Medication Summary
A brief course of a tetracycline antibiotic is recommended. Quinolones may also be considered. Chloramphenicol is an alternate treatment but is not usually recommended because of substantial toxicity.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Doxycycline (Bio-Tab, Doryx, Vibramycin, Doxy)
Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
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Multiple papulovesicles involving the upper trunk on a patient with rickettsialpox in North Carolina. Courtesy of the CDC.
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Global distribution of confirmed cases of rickettsialpox.
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Rickettsialpox eschar on posterior right calf of patient from North Carolina. Courtesy of the CDC.
Tables
Disease |
Rash/Eschar |
Generalized Rash |
Clinical Features |
Geography |
Rickettsialpox secondary to R akari infection |
A red papule with a vesicle in the center dries and forms a black eschar with surrounding induration. Multiple eschars are possible. |
The papulovesicular rash is usually on the trunk and extremities; the palms, soles, and oral mucosa may also be involved. |
The papule precedes the febrile illness and mild systemic symptoms. Regional lymphadenopathy may develop. |
See Frequency |
Chickenpox secondary to varicella zoster infection |
The papule turns into a vesicle on an erythematous base and resembles a "dew drop on a rose petal." |
The rash begins on the head and progresses to the trunk, arms, and then legs; vesicles are present in all stages. |
It is common in children. No black eschar is present. |
Worldwide |
Mediterranean spotted fever secondary to Rickettsia conorii infection |
At the site of a tick bite, a single eschar with a red halo forms. |
The rash is generalized, involves the palms and soles, and is often maculopapular, occasionally petechial. |
Fever, headache, myalgias may develop. The onset is abrupt. The disease may be severe in context of comorbidity. |
North Africa, Middle East, Southern Europe |
African tick bite fever secondary to R africae infection |
Single or multiple eschars with regional lymphadenopathy |
A scant generalized rash, vesicular or maculopapular, may be present. Conversely, the rash may be absent. |
Fever, headache, myalgias, regional lymphadenopathy; associated with reports of subacute neuropathy |
Sub-Saharan Africa, Caribbean |
Human spotted fever secondary to R parkeri infection |
Single or multiple eschars develop from erythematous papules. |
Scant nonpruritic papules |
Fever, headache, myalgias, arthralgias |
United States |
Scrub typhus secondary to Orientia tsutsugamushi infection |
A vesicle or black scab appears on an erythematous base at the bite site. |
Vesicles are usually on the trunk or extremities. |
The rash fades within a few days; pneumonitis is common. |
Asia-Pacific rim |
