-ROCKY MOUNTAIN SPOTTED FEVER

rises steadily to maximum on 5th day. (b) Stage of eruption and nervous excitement - (i) Rash - usually on 5th day. Pink macules varying in size and shape, disappearing on pressure. Generalised but face rarely involved In a day or two lesions become dull red and finally slate blue or grey before disappearing. Petechiae may occur. Following eruption of macules, paler subcuticular lesions appear between the macules - subcuticular mottling or mulberry rash. (ii) Temperature - high till the 6th day. (iii) Delirium -replaces headache and stupor. Mostly at night. (iv) Spleen may be palpable. (c) Stage of prostration -Patient appears exhausted and stuporose, this may progress to delirium or coma. Hypotension may result from myocarditis and peripheral vasodilatation. Features of grave prognostic significance include -progressive fall of B. P. , gangrene of fingers or toes, pressure areas and genitalia, urinary and faecal incontinence, renal failure and secondary infection. (d) Stage of defervescence- In favourable cases about the 12th or 14th day striking improvement occurs. Patient becomes quieter. Fever becomes remittent and drops to normal in a few days. Complications - (a) Bronchopneumonia. (ii) Myocarditis. (iii) Thromboembolic complications. (iv) Peripheral failure. (v) Suppurative parotitis. (vi) Gangrene of areas of skin. 2. BRILL-ZINSSER DISEASE - is a recrudescent form of epidemic typhus. Intense frontal headache and low B. P. are prominent features. Scrub typhus - caused by R. tsutugamushi and transmitted by larval mites. Eschar at site of mite feeding. Lymph nodes draining the eschar swollen and tender with generalised lymphadenopathy, fever, chills, headache, malaise and orbital pain. Maculopapular rash in about 50% may appear between 3rd and 7th day. Lymphocytosis in blood (large lymphocytes). Convalascence prolonged Diag. - (a) Serology: Detection of antibodies by microimmunofluorescence (MIF). A titre of 1:128 in diagnostic. (b) Weil Felix reaction- Louse and flea or tick borne typhus agglutinate with strain OX-19 and OX-2, scrub typhus with OX-K alone. Tr. - Doxycycline 200 mg/day for 10 days. II. Spotted fevers-ROCKY MOUNTAIN SPOTTED FEVER - is the most severe form. Caused by R. ricketsii and carried by ticks. Abrupt onset of fever with chills, severe headache, photophobia, prostration and muscle and joint pains Temperature 40°-41 °C with irregular morning remissions. Rash on 3rd or 4th day, maculopapular, first on extremities then spreading to the trunk; the rash becoming petechial. In severe cases rash becomes confluent, deep red or purple and may necrose. CNS manifestations include restlessness, confusion and delirium. In severe cases coma and peripheral vascular collapse precede death. BOUTONNEUSE FIEVRE - Milder than Rocky Mountain spotted fever. Primary cutaneous lesion or eschar at the site of tick bite. Regional lymphadenopathy in glands draining the eschar. Maculopapular rash Fever subsides by lysis in 2nd week. RICKETTSIALPOX - caused by R akari, transmitted to man by blood-sucking mite. Fever, eschar and papulovesicular eruption. Recovery in 1-2 weeks without sequelae. Diag. -Serology: MIF. Rickettsia of the spotted fever group are antigenitically cross-reactive and the same antigen may be used to detect all species. A titre of 128 is diagnostic. Tr. - Doxycycline 200 mg/day, for 1 -7 days depending on severity. Q-fever - Casual organism coxiella burnetti. Transmission - is