Complications
Surgical specialists should be consulted.
May lead to the need for amputation.
May be severe and even fatal. Commonly occurs with fever, and 70% to 75% may also have maculopapular rash, headache, and hepatosplenomegaly. Recovery is normally within 48 hours of starting doxycycline. Analysis of cerebrospinal fluid (CSF) is similar to that seen in leptospirosis, viral, or tuberculous meningitis with a predominance of polymorphonuclear leukocytes, usually near-normal CSF glucose, and mildly elevated protein.[46][47]
May be transient. Dialysis is rarely required.
May be transient or permanent, unilateral or bilateral. Thought to be caused by vasculitis-induced cochlear damage or possibly immune mediated.[51]
Surgical specialists should be consulted. Surgical debridement and skin grafting may be required.[52]
May include acute liver failure (hepatomegaly, deranged liver function tests), pulmonary involvement (pneumonitis, acute respiratory distress syndrome), acute kidney injury, and disseminated intravascular coagulation. Has been associated with septic shock.[57] Intensive care unit supportive care is usually required in the short term. With prompt diagnosis and treatment of the rickettsial infection most people will make a complete recovery.
Some patients have described a long period of lethargy after recovery, akin to a post-infectious chronic fatigue condition.[38]
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