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Key Features

  • Residing in endemic area

  • Fever for 10–14 days

  • Headache, chills, myalgia

  • Maculopapular rash spreading from trunk to extremities (not on palms and soles) 3–7 days after fever onset

  • Definitive diagnosis by serology

Clinical Findings

  • No eschar appears at the inoculation site

  • Incubation period is 6–14 days

  • Headache, myalgia and arthralgia, and chills slowly worsen

  • Fever may last 10–14 days

  • After 3–7 days, a rash appears

    • Truncal macules and papules spread to the extremities; the rash is rarely petechial and resolves in < 5 days

    • May be absent in 20–40% of patients

  • Intestinal and respiratory symptoms may occur

  • Prolonged neurologic symptoms can occur


  • Hepatomegaly may be present

  • Mild thrombocytopenia and elevated liver enzymes may be present


  • Doxycycline

    • Drug of choice

    • Should be continued for 3 days after evidence of clinical improvement

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