Rocky Mountain spotted fever needs early treatment

DEAR DR. GOTT: I need some information on Rocky Mountain spotted fever. My 47-year-old boyfriend was diagnosed with this in November 2009. He continues to get worse, has a lot of memory loss, poor balance and uses a walker. He still tests positive after all this time. He waited several weeks before getting any help. He had a high fever, was confused, and could not walk. At this point, I called the ambulance and had him taken to the hospital. All the doctors that we have seen during several hospital stays have said that he will never recover. He was given antibiotics at one point, which his doctors called a “big gun” and were the strongest there is. He is depressed, has mood swings, cries a lot, and depends on me 24/7. Around the same time, he also had a staph infection that he got from an open wound. Is there anything I can do to help him?

DEAR READER: Let’s start with the staph infection. I cannot determine whether this was related to his symptoms because you did not elaborate on how severe the infection was. Staph bacteria are common and can be found just about everywhere. Most cases of infection are minor and only affect the skin; however, rarely, the infection can become severe and result in symptoms similar to those your boyfriend experienced (I assume due to his Rocky Mountain spotted fever and not the staph) and may, in some instances, result in life-threatening consequences. Treatment involves antibiotics. In many cases, cultures should be taken to determine which antibiotic will be most effective in eradicating the infection. This is because staph are adaptable. Less than 10 percent of cases can be treated with penicillin, and up to 50 percent of staph found in hospitals is resistant to another common antibiotic, methicillin (referred to as methicillin-resistant staphylococcus aureus, or MRSA).

Now to the Rocky Mountain spotted fever. Caused by the bacteria Rickettsia rickettsii, this illness is most commonly transmitted by the American dog tick, wood tick or the Lone Star tick. Contrary to popular belief, Rocky Mountain spotted fever is not found only in the Rocky Mountains. The name was given because some of the first identified cases came from the area.

In 2002, according to the CDC, North and South Carolina, Oklahoma, Missouri and Arkansas had the most cases reported. North Carolina and Oklahoma alone accounted for 35 percent of all reported cases between 1993 and 1996.

Early symptoms include high fever (102 F or higher), severe headache, chills, abdominal pain, fatigue, loss of appetite, nausea, vomiting and sensitivity to light. As the infection progresses, sufferers may experience diarrhea, restlessness, widespread aches and pains, a red-spotted or blotchy rash on the wrists or ankles, and delirium (restlessness, confusion, possible hallucinations).

If treatment is delayed or not sought, Rocky Mountain spotted fever can cause brain damage, shock, gangrene (resulting in amputation of the affected area), meningitis, blood-clotting abnormalities and heart, lung or kidney failure. On rare occasions, it can be fatal.

Treatment is fairly straightforward for those who seek and initiate treatment within five days of developing symptoms. For these cases, antibiotic medication, most often doxycycline, is taken for one week to 10 days or until at least three days after the fever and symptoms subside.

Because your boyfriend waited so long before seeking help, he may be suffering from permanent damage to his brain and/or other organs. I urge him to be examined by a physician or specialist familiar with Rocky Mountain spotted fever, particularly in cases in which treatment was delayed. He likely needs an extended course of antibiotic therapy.

DEAR DR. GOTT: My 16-year-old son gets little almost hard balls in his throat. Yellowish in color, they are usually a little larger than a grain of sand. They are not hard but not soft, either. Today, he choked up one that was larger than usual and pink. Any idea what they could be?

DEAR READER: Your son may be experiencing tonsil stones. These are compressed particles of bacteria, food and other debris that get caught in the tonsils. His latest one was pink, suggesting that there was some irritation and mild bleeding into the tonsillar stone. Make an appointment for him with his physician to discuss the situation. Perhaps a referral to an ear-nose-and-throat specialist is in order, especially if he has other symptoms such as a sore throat, swollen tonsils, bad breath or difficulty swallowing. Those with minor or no symptoms may not require treatment. For those with associated symptoms, the only surefire treatment for stones that cause problems is removal of the tonsils; however, some patients may respond well to antibiotics. In the meantime, he may wish to try gargling with saltwater in an attempt to remove them.