Rickettsial Illness: A Diagnostic Challenge

SPO 2 : 96% on room air.• Blood pressure: 110/70 mm Hg.• Respiratory system: Retractions present, nasal flaring positive, grunting absent, chest clear.• Per abdomen: Hepatomegaly -liver palpable 5-6 cm below the right costal margin in the midclavicular line, soft in consistency with a smooth surface; no splenomegaly. Investigations• Hemogram: Progressive fall in hemoglobin, with a decrease of 3.5 g/dL from the admission value; leukopenia (total leukocyte count 3,590/mm³); and thrombocytopenia (platelet count 25,000/mm³).• Widal test: Negative.• Dengue serology: Negative.• Malarial parasite: Negative.• Ultrasound: Bilateral mild pleural effusion and mild-to-moderate ascites.• Cerebrospinal fluid analysis: Normal.• MRI brain: Normal.• Rathi-Goodman-Aghai (RGA) clinical score: 23/35, suggestive of rickettsial infection.A score of ≥14 has been reported to have a sensitivity of 96.15% and a specificity of 98.84% for spotted fever group rickettsial disease.3,5 • Weil-Felix test: Negative. IntroductIonRickettsial illnesses, including spotted fever group, typhus group, and scrub typhus, are vector-borne infections re-emerging or newly emerging among humans, who are accidental dead-end hosts.These illnesses typically present as acute febrile syndromes with characteristic features such as a rash or an eschar.Illness severity varies depending on the organism's virulence, and delayed diagnosis may result in life-threatening multiorgan dysfunction.1,2 case descrIptIon A 7-year-old male presented with a history of high-grade fever with 3-4 spikes per day, associated with chills and body aches, for 6 days.Subsequently, the patient developed a petechial rash across the body and experienced progressive difficulty in breathing (Fig. 1).On admission, the patient was disoriented (Glasgow Coma Scale score: E3V4M5), tachypneic, breathless, and had complaints of high-grade fever with petechiae.Clinical examination revealed:• Heart rate: 117/min.• Respiratory rate: 44/min.