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Volume 32, Number 2—February 2026

Research

Predictors of Fatal Outcomes among Pediatric Patients Hospitalized for Rocky Mountain Spotted Fever, Sonora, Mexico, 2004–20241

Stephanie Bellman, Kaci D. McCoy, Diana Enriquez, Pamela Romo, JongIn Hwang, Kathleen Weimer, Sarah M. Gunter, José Luis Alomía-Zegarra, Kristy O. Murray2Comments to Author , and Gerardo Álvarez-Hernández2
Author affiliation: Emory University School of Medicine, Atlanta, Georgia, USA (S. Bellman, K.D. McCoy, J. Hwang, K. Weimer, K.O. Murray); Children’s Healthcare of Atlanta, Atlanta (S. Bellman, K.D. McCoy, J. Hwang, K. Weimer, K.O. Murray); University of Sonora, Hermosillo, Mexico (D. Enriquez, P. Romo, G. Álvarez-Hernández); Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA (S.M. Gunter); Secretaría de Salud Pública del Estado de Sonora, Hermosillo (J.L. Alomía-Zegarra); Hospital Infantil del Estado de Sonora, Hermosillo (G. Álvarez-Hernández)

Main Article

Table 3

Treatment and outcomes for fatal and nonfatal cases in study of predictors of fatal outcomes among pediatric patients hospitalized for Rocky Mountain spotted fever, Sonora, Mexico, 2004–2024*

Characteristic No. cases No. (%) cases
 p value†
Fatal Nonfatal cases Total
Doxycycline initiated 500 0.01
<5 days 40 (40.4) 236 (58.9) 276 (55.2)
>6 days 50 (50.5) 164 (40.9) 214 (42.8)
Not treated
9 (9.1)
 1 (0.2)
 10 (2.0)
Clinical complications‡
Vascular§ 496 80 (83.3) 106 (26.5) 186 (37.5) <0.001
Bacterial¶ 494 72 (75.0) 141 (35.4) 213 (43.1) <0.001
Neurologic# 461 14 (21.5) 58 (14.6) 72 (15.6) 0.19
Acute respiratory distress syndrome 500 63 (63.6) 89 (22.2) 152 (30.4) <0.001
Acute renal failure 499 60 (61.2) 27 (6.7) 87 (17.4) <0.001
Shock 500 79 (79.8) 135 (33.7) 214 (42.8) <0.001

*Bold font indicates statistical significance (p<0.05). †Based on Fisher exact or Pearson’s χ2 test. ‡Patients could have >1 complication. §Including hemorrhage, disseminated intravascular coagulation, necrosis, edema of target organs (brain, lung), and others. ¶Including nosocomial pneumonia, meningitis/encephalitis, septic hepatitis, bacterial endocarditis, and others. #Including neuromuscular disturbances, neuropsychiatric alterations, speech disorders, cerebral palsy, hepatic encephalopathy, and others.

Main Article

1Preliminary results from this study were presented at the Southeastern Pediatric Research Conference; June 6, 2025; Atlanta, Georgia, USA; and at the American Society of Tropical Medicine and Hygiene Conference; November 10, 2025; Toronto, Ontario, Canada.

2These senior authors contributed equally to this article.

Page created: January 20, 2026
Page updated: February 05, 2026
Page reviewed: February 05, 2026
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