Rickettsia is a group of vector-borne organisms that beget acute febrile illnesses throughout the world. While the clinical presentation of rickettsial infection is analogous, the causative species and epidemiology can vary depending upon the region. Purpura fulminans (PF) is a rare pattern of intravascular thrombosis and haemorrhagic infarction of the skin that is fleetly progressive and is accompanied by vascular collapse and disseminated intravascular coagulation. We report a case of 11 month old male child presented with high grade fever and necrotic skin lesion over lower limbs. The child was diagnosed with acute contagious PF secondary to Indian tick typhus of spotted fever group of rickettsial infections. Underdiagnosed and misdiagnosed rickettsial infections are an important public health problem leading to an increased morbidity and mortality in cases with PF.
Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clinical Microbiology and Infection. 2018 Aug 1;24(8):827-35.
Khamesipour F, Dida GO, Anyona DN, Razavi SM, Rakhshandehroo E. Tick-borne zoonoses in the Order Rickettsiales and Legionellales in Iran: A systematic review. PLoS neglected tropical diseases. 2018 Sep 11;12(9):e0006722.
Dehhaghi M. Kazemi Shariat Panahi H, Holmes EC, Hudson BJ, Schloeffel R, Guillemin GJ. Human Tick-Borne Diseases in Australia. Front Cell Infect Microbiol. 2019;9:3.
Hardstone Yoshimizu M, Billeter SA. Suspected and confirmed vector-borne rickettsioses of North America associated with human diseases. Tropical medicine and infectious disease. 2018 Jan 3;3(1):2.
Eldin C, Parola P. Update on tick-borne bacterial diseases in travelers. Current infectious disease reports. 2018 Jul;20(7):1-9.
Talwar A, Kumar S, Gopal M, Nandini A. Spectrum of purpura fulminans: report of three classical prototypes and review of management strategies. Indian Journal of Dermatology, Venereology and Leprology. 2012 Mar 1;78(2):228.
Adcock DM, Brozna J, Marlar RA. Proposed classification and pathologic mechanisms of purpura fulminans and skin necrosis. InSeminars in thrombosis and hemostasis 1990 Oct (Vol. 16, No. 04, pp. 333-340). Copyright© 1990 by Thieme Medical Publishers, Inc.
Mittal V, Gupta N, Bhattacharya D, Kumar K, Ichhpujani RL, Singh S, Chhabra M, Rana UV. Serological evidence of rickettsial infections in Delhi. The Indian journal of medical research. 2012 Apr;135(4):538.
Adem PV. Emerging and re-emerging rickettsial infections. InSeminars in diagnostic pathology 2019 May 1 (Vol. 36, No. 3, pp. 146-151). WB Saunders.Darmstadt GL. Acute infectious purpura fulminans: Pathogenesis and medical management. Pediatr Dermatol 1998;15:169 83
Jain D, Viswanathan S, Ramasamy C. A life threatening rash, an unexpected cause. Case Reports in Dermatological Medicine. 2014 Nov 9;2014.
Parola P, Fenollar F, Badiaga S, Brouqui P, Raoult D. First documentation of Rickettsia conorii infection (strain Indian tick typhus) in a Traveler. Emerging infectious diseases. 2001 Sep;7(5):909.
Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian pediatrics. 2010 Feb;47(2):157-64.
Delgado-de la Mora J, Licona-Enríquez JD, Álvarez-López DI, Aguilar-León DE, Álvarez-Hernández G. Clinical features of patients with Rocky Mountain spotted fever, dengue and chikungunya infection. Gaceta médica de México. 2021 Feb;157(1):61-6.
Kundavaram A, Francis NR, Jude AJ, Varghese GN. Acute infectious purpura fulminans due to probable spotted fever. Journal of Postgraduate Medicine. 2014 Apr 1;60(2):198.
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Copyright (c) 2023 Dr. Surbhi D. Sawant, Dr. Abhijit Shinde, Dr. Suresh Waydande, Prof. Dr. Sunil Natha Mhaske, Dr. Sushrut Kumar