{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:57:16Z","timestamp":1787065036985,"version":"build-2736575974"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2019,8,15]],"date-time":"2019-08-15T00:00:00Z","timestamp":1565827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["1U50CK000491"],"award-info":[{"award-number":["1U50CK000491"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The spotted fever rickettsioses (SFR), including Rocky Mountain spotted fever, are tick-borne infections with frequent neurologic involvement. High morbidity and mortality make early recognition and empiric treatment critical. Most literature on SFR meningoencephalitis predates widespread magnetic resonance imaging (MRI) utilization. To better understand the contemporary presentation and outcomes of this disease, we analyzed clinical and radiographic features of patients with SFR meningoencephalitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients were identified through hospital laboratory-based surveillance or through the Tennessee Unexplained Encephalitis Study. Cases meeting inclusion criteria underwent medical records review and, when available, independent review of the neuroimaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen cases (11 children, 8 adults) met criteria for SFR meningoencephalitis. Rash was significantly more common in children than adults (100% vs 50%, respectively), but other clinical features were similar between the 2 groups. Cerebrospinal fluid pleocytosis and protein elevation were each seen in 87.5% of cases, and hypoglycorrhachia was present in 18.8% of cases. The \u201cstarry sky\u201d sign (multifocal, punctate diffusion restricting or T2 hyperintense lesions) was seen on MRI in all children, but no adults. Ninety percent of patients required intensive care unit admission and 39% were intubated. Outcomes were similar between adults and children, with only 46% making a complete recovery by the time of discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SFR meningoencephalitis is a life-threatening infection. The clinical presentation varies between adults and children based on the presence of rash and brain MRI findings. The starry sky sign was ubiquitous in children and should prompt consideration of empiric treatment for SFR when present.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciz776","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T15:12:25Z","timestamp":1565277145000},"page":"188-195","source":"Crossref","is-referenced-by-count":28,"title":["Meningoencephalitis due to Spotted Fever Rickettsioses, Including Rocky Mountain Spotted Fever"],"prefix":"10.1093","volume":"71","author":[{"given":"Michael J","family":"Bradshaw","sequence":"first","affiliation":[{"name":"Department of Neurology, Rosalind Franklin University of Medicine and Science, Chicago Medical School, Billings Clinic, Montana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly Carpenter","family":"Byrge","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey S","family":"Ivey","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham, Huntsville Regional Medical Campus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Pruthi","sequence":"first","affiliation":[{"name":"Department of Pediatric Neuroradiology, Monroe Carell Jr Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen C","family":"Bloch","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,8,15]]},"reference":[{"key":"2020062404335164100_CIT0001","doi-asserted-by":"crossref","first-page":"26","DOI":"10.4269\/ajtmh.15-0472","article-title":"National surveillance of spotted fever group rickettsioses in the United States, 2008-2012","volume":"94","author":"Drexler","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"2020062404335164100_CIT0002","doi-asserted-by":"crossref","first-page":"713","DOI":"10.4269\/ajtmh.2012.11-0453","article-title":"Fatal Rocky Mountain spotted fever in the United States, 1999-2007","volume":"86","author":"Dahlgren","year":"2012","journal-title":"Am J Trop Med Hyg"},{"key":"2020062404335164100_CIT0003","doi-asserted-by":"crossref","first-page":"496","DOI":"10.15585\/mmwr.mm6717e1","article-title":"Vital signs: trends in reported vectorborne disease cases\u2014United States and territories, 2004-2016","volume":"67","author":"Rosenberg","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020062404335164100_CIT0004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr6502a1","article-title":"Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis\u2014United States","volume":"65","author":"Biggs","year":"2016","journal-title":"MMWR Recomm Rep"},{"key":"2020062404335164100_CIT0005","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1093\/cid\/civ116","article-title":"Risk factors for fatal outcome from Rocky Mountain spotted fever in a highly endemic area\u2014Arizona, 2002-2011","volume":"60","author":"Regan","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2020062404335164100_CIT0006","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1056\/NEJMoa050043","article-title":"Rocky Mountain spotted fever from an unexpected tick vector in Arizona","volume":"353","author":"Demma","year":"2005","journal-title":"N Engl J Med"},{"key":"2020062404335164100_CIT0007","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2006.11.023","article-title":"Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children","volume":"150","author":"Buckingham","year":"2007","journal-title":"J Pediatr"},{"key":"2020062404335164100_CIT0008","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0022-3476(70)80285-2","article-title":"Rocky Mountain spotted fever in children","volume":"76","author":"Haynes","year":"1970","journal-title":"J Pediatr"},{"key":"2020062404335164100_CIT0009","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/00005792-199001000-00003","article-title":"Rocky Mountain spotted fever. 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