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Tick-borne illness severe rickettsial disease — ABEM Board MCQ

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ModerateInfectious disease emergenciesTick-borne illness severe rickettsial diseaseABEM Board

A 9-year-old boy arrives with fever, headache, and rash after camping in North Carolina. Triage acuity is ESI 2; T 103.0 F, BP 94/54 mm Hg, HR 138/min. Rash began on wrists and ankles and now involves palms and soles. Platelets are low and sodium is 128 mEq/L. Which of the following is the most appropriate next step in management?

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Correct answer: D — Start doxycycline immediately

Suspected Rocky Mountain spotted fever is treated immediately with doxycycline in children and adults; treatment should not wait for serology.

Reference: CDC Rocky Mountain spotted fever guidance