Rickettsialpox in Child
An eschar develops at the site of the mite bite within 24-48 hours, and this typically precedes the fever and systemic illness by another 1 or 2 days. The clinical course consists of fever that ranges from 38.3-41.1°C (101-106°F), malaise, headache, stiff neck, photophobia, myalgias, sweats, and chills. Conjunctival inflammation, cough, generalized adenopathy, and pharyngitis have all been described. The disease lasts 2-3 weeks with a persistent headache and lassitude that can last for weeks following the acute illness.
A79.1 – Rickettsialpox due to Rickettsia akari
75096007 – Rickettsialpox
Differential Diagnosis & Pitfalls
- Other rickettsioses with eschar that are typically acquired outside the United States (eg, tick typhus, Mediterranean spotted fever, and scrub typhus).
- Varicella lesions (primary or post-vaccination) evolve in different stages (ie, they do not appear uniform) and often scar, whereas rickettsialpox lesions do not.
- Eczema herpeticum
- Eczema vaccinatum
- Enteroviral infections
- Infectious mononucleosis
- Cutaneous anthrax
- Spider bite
- Acute meningococcemia (early)
- Coxsackie A viruses
- The lesions of smallpox are deeper and larger and are prominent on the face (this has been eradicated but remains a bioterrorism threat).