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Diagnosis of Rocky Mountain spotted fever

Tests and diagnosis discussion for Rocky Mountain spotted fever:

Rocky Mountain spotted fever: Signs and Symptoms: DVRD (Excerpt)

Rocky Mountain spotted fever can be very difficult  to diagnose in its early stages, even among experienced physicians who are familiar with the disease.   (Source: excerpt from Rocky Mountain spotted fever: Signs and Symptoms: DVRD)

Rocky Mountain spotted fever: Signs and Symptoms: DVRD (Excerpt)

Abnormal laboratory findings seen in patients with Rocky Mountain spotted fever may include thrombocytopenia , hyponatremia , or elevated liver enzyme levels. See Laboratory Detection for more information on laboratory confirmation of Rocky Mountain spotted fever. (Source: excerpt from Rocky Mountain spotted fever: Signs and Symptoms: DVRD)

Rocky Mountain spotted fever: Laboratory: DVRD (Excerpt)

There is no widely available laboratory assay that provides rapid confirmation of early Rocky Mountain spotted fever.  Therefore, treatment decisions should be based on epidemiologic and clinical clues, and should never be delayed while waiting for confirmation by laboratory results. Fundamental understanding of the signs, symptoms, and epidemiology of the disease is crucial in guiding requests for tests for Rocky Mountain spotted fever and interpretation of results. Routine clinical laboratory findings suggestive of Rocky Mountain spotted fever may include normal white blood cell count, thrombocytopenia, hyponatremia, or elevated liver enzyme levels (Source: excerpt from Rocky Mountain spotted fever: Laboratory: DVRD)

Rocky Mountain spotted fever: Laboratory: DVRD (Excerpt)

Serologic assays are the most widely available and frequently used methods for confirming cases of Rocky Mountain spotted fever. The indirect immunofluorescence assay (IFA) is generally considered the reference standard in Rocky Mountain spotted fever serology and is the test currently used by CDC and most state public health laboratories (Figure 15). (Source: excerpt from Rocky Mountain spotted fever: Laboratory: DVRD)

Rocky Mountain spotted fever: Laboratory: DVRD (Excerpt)

IFA can be used to detect either IgG or IgM antibodies. Blood samples taken early (acute) and late (convalescent) in the disease are the preferred specimens for evaluation. Most patients demonstrate increased IgM titers by the end of the first week of illness. Diagnostic levels of IgG antibody generally do not appear until 7-10 days after the onset of illness.  It is important to consider the amount of time it takes for antibodies to appear when ordering laboratory tests, especially because most patients  visit their physician relatively early in the course of the illness, before diagnostic antibody levels may be present.  The value of testing two sequential serum or plasma samples together to show a rising antibody level is considerably more important in confirming acute infection with rickettsial agents because antibody titers may persist in some patients for years after the original exposure.

Another approach to Rocky Mountain spotted fever diagnostics is immunostaining . This method is used by taking a skin biopsy of the rash from an infected patient prior to therapy or within the first 48 hours after antibiotic therapy has been started.  Because rickettsiae are focally distributed in lesions of Rocky Mountain spotted fever, this test may not always detect the agent.  Even in laboratories with expertise in performing this test, the sensitivity is only about 70% on biopsied tissues.  This assay may also be used to test tissues obtained at autopsy and has been used to confirm Rocky Mountain spotted fever in otherwise unexplained deaths (Figure 16).  Immunostaining for spotted fever group rickettsiae is offered by the CDC, a few state health departments, and some university-based hospitals and commercial laboratories in the United States. (Source: excerpt from Rocky Mountain spotted fever: Laboratory: DVRD)

Diagnosis of Rocky Mountain spotted fever: medical news summaries:

The following medical news items are relevant to diagnosis and misdiagnosis issues for Rocky Mountain spotted fever:

 

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