Knowledge, Attitudes, and Practices Regarding Rocky Mountain Spotted Fever among Healthcare Providers, Tennessee, 2009

Vanderbilt University, Нашвилл, Michigan, United States
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 12/2012; 88(1). DOI: 10.4269/ajtmh.2012.12-0126
Source: PubMed


Tennessee has a high incidence of Rocky Mountain spotted fever (RMSF), the most severe tick-borne rickettsial illness in the United States. Some regions in Tennessee have reported increased illness severity and death. Healthcare providers in all regions of Tennessee were surveyed to assess knowledge, attitudes, and perceptions regarding RMSF. Providers were sent a questionnaire regarding knowledge of treatment, diagnosis, and public health reporting awareness. Responses were compared by region of practice within the state, specialty, and degree. A high proportion of respondents were unaware that doxycycline is the treatment of choice in children ≤ 8 years of age. Physicians practicing in emergency medicine, internal medicine, and family medicine; and nurse practitioners, physician assistants, and providers practicing for < 20 years demonstrated less knowledge regarding RMSF. The gaps in knowledge identified between specialties, designations, and years of experience can help target education regarding RMSF.

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    ABSTRACT: Among 2012 Docstyle survey respondents, 80% identified doxycycline as the appropriate treatment for Rocky Mountain spotted fever in patients ≥8 years old, but only 35% correctly chose doxycycline in patients <8 years old. These findings raise concerns about the higher pediatric case-fatality rate of Rocky Mountain spotted fever observed nationally. Targeted education efforts are needed.
    No preview · Article · Nov 2013 · The Journal of pediatrics
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    ABSTRACT: Strains of Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever (RMSF), differ dramatically in virulence despite>99% genetic homology. Spotted fever group (SFG) rickettsiae produce two immunodominant outer membrane proteins, rickettsial OmpA (rOmpA) and rOmpB, which are conserved throughout the SFG and thought to be fundamental to pathogenesis. rOmpA is present in all virulent strains of R. rickettsii but is not produced in the only documented avirulent strain, Iowa, due to a premature stop codon. Here we report the creation of an isogenic ompA mutant in the highly virulent strain Sheila Smith by insertion of intronic RNA to create a premature stop codon 312 bp downstream of the 6,747-bp open reading frame initiation site (int312). Targeted insertion was accomplished using an LtrA group II intron retrohoming system. Growth and entry rates of Sheila Smith ompA::int312 in Vero cells remained comparable to those of the wild type. Virulence was assessed in a guinea pig model by challenge with 100 PFU of either ompA::int312 Sheila Smith or the wild type, but no significant difference in either fever peak (40.5°C) or duration (8 days) were shown between the wild type and the knockout. The ability to disrupt genes in a site-specific manner using an LtrA group II intron system provides an important new tool for evaluation of potential virulence determinants in rickettsial disease research.
    Full-text · Article · Mar 2015 · mBio
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    ABSTRACT: Tick-borne infections create diagnostic challenges because they tend to present with nonspecific findings. Because clinicians often fail to recognize tick-borne illnesses in early stages, therapy is frequently delayed or omitted. This is especially problematic for rickettsial infections (Rocky Mountain spotted fever, ehrlichiosis, and anaplasmosis), because the risk of long-term morbidity and mortality increases with delayed treatment. We emphasize the need for clinicians to maintain a high index of suspicion for tick-borne infections; to diagnose these illnesses presumptively, without waiting for confirmatory laboratory test results; and to promptly start therapy with doxycycline, even in young children, when rickettsial infections are suspected. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Infectious disease clinics of North America
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