Skip Navigation LinksHome > February 2015 - Volume 34 - Issue 2 > Clinical Profile and Predictors of Fatal Rocky Mountain Spot...
Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000496
Original Studies

Clinical Profile and Predictors of Fatal Rocky Mountain Spotted Fever in Children from Sonora, Mexico

Alvarez-Hernandez, Gerardo MD, PhD*; Murillo-Benitez, Coral MD; del Carmen Candia-Plata, Maria MD, PhD*; Moro, Manuel DVM, PhD

Supplemental Author Material
Collapse Box


Background: Rocky Mountain spotted fever (RMSF) is an increasingly important cause of preventable mortality in children in Sonora, Mexico. Although early treatment with tetracycline has shown to prevent fatal outcome, the disease remains a life-threatening condition, particularly for children. This study describes the clinical factors associated with pediatric mortality due to RMSF in Sonora, in order to guide healthcare practices.

Methods: This is a retrospective analysis of 104 children consecutively hospitalized at the major pediatric hospital of Sonora, diagnosed with RMSF between January 2004 and December 2013. Descriptive statistics and multiple logistic regression were used to identify risk factors for fatal outcome.

Results: The case fatality ratio in this cohort was 20.2%. Children were hospitalized after a median of 6 days from onset of symptoms including fever (100%), rash involving palms and soles (88.5%) and headache (79.8%); 90.4% of fatal cases had low platelet counts (<50,000/μL) and 33.3% showed serum creatinine concentrations above the normal value. Acute kidney injury increased mortality, odds ratio (ORadj) = 4.84, 95% confidence interval (CI): 1.2–16.2, as well as delay in treatment (≥ 5th day from onset) with doxycycline, ORadj = 2.62, 95% CI: 1.24–5.52 and hemorrhage, ORadj = 6.11, 95% CI: 1.89–19.69.

Conclusions: RMSF is a public health problem in Sonora. Clinically, fatal cases differ from non-fatal cases in renal function and hemorrhagic manifestations, although these findings may occur too late for a timely intervention. First-line providers must be educated to harbor a timely suspicion of RMSF, and should provide empiric treatment with doxycycline when febrile patients first present for care.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.