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Scrub typhus and other rickettsial infections contribute to 25 - 50% of acute undifferentiated febrile illnesses in endemic regions. Delayed recognition and therapy increase the morbidity and mortality. The constellation of fever with eschar or rash and multisystem involvement should facilitate the diagnosis and initiation of appropriate therapy. The pathological hallmark of rickettsial infections is endothelial infection and inflammation causing vasculitis. Endothelial inflammation results in microvascular dysfunction and increased vascular permeability. Immune and endothelial activation may worsen microvascular dysfunction, predisposing to multi-organ failure. Serology is the mainstay of diagnosis, although false negatives occur early in the disease. Point-of-care rapid diagnostic tests and molecular techniques, such as quantitative polymerase chain reaction (qPCR), can hasten diagnostic processes. Intravenous doxycycline with a loading dose is the most widely used antibiotic in critically ill patients, with azithromycin as a suitable alternative. Early appropriate treatment and organ support can decrease the duration of illness and be life-saving. [ABSTRACT FROM AUTHOR]

The article describes a case of a 28-year-old female who developed rashes and intermittent fever after camping and gathering mushrooms in a wooded area. It is reported that the patient presented with enlarged lymph nodes, an eschar with an erythematous halo, and multiple erythematous maculae on the trunk and limbs.

Background Murine typhus, or infection with Rickettsia typhi, is a global but neglected disease without randomized clinical trials to guide antibiotic therapy. Methods A prospective, open, randomized trial was conducted in nonpregnant, consenting inpatient adults with rapid diagnostic test evidence of uncomplicated murine typhus at 2 hospitals in Vientiane, Laos. Patients were randomized to 7 days (D7) or 3 days (D3) of oral doxycycline or 3 days of oral azithromycin (A3). Primary outcome measures were fever clearance time and frequencies of treatment failure and relapse. Results Between 2004 and 2009, the study enrolled 216 patients (72 per arm); 158 (73.2%) had serology/polymerase chain reaction (PCR)–confirmed murine typhus, and 52 (24.1%) were R. typhi PCR positive. The risk of treatment failure was greater for regimen A3 (22.5%; 16 of 71 patients) than for D3 (4.2%; 3 of 71) or D7 (1.4%; 1 of 71) (P <.001). Among R. typhi PCR–positive patients, the area under the time-temperature curve and the fever clearance time were significantly higher for A3 than for D3 (1.8- and 1.9-fold higher, respectively; P =.005) and D7 (1.5- and 1.6-fold higher; P =.02). No patients returned with PCR-confirmed R. typhi relapse. Conclusion In Lao adults, azithromycin is inferior to doxycycline as oral therapy for uncomplicated murine typhus. For doxycycline, 3- and 7-day regimens have similar efficacy. Azithromycin use in murine typhus should be reconsidered. Investigation of genomic and phenotypic markers of R. typhi azithromycin resistance is needed. Clinical Trial Registration ISRCTN47812566. [ABSTRACT FROM AUTHOR]

Purpose: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced-scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced-Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever-serologically proven Indian tick typhus (Rickettsia conorii)-has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients.Methods: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes.Results:: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil-Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition.Conclusion:: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-year-old female presented to the hospital with a 7-day history of fever, 5-day history of rash, as well as headache, emesis, and joint pain. It mentions that a chest radiograph was notable for left basilar airspace opacity, possibly representing pneumonia versus pleural effusion. It states that the patient’s antibiotic coverage was transitioned to oral cefdinir and azithromycin.

A 24-year-old man presented to a university health center in January with a persistent headache that began abruptly 6 days earlier. He noted nonpulsating discomfort in the right retro-orbital area that was not relieved by ibuprofen (400 mg four times daily). He reported no prodromal symptoms, sensitivity to light or sound, neurologic symptoms, nausea, or vomiting and had no history of headaches. A day before presentation, he noted subjective fevers. The patient was evaluated, and amoxicillin was prescribed for presumed acute rhinosinusitis. [ABSTRACT FROM AUTHOR]

We report a case of Rickettsia sibirica mongolitimonae infection, an emerging tickborne rickettsiosis, with associated encephalitis in a 66-year-old man. Diagnosis was rapidly confirmed by quantitative PCR obtained from an eschar swab sample. The patient was successfully treated with oral doxycycline. [ABSTRACT FROM AUTHOR]

