Pathogenic Bacteria: Rickettsia, Ehrlichia, Anaplasma, and Bartonella
A 6-year-old girl from North Carolina was in her usual state of good health until 10 days before admission, when she had a tick removed from her scalp. She developed a sore throat, malaise, and a low-grade fever 8 days after tick removal. She was seen by her pediatrician when she began developing a pink, macular rash, which started on her palms and lower extremities and spread to cover her entire body. The pediatrician’s diagnosis was viral exanthem. One day before admission, she developed purpura, emesis, diarrhea, myalgias, and increased fever. On the day of admission, she was taken to her local hospital emergency room because of mental status changes. Her physical examination was significant for diffuse purpura; periorbital, hand, and foot edema; cool extremities with weak pulses; and hepatosplenomegaly. Her laboratory studies revealed: Na+ level of 125 mmol/L, platelet count 26 000/mm3, WBC count 14 900/mm3, hemoglobin level of 8.8 g/L, and greatly increased coagulation times. Ampicillin therapy was begun, and she was intubated but died soon after transfer to another institution.
Question 1 of 3
What feature in this patient’s history is most helpful?
A - Sore throat
B - Rash
C - Tick bite
D - Diarrhea
E – Leukocytosis
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