Rash on palms and soles:

A 13-year-old girl who returned a few days ago from a school camping trip in North Carolina is home ill from school. She tells her parents that she has a headache and the chills. Over the next few days, she develops a rash that begins on her palms and soles, but spreads inward to her wrists and ankles and then to her trunk. Her worsening condition leads her parents to take her to the emergency department, where a blood test reveals antibodies that react with the Proteus antigen. This patient is most likely infected with which of the following?

A) Borrelia burgdorferi
B) Coxiella burnetti
C) Coxsackievirus A
D) Rickettsia rickettsii
E) Rickettsia typhi
F) Treponema pallidum

First Aid Q&A for Step1 [2nd edition]©

[expand title=”CLICK HERE VIEW CORRECT ANSWER:”][sociallocker]The correct answer is D. This patient most likely has Rocky Mountain spotted fever, as indicated by the rash on her palms and soles and the inward, “centripetal” pattern of spread. Other supporting evidence are the accompanying headache and fever, and a positive Weil-Felix reaction, which is a cross-reaction of certain anti-rickettsial antibodies with the Proteus antigen. Rocky Mountain spotted fever is caused by the rickettsial organism Rickettsia rickettsii, and is endemic to the east coast of the United States. It is transmitted by the Ixodes tick, thus the patient probably acquired it during her recent camping trip.[/sociallocker][/expand]