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rickettsial spotted fever; tick typhus
Classification:
1) Rocky Mountain spotted fever
2) boutonneuse fever (Mediterranean tick typhus)
3) Queensland tick typhus
4) Siberian tick typhus
5) African tick typhus
6) Indian tick typhus
Epidemiology:
- worldwide
Clinical manifestations:
- fever, headache, malaise, pharyngitis [2]
- maculopapular, vesicular or petechial rash occurs early
- rash involves palms & soles
- anterior uveitis
- blurred vision, photophobia, floaters
- subconjunctival hemorrhage
- dry cough [3]
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 [3]
Special laboratory:
- skin biopsy of rash
Management:
- doxycycline for 7-10 days [2]
- shorter course may be associated with relapse
- symptoms typically diminish markedly within 24 hours of appropriate therapy [3]
- prednisolone ophthalmic for uveitis
Specific
African Tick-Bite Fever; African tick typhus
boutonneuse fever; Mediterranean spotted fever
Indian tick typhus
North Queensland tick typhus
Rocky Mountain spotted fever (RMSF)
Siberian tick typhus; North Asian Tick Fever
General
Rickettsia infection; Rickettsia spotted fever
tick borne infection
typhus
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 91
- Medical Knowledge Self Assessment Program (MKSAP) 15, 19.
American College of Physicians, Philadelphia 2009, 2021
- 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