Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • spring or summer season
  • fever
  • localised unilateral lymphadenopathy
  • painful skin ulcer
  • unilateral conjunctivitis

Other diagnostic factors

  • rales
  • non-productive cough/dyspnoea
  • systemic toxicity symptoms
  • sore throat
  • photophobia
  • jaundice, hepatosplenomegaly, diarrhