A patient presented with fever for 8 days and difficulty in breathing for two days, on examination there is red painless rash found on the left side of the chest. Treatment will be
Correct Answer: Doxycycline
Description: (c) DoxycyclineRef: Harrison 18th ed.,pg. 14081,1413The presence of rash over the chest is typically an eschar, which is black necrotic, painless. Usually it is present in axilla, groin region.INFECTIOUS AGENTSRickettsial infections are caused by various bacterial species from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma. Rickettsia spp. are classically divided into the typhus group and spotted fever group (SFG). Orientia spp, make up the scrub typhus group. The rickettsial pathogens most likely to be encountered during travel outside the United States include R. africae (African tick- bite fever), R. conorii (Mediterranean spotted fever), R. rickettsii (known as both Rocky Mountain spotted fever and Brazilian spotted fever), O. tsutsugamushi (scrub typhus), and R. typhi (murine or fleaborne typhus).TRANSMISSIONMost rickettsial pathogens are transmitted by ectoparasites such as fleas, lice, mites, and ticks. Organisms can be transmitted by bites from these ectoparasites or by inoculating infectious fluids or feces from the ectoparasites into the skin. Inhaling or inoculating conjunctiva with infectious material may also cause infection for some of these organisms. Transmission of some rickettsial diseases after transfusion or organ transplantation is rare but has been reported.EPEDIMIOLOGYEhrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are not seen in Indian subcontinent.Rickettsial infections have been reported in India for several decades. During the World War II era, there were many deaths due to scrub typhus in this region. It was thought that these infections declined over time; however, several reports in the past decade indicate the presence of disease in various parts of India, such as the Himalayan region, the northeast, and the south.TREATMENTThe drug most commonly used is doxycycline or tetracycline, but Azithromycin or chloramphenicol is an alternative. As Rickettsial spp. Lack specific cell wall, so beta lactams and cephalosporins are not indicated in management of Rickettsial diseases.
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