| Identifier |
Spotted_fever_Lee |
| Title |
Spotted Fever |
| Creator |
Andrew G. Lee, MD |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York |
| Subject |
Infectious Disease; Rocky Mountain Spotted Fever; Spotted Fever Group |
| Description |
Dr. Lee lectures medical students on neuro-ophthalmological manifestation of the spotted fever group. |
| Transcript |
"So today we're going to talk about how spots and fever come to us in neuro-op. And we're not going to cover all the infectious disease aspects, but when you have a patient who has a rash and fever and has meningeal signs plus neuro-op signs, you really should be thinking about the spotted fever groups. And the spotted fevers come in different flavors because they are arthropod-borne and that means they have different vectors and so you need to know a little bit about the different vectors. We have flea, tick, and the louse which is the body louse. So for the flea that's going to be rickettsia typhi - that's our endemic form. Usually it's in cats and dogs but also possums in the wild. The tick that's the rocky mountain spotted fever group - that's rickettsia rickettsii. And you don't have to be from the Rockies or been to the mountains; in fact you don't even have to have spots. But you do have to have the fever. And rocky mountain spotted fever mostly comes in our country from not the Rockies, but from the Smokies and from Applachians and North Carolina and Missouri - that's where kind of our rocky mountain spotted fever is. And the body louse causes the epidemic form of typhus: rickettsia prowazekii. So typhi is the one we see here in Houston - it's like the city version of it because of flea and pets. And then the country version of it is the tick one - hiking, biking, walking your dog in the woods. These are all tested by serologies, and as you know we have IgM and IgG responses. And so if you have IgM positive that's evidence for an acute infection. If you have a rising or very high IgG titer then that's diagnostic. But if you've got this in between version you have to show the titer is rising - that means you have to have an acute and a convalescent titer just so it's going up. And so normally the cut points are going to be like 1:128 or 1:256. So once you get to numbers like 1:512 and 1:1024 those are positive. Or if you have IgM positive that's pretty much acute infection - do the IgG to show that it's rising titer. And the reason it's important to neuro-op is they start with constitutional symptoms (fever) then they get the rash (spots) then they have the nausea, vomiting, headache, and the stiff neck, photosensitivity. And so what we're going to be called for in this setting is they're going to have blurry vision, and we're going to be looking in their eye. What we're going to be looking for is papillitis (the disc is swollen), papilledema from increased intracranial pressure and the retinis which can show up as hemorrhages or fluid in the macula, cottonwool patches, infectious neuroretinitis. And OCT is really great in these cases because it can help differentiate whether we're dealing with an optic neuropathy or are we dealing with the inner or outer retinopathy. And really you can't see that to the micron level but OCT can so we're going to do OCT of the nerve and the macula in these cases. And while we're waiting for the serology, we're going to treat the patient empirically with some sort of tetracycline - usually doxycycline - and they're going to get better real quick. So you should be thinking about the spotted fever group when we have spots, fever, constitutional symptoms, the neuro-op findings: swollen disc, retrobulbar optic neuritis, papillitis, papilledema, and infectious retinitis. Do OCT on these people, serology (IgM, IgG), and treat them with doxycycline." |
| Date |
2022-03 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s63vrhj0 |
| Setname |
ehsl_novel_lee |
| ID |
1751095 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s63vrhj0 |
