INFECTIONS - Medicine for Mountaineering and Other Wilderness Activities - page 307

ache,astiffneck,andnauseaandvomitingsuggestinvolvementofthebrainoritscovering
(meningitis). Cough, shortness of breath, and pain with breathing suggest pneumonia.
With such severe infections, prompt administration of antibiotics may be lifesaving.
Ceftriaxone (Rocephin®) combined with ciprofloxacin is a broadly effective regimen. If
only aqueous penicillin G is available, it should be given intravenously. Persons with such
severe infections should be evacuated.
Individuals with bacteremia should be provided with rest, warmth, a soft or liquid diet,
and adequate fluids. Medications for pain and sleep are often helpful; aspirin or acet-
aminophen may be given to reduce fever. A record must be kept and should include the
individual's temperature and the times any drugs are administered.
Rocky Mountain Spotted Fever
The triad of fever, severe headache, and rash occurring in the warmer seasons should
suggest the possibility of a rickettsial infection. Rickettsiae, a bacteria with worldwide dis-
tribution,aretransmittedtohumansbythebiteofarthropodvectors,suchasticks,lice,and
fleas. Not only the most severe of the rickettsial infections, Rocky Mountain spotted fever
(RMSF) is also the most prevalent rickettsial disease in the United States. Other spotted
feversareamongtheemerginginfectiousdiseasesoccurringwithincreasingfrequency,not
only in the United States but also around the world. RMSF is caused by Rickettsia rick-
ettsii transmitted to humans by the bite of a wood- or dog tick. Two to fourteen days after
the bite, mild chilliness, loss of appetite, and a general rundown feeling appear. These mild
symptoms are followed by chills, fever, pain in the bones and muscles, severe headache,
and confusion. Between two and six days after the onset of symptoms, small red spots ap-
pear on the skin around the wrists and ankles and spread over the entire body, frequently
including the palms of the hands and the soles of the feet. These spots are actually hemor-
rhages into the skin; in severe cases, large blotchy red areas may appear all over the body.
The person appears seriously ill without an obvious cause. Untreated infections last about
two weeks and have a mortality rate of 20 to 30 percent; treatment reduces the rate to 3
to 10 percent. Diagnosis is aided by a history of a tick bite in an endemic area. In spite of
this infection's name, which reflects the site where it was first identified, the most import-
ant endemic area is the south-Atlantic coastal states; over half of Rocky Mountain spotted
fever infections are reported from Delaware, Maryland, Washington, D.C., Virginia, West
Virginia, North Carolina, South Carolina, Georgia, and Florida ( Fig. 22-1 ) . Infections also
occurinotherpartsoftheUnitedStates,thePacificregion(Washington,Oregon,andCali-
fornia)andthewestsouth-central(Arkansas,Louisiana,Oklahoma,andTexas)region.The
two states with the highest incidences of Rocky Mountain spotted fever, North Carolina
and Oklahoma, accounted for 35 percent of the total number of U.S. cases reported from
1993 through 1996. This infection can occur in any of the fortyeight contiguous states.