Background: Rocky Mountain spotted fever (RMSF) is potentially deadly and can present subtly with signs and symptoms overlapping with other clinical conditions. Delayed diagnosis can be fatal.Objective: This review provides an evidence-based summary of the current data for the evaluation and management of RMSF in the emergency department.Discussion: RMSF occurs through transmission of Rickettsia rickettsii by an infected tick. Exposure in the United States occurs most commonly from April to September, and high-risk locations include wooded, shrubby, or grassy areas. Approximately half of patients with infection do not recall tick exposure. Symptoms can include fever, headache, photophobia, malaise, myalgias, and a petechial rash that begins on the wrists and ankles and spreads to the trunk. Rash may not occur in ≤15% of patients, and the classic triad of fever, headache, and rash is also not definitive. Laboratory evaluation may demonstrate hyponatremia, anemia, thrombocytopenia, abnormal liver enzymes, and elevated coagulation tests. Antibody testing can be helpful, but these results are not typically available to the emergency clinician. Doxycycline is the treatment of choice in adults, children, and pregnant patients. Patients should be advised about prevention strategies and effective techniques for removing ticks.Conclusions: RMSF is a potentially deadly disease that requires prompt recognition and management. Focused history, physical examination, and testing are important in the diagnosis of this disease. Understanding the clinical features, diagnostic tools, and proper treatment can assist emergency clinicians in the management of RMSF. [ABSTRACT FROM AUTHOR]

Background. Rickettsia raoultii is frequently detected in multiple tick species, whereas human infection remains scarcely studied. Methods. A surveillance study was performed at 3 sentinel hospitals in China, to recruit participants with suspected tick exposure. Rickettsia raoultii infection was identified through polymerase chain reaction, followed by sequencing, and confirmed serologically. Isolation by cell culture was performed and the isolates were genome sequenced. Results. Twenty-six subjects were determined to have R. raoultii infection, including 7 with asymptomatic infection, 15 with mild to moderate illness, and 4 with severe illness. Common nonspecific manifestations in the 19 patients with mild to moderate or severe illness included fever (100%), malaise (95%), myalgia (58%), lymphadenopathy (53%), and nausea (42%). Only 5% of them had rash, and 16% had eschar. Scalp eschar and neck lymphadenopathy after a tick bite syndrome was only seen in 2 patients. Of the 4 patients with severe complications, 3 developed pulmonary edema, and 1 developed clouding of consciousness and lethargy. Frequent abnormalities of laboratory testing included leukopenia, thrombocytopenia, lymphopenia, neutropenia, hypoproteinemia, and elevated levels of total bilirubin, hepatic aminotransferases, lactate dehydrogenase, and creatine kinase. All the 19 patients recovered without sequelae after receiving doxycycline treatment. Two R. raoultii strains were isolated, and a significantly less degraded genome was observed than other more virulent Rickettsia strains, indicating a low pathogenicity of the current strain. Conclusions. Human infection with R. raoultii has a wide clinical spectrum that ranged from subclinical infection to severe complications. Physicians need to be aware of the high potential and clinical complexity of R.raoultii infection, to ensure appropriate testing and treatment in endemic regions. [ABSTRACT FROM AUTHOR]

We report an unusual case of myopericarditis caused by Rickettsia sibirica mongolitimonae. Because of increasing reports of Rickettsia spp. as etiologic agents of acute myopericarditis and the ease and success with which it was treated in the patient reported here, rickettsial infection should be included in the differential diagnosis for myopericarditis. [ABSTRACT FROM AUTHOR]

In a tropical country like India, fevers are caused by different etiological agents. Rickettsial infections, which have a global distribution is one of the differential diagnosis in such cases and are reported from almost all parts of India. Rickettsial diseases widely vary in severity from self-limited mild illnesses to fulminating life-threatening infections. They are obligate intracellular gramnegative coccobacillary forms that multiply within eukaryotic cells which makes it difficult to culture them on artificial culture medium. With globalization there is rapid spread of disease across the continents and therefore, skills for diagnosis and management of the disease attains global importance. Rickettsial diseases can be clinically classified as Spotted Fever group, typhus group, distinctive clinical rickettsiae and emerging rickettsiae. The clinical course will have incubation period, stage non-specific clinical signs and symptoms followed by typical/classical features depending on the type of rickettsiae infecting a person. However the clinical manifestation varies from one geographical area to another area for same species. The rickettsial diseases once thought to have been eradicated from India are re-emerging in many parts of our country. Their presence has recently been documented in at least eleven states of our country. Greater clinical awareness, a higher index of suspicion, better use of available diagnostic tools would increase the frequency with which rickettsial diseases are diagnosed. [ABSTRACT FROM AUTHOR]

