemolytic anemia, which is most dangerous in asplenic patients and patients with sickle cell anemia. Laboratory diagnosis of babesiosis is usually made by microscopy and/or PCR; serology is less commonly used. On the peripheral blood smear, Babesia parasites resemble Plasmodium falciparum but Babesia has several distinguishing features: the parasites are pleomorphic (vary in shape and size), can be vacuolated, and do not produce pigment. Babesiosis does not have an associated rash, making it an unlikely diagnosis in this patient. Option D: Lyme disease is caused by Borrelia burgdorferi, a gram-negative bacterium transmitted via the Ixodes tick. Lyme disease is characterized by a stepwise progression, beginning with the characteristic ‘bullseye’ rash known as erythema migrans. The rash is a telltale but transient sign that may go unnoticed depending on location. The next stage of progression is the early dissemination stage, which includes flu-like symptoms; fatigue; myalgias; and transient, migrating joint pain. Next is the late disseminated stage, which can involve encephalopathy, neuropathy, and carditis. This patient’s rash is not consistent with the presentation of Lyme disease, making this an unlikely diagnosis. Option E: Coxsackievirus is a member of the Picornaviridae family – encapsulated, single-stranded RNA viruses. There are 2 subgroups of coxsackievirus: group A and group B. Group A is responsible for herpangina; hemorrhagic conjunctivitis; and hand, foot, and mouth disease (HFMD). HFMD is a highly contagious disease associated with children. It involves constitutional symptoms, including a fever accompanied by a rash that occurs in and around the mouth, on the palms of the hands, and on the soles of the feet. This patient’s rash is not consistent with HFMD, making this an unlikely diagnosis. Learning objective: Know the typical signs and symptoms of Rocky Mountain spotted fever (RMSF) and its etiologic agent. RMSF is an infection caused by the bacterium Rickettsia rickettsii and is introduced to humans via the Dermacentor ("American dog") tick. The disease presents with a characteristic rash that can include the palms of the hands and soles of the feet. |
| Related Videos: Tick-Borne Disease, Lyme Disease, Rocky Mountain Spotted Fever (RMSF) & Ehrlichiosis09:08 min 0% Complete |
| Book References: First Aid for the USMLE Step 1 (2021, 31st ed): 149, 150 First Aid for the USMLE Step 1 (2020, 30th ed): 149, 150 First Aid for the USMLE Step 1 (2019, 29th ed): 149, 150 First Aid for the USMLE Step 1 (2018, 28th ed): 149, 150 First Aid for the USMLE Step 1 (2017, 27th ed): 144, 145 |
https://terms.naver.com/entry.naver?docId=987508&cid=42478&categoryId=42525
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