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Rocky Mountain spotted fever complicated by gangrene: report of six cases and review.

Publication ,  Journal Article
Kirkland, KB; Marcom, PK; Sexton, DJ; Dumler, JS; Walker, DH
Published in: Clin Infect Dis
May 1993

Although mortality due to fulminant Rocky Mountain spotted fever (RMSF) is well appreciated, the ability of the disease to cause survivors to become permanently disabled is not as widely known. We report six cases of RMSF complicated by gangrene. Although four patients required multiple limb and/or digital amputations, only one death resulted. Our review of the English-language literature revealed 23 additional cases of RMSF complicated by gangrene. Pathophysiologically, gangrene is most likely related to small-vessel occlusion. Skin necrosis and gangrene in association with RMSF are the extreme end on a continuum from reversible to irreversible skin and tissue damage caused by Rickettsia rickettsii. Most patients with RMSF have a typical skin rash that resolves without sequelae. Some patients develop minute cicatrices marking the location of focal cutaneous necrosis; for other patients, digital ischemia occurs transiently or evolves to produce severe ischemic changes without gangrene that result in permanent impairment. At the far end of this clinical continuum are patients who develop gangrene requiring amputation.

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Published In

Clin Infect Dis

DOI

ISSN

1058-4838

Publication Date

May 1993

Volume

16

Issue

5

Start / End Page

629 / 634

Location

United States

Related Subject Headings

  • Rocky Mountain Spotted Fever
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Gangrene
  • Female
  • Extremities
  • Child
  • Amputation, Surgical
 

Citation

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Kirkland, K. B., Marcom, P. K., Sexton, D. J., Dumler, J. S., & Walker, D. H. (1993). Rocky Mountain spotted fever complicated by gangrene: report of six cases and review. Clin Infect Dis, 16(5), 629–634. https://doi.org/10.1093/clind/16.5.629
Kirkland, K. B., P. K. Marcom, D. J. Sexton, J. S. Dumler, and D. H. Walker. “Rocky Mountain spotted fever complicated by gangrene: report of six cases and review.Clin Infect Dis 16, no. 5 (May 1993): 629–34. https://doi.org/10.1093/clind/16.5.629.
Kirkland KB, Marcom PK, Sexton DJ, Dumler JS, Walker DH. Rocky Mountain spotted fever complicated by gangrene: report of six cases and review. Clin Infect Dis. 1993 May;16(5):629–34.
Kirkland, K. B., et al. “Rocky Mountain spotted fever complicated by gangrene: report of six cases and review.Clin Infect Dis, vol. 16, no. 5, May 1993, pp. 629–34. Pubmed, doi:10.1093/clind/16.5.629.
Kirkland KB, Marcom PK, Sexton DJ, Dumler JS, Walker DH. Rocky Mountain spotted fever complicated by gangrene: report of six cases and review. Clin Infect Dis. 1993 May;16(5):629–634.

Published In

Clin Infect Dis

DOI

ISSN

1058-4838

Publication Date

May 1993

Volume

16

Issue

5

Start / End Page

629 / 634

Location

United States

Related Subject Headings

  • Rocky Mountain Spotted Fever
  • Middle Aged
  • Microbiology
  • Male
  • Humans
  • Gangrene
  • Female
  • Extremities
  • Child
  • Amputation, Surgical