Introduction: There are different genera and species of the family Ricketiciaceae that they pose a threat in humans and they are often transmitted by ectoparasites staying in primary guests. These organisms of the genus rickettsia are grouped into the maculous fever, typhus, among others, being a health problem in the nor thamer ica. Material and Methods: A retrospective review of cases of rickettsiosis in Baja California was made. They were considered to be variables: Age, sex, place of origin, as well as clinical signs presented with emphasis on its classification on suspected,probable and confirmed cases and laboratory studies that include hemat ic biometry, liver function tests in addition to testing Elisa Felix Weil, and received treatment. Results: Confirmed in 258 patients diagnosisof rickettsiosis, by the method of Weil Felix confirmed by Elisa ; in 275 casesthe causative agent was by rickettsia rickettsi and in three cases by rickettsia prowazeki. 96%of all cases in the city of Mexicali, 42 per cent were male and 58% female. The signs and symptoms were: Fever, headache, nausea, abdominal pain, vomiting, myalgia and arthalgia, meningeal signs, seizures and exantema. The cases were treated wi th doxycycline 100 mg every 12 hours in adults, chi ldren over the age of 9 at a rate of 5 mg/kg/da y every 12 hours, chloramphenicol 50 mg/kg/day, clarithromycin 15 mg/kg/day to every 12 hours, ciprofloxacin 750 mg every 12 hours in adults, there was a good response to treatment. The total deaths of suspected cases was 13 and 8 deaths confirmed by the CDC. The rate of morbidity of 2.9% compared with geographical areas close to the state less than these was that other entities reported mortality from 22 to 33.5%. Conclusions: The rickettsiosis is a condition that did not had been suspected in years in Baja California this reflected deficiencies in handling delayed treatment, Mexicali confirmed 100% of the cases, clinical manifesta tions of poor prognosis the rash and thrombocytopenic purpura are considered. [ABSTRACT FROM AUTHOR]

Rickettsia species are increasingly being recognized as a cause of infection among returning travelers. Murine typhus (MT) was mistakenly thought to have disappeared in the 1970s in Tunisia, yet recent serological data show that Rickettsia typhi, the causative agent of MT, still circulates in the Tunisian population. We report here a case of MT in a woman returning from Tunisia and hospitalized in France. Her presentation was nonspecific, with acute noneruptive fever. Diagnosis was confirmed by cross-adsorption and immunoblotting. Clinicians taking care of returning travelers with fever should be aware of MT, and know how to diagnose and treat it. [ABSTRACT FROM AUTHOR]

We report 3 rickettsioses on Darnley Island, Australia, in the Torres Strait. In addition to previously described cases of Flinders Island spotted fever (Rickettsia honei strain "marmionii"), we describe 1 case of Queensland tick typhus (R. australis) and 2 cases of scrub typhus caused by a unique strain (Orientia tsutsugamushi). [ABSTRACT FROM AUTHOR]

Purpura fulminans (PF) is associated with several infections, most notably with meningococcus, staphylococcus, and streptococcus infections. However, there are few reports of association of this entity with spotted fever from India. We report the case of a 55-year-old man who presented with fever, headache, and myalgia. On the seventh day of fever he developed nonblanching purple hemorrhagic purpura on the trunk and most prominently on the extremities consistent with purpura fulminans. Immunofluorescent assay confirmed the diagnosis of spotted fever. PF though common with rocky mountain spotted fever (RMSF) is rarely seen in association with Indian tick typhus, the usual cause of spotted fever in India. [ABSTRACT FROM AUTHOR]

The article discusses research on the neurological manifestations of scrub typhus. It references the study "Neurological Manifestations of Scrub Typhus" by U. K. Misra published in the "Journal of Neurology and Neurosurgical Psychiatry" in June 2015. Topics covered include rickettsial diseases as well as the typical presentation, signs, diagnostic testing and prognosis of patients.