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Dr. Su S.
Dr. Su S., Pediatrician
Category: Pediatrics
Satisfied Customers: 20412
Experience:  20 years of experience in treating children.
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If the dx of rmsf is missed in a 7 year old and she is now

Customer Question

If the dx of rmsf is missed in a 7 year old and she is now 6-7 weeks from fever and seizures, should she get an emperic course of doxycycline for two weeks
JA: How long have you had a fever? Do you have any respiratory symptoms?
Customer: The patient had a fever for a week. 3 seizures. Was camping in the mountains 2 weeks before illness. Was in. Pediatric icu for a week. Intubated for seizures
JA: Anything else in your medical history you think the doctor should know?
Customer: had testing for hhv6, neg in hospital, 30 now, only; one dose of acyclovir given. No testing for for hohv7 or rmsf. No doxy given
Submitted: 29 days ago.
Category: Pediatrics
Expert:  Dr. Su S. replied 29 days ago.

Greetings,
Thank you for your question.
I am Dr. Su S.
I will try my best to help you.

Did she have rash?

What medicines were given in ICU?

What other medicines is she taking now?

Customer: replied 29 days ago.
No rash.
Keppra
Acyclovir- 1 dose only
Taking Keppra
In the hospital, her transaminase was 4000, but quickly dropped. Still complaining of abdominal pain.
Expert:  Dr. Su S. replied 29 days ago.

Thank you for the input.
As she had a history of travelling in the mountain area two weeks before illness, RMSF can be taken in differential diagnosis.
Usually fever, rash, abdominal pain are common symptoms.
Rash is present in 90% of cases, but she did not have it.
Initially tests may not be positive.
Doxycycline is the drug of choice.
Now you can discuss with her doctor about this.
If he feels, he can consider taking tests for RMSF.
I hope this information will be helpful.
If you have any query, please feel free to ask.
If you are happy with my answer please click on the Excellent/Good rating.
Wish her healthy life.
Regards.

Customer: replied 29 days ago.
Can you ever have a late relapse of RMSF, especially if no doxycycline was given initially? If yes, should she have doxycycline now? Given the change in titer of HHV6, should she have antiviral therapy, such as acyclovir?
Expert:  Dr. Su S. replied 29 days ago.

When repeat test for HHV6 was taken?

When did she receive Acyclovir?

Customer: replied 29 days ago.
Repeat HHV6 was done four weeks after initial testing. No testing was done for RMSF. She received Acyclovir within the first couple of days of hospitalization.
Expert:  Dr. Su S. replied 29 days ago.

HHV6 is usually self limiting disease.

She does not have fever, treatment may not be needed.

Persisting abdominal pain needs to be evaluated.

Ultrasound abdomen, repeat liver function test can be taken.

She should have a review by doctor.

Customer: replied 29 days ago.
Thank you, ***** ***** going to try to compromise and convince her pediatrician to give her a two week cycle of doxycycline since RMSF causes a vasculitis and the organisms remain in the endothelium and a late relapse is possible. Is it possible to discuss this with an Infectious Disease specialist?
Expert:  Dr. Su S. replied 29 days ago.

You are welcome.

You should to consult her pediatrician first.

After initial evaluation and tests, you can ask a referral for an Infectious Disease specialist.

If you are pleased with my answer, click on the 5 star rating.

Wish her early recovery.

Warm Regards.