Epidemic arthritic erythema

Clinical manifestation

Painless papule at site of chigger bite; subsequently undergoes central necrosis with formation of eschar; fever; headache; regional or generalized lymphadenopathy; rigors; myalgias; malaise; CNS symptoms; recrudescent form (Brill-Zinser disease): months to decades after treatment, organisms reemerge and cause recurrence of typhus

Differential diagnosis

Tularemia; leptospirosis; typhoid fever; other rickettsial infections; viral exanthem; dengue fever; anthrax; ehrlichiosis; infectious mononucleosis; Kawasaki disease; malaria; meningococcemia; relapsing fever; toxic shock syndrome; rubella; rubeola

Therapy

Doxycycline*; chloramphenicol - 0.51 gm IV every 6 hours until 48-72 hours after patient becomes afebrile; pediatric dose - 80-100 mg per kg per day IV divided into 4 doses until 48-72 hours after patient becomes afebrile

210 Epidermal cyst

References

Baxter JD (1996) The typhus group. Clinics in Dermatology 14(3)1271-278

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