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The spotted fevers include Rocky Mountain spotted fever (RMSF), tick typhus, and rickettsialpox and are characterized by an exanthem and fever. All, except for rickettsialpox, are transmitted to humans by the bite of ixodid ticks. Clinically, the spectrum of severity of clinical findings is broad, ranging from mild symptoms of general malaise and an exanthem to life-threatening illness.



Causes

Rickettsiae reproduce within endothelial cells at the bite site; the subsequent injury results in dermal and epidermal necrosis and perivascular edema, which presents clinically as a papule that evolves to a crusted ulcer at the bite site (tache noire or eschar). Rickettsiae then seed from this site into blood and systemically. In severe cases, disseminated vascular infection occurs with meningoencephalitis and vascular lesions in kidneys, lungs, GI tract, liver, pancreas, heart, spleen, and skin.



Symptoms

Initial symptoms may include:

*fever
*nausea
*emesis
*severe headache
*muscle pain
*lack of appetite



Later signs and symptoms include:

*maculopapular rash
*petechial rash
*abdominal pain
*joint pain
*sdiarrhea

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