1. Maculopapular rashes: usually not emergent but can occur in early meningococcemia or rickettsial disease
  2. Petechiae: warrant urgent attention when accompanied by hypotension or a toxic appearance
  3. Meningococcemia: Young children and their household contacts are at greatest risk; outbreaks occur in schools, day-care centers, and military barracks.
  4. Petechiae begin at ankles, wrists, axillae, and mucosal surfaces and progress to purpura and DIC.
  5. Other symptoms include headache, nausea, myalgias, altered mental status, and meningismus.
  6. Mortality rates are 50–60%; early treatment initiation may be life-saving.
  7. Rocky Mountain spotted fever: A history of a tick bite and/or travel or outdoor activity can often be ascertained.
  8. Rash appears by day 3 (but never develops in 10–15% of pts). Blanching macules become hemorrhagic, starting at wrists and ankles and spreading to legs and trunk and palms and soles.

Other symptoms include headache, malaise, myalgias, nausea, vomiting, and anorexia. In severe cases, hypotension, encephalitis, and coma can ensue.

  1. Other rickettsial diseases: Mediterranean spotted fever (Africa, southwestern and south-central Asia, southern Europe) is characterized by an inoculation eschar at the site of the tick bite and has a mortality rate of ~50%. Epidemic typhus occurs in louse-infested areas, usually in a setting of poverty, war, or natural disaster; mortality rates are 10–15%.

In scrub typhus (southeastern Asia and western Pacific), the etiologic organism is found in areas of heavy scrub vegetation (e.g., riverbanks); 1–35% of pts die.


The medicines that can be thought of use are:-

  • Apis mel
  • Arsenic
  • Baptisia
  • Bryonia
  • Lycopodium.