Clinical manifestation

Presents within 1 week of tick bite; prodrome of fever, headache, myalgias; skin and mucous membrane changes: confluent macular and papular eruption on wrists and ankles; spreads centripetally to trunk and proximal extremities and palms and soles; eruption becomes petechial after a few days; conjunctival suffusion; periorbital edema, especially in children; photophobia

Cardiovascular system: myocarditis; brady-cardia; arrhythmias; occasional hypotension; congestive heart failure secondary to myocarditis

Pulmonary system: pulmonary edema in severe cases; pneumonitis Gastrointestinal system: anorexia; abdominal pain and tenderness; jaundice in severe cases; hepatomegaly and splenomegaly; diarrhea

Musculoskeletal system: myalgia, especially in the legs, abdomen, and back; diffuse arthralgias; edema of the dorsum of hands and feet

Central nervous system: restlessness and irritability; altered mental status; menin-goencephalitis; cranial neuropathies; paralysis; ataxia; meningismus

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