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Indian tick typhus
Etiology:
- Rickettsia conorii
Epidemiology:
- reported throughout the Indian subcontinent
Clinical manifestations:
- maculopapular rash occurs early
- rash involves palms & soles
- anterior uveitis
- blurred vision, photophobia, floaters
- subconjunctival hemorrhage
- dry cough
Laboratory:
- basic metabolic panel: hyponatremia
- Rickettsia spotted fever group antibody in serum
- Rickettsia spotted fever group IgG in serum
- Rickettsia spotted fever group IgM in serum
- Rickettsia spotted fever group DNA
- Rickettsia spotted fever group RNA
- exclusion testing
- Rickettsia typhus group antibody in serum
- Orientia tsutsugamushi antibody
Special laboratory:
- skin biopsy of rash
Management:
- doxycycline for 2 weeks
- shorter course may be associated with relapse
- symptoms typically diminish markedly within 24 hours of appropriate therapy
- prednisolone ophthalmic for uveitis
General
rickettsial spotted fever; tick typhus
References
- Paras ML, Hyle EP, Foreman RK, Coffey KC
Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia,
and Uveitis.
N Engl J Med 2018; 378:1825-1833. May 10, 2018
PMID: 29742372
https://www.nejm.org/doi/full/10.1056/NEJMcpc1800337