RESUMEN
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.
Asunto(s)
Púrpura Fulminante/complicaciones , Rickettsia rickettsii/aislamiento & purificación , Fiebre Maculosa de las Montañas Rocosas/diagnóstico , Enfermedad Aguda , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Fiebre/etiología , Fluoroinmunoensayo , Humanos , India , Masculino , Persona de Mediana Edad , Fiebre Maculosa de las Montañas Rocosas/complicaciones , Fiebre Maculosa de las Montañas Rocosas/tratamiento farmacológico , Fiebre Maculosa de las Montañas Rocosas/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND: Scrub typhus is an acute febrile illness widely prevalent in the 'tsutsugamushi triangle' region of the world. Clinical features include fever, myalgia, headache, rash, and a pathognomonic eschar. An eschar is formed by the bite of chigger mite that inoculates the causative agent of Scrub typhus Orientia tsutsugamushi. The aim of this study is to determine the most common sites of eschars over the bodies of patients with Scrub typhus. MATERIALS AND METHODS: In a retrospective analysis, we examined a total of 418 patients who presented to Christian Medical College, Vellore between 2009 and 2012 with an acute febrile illness and an eschar on clinical examination and confirmed to have scrub typhus with a positive Scrub typhus IgM ELISA test. We studied the distribution of eschars over the bodies of 418 patients with Scrub typhus. RESULTS: There was a significant difference in the distribution of eschars between males and females with a preponderance of the chest and abdomen (42.3%) among females and the axilla, groin and genitalia (55.8%) in males. Some unusual sites of an eschar were the cheek, ear lobe and dorsum of the feet. CONCLUSION: The eschar is the most useful diagnostic clue in patients with acute febrile illness in areas endemic for Scrub typhus and therefore should be thoroughly examined for its presence especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.