Atypical presentation of Rickettsial spotted fever
Abstract
Acute febrile illness is a common entity in tropics and often is challenging due a host of pathogenic bacteria, viruses and fungi. Extensive work up is required for better management. Rickettsiosis is uncommon and hence comes lower down in the differentials of multiorgan failure being superseded by the more common diseases as malaria, enteric fever and Dengue. We document a case of young male presenting with high grade fever, multiorgan dysfunction (hepatic, renal, neurological and respiratory involvement), conjunctival suffusion, retiform rash and without lymphadenopathy. The diagnosis was further challenging because the rashes appeared late at 8th day in the course of illness, unlike the typical disease where rashes come on early in day 3–6 of the disease. Patient responded to timely treatment with doxycycline. Thus, a high index of suspicion is needed to diagnose Rickettsiosis in geographical areas apparently free of the disease.Keywords: Rickettsia; Weil-Felix; Purpura fulminans; Multiorgan dysfunction; RashReferences
Dasari V, Kaur P, Murhekar MV. Rickettsial disease outbreaks in India: A review. Ann Trop Med Public Health 2014;7(6):249–54.
Mittal V, Gupta N, Bhattacharya D, Kumar K, Ichhpujani RL, Singh S, et al. Serological evidence of rickettsial infections in Delhi. Indian J Med Res 2012;135(4):538–41.
Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s principles of internal medicine, 19e. USA2015. 2015.
Murali N, Pillai S, Cherian T, Raghupathy P, Padmini V, Mathai E. Rickettsial infection in South India-How to spot the spotted fever. Indian Pediatr 2001;38(12):1393–6.
Kularatne SA, Gawarammana IB. Validity of the Weil-Felix test in the diagnosis of acute rickettsial infections in Sri Lanka. Trans R Soc Trop Med Hyg 2009;103(4):423–4.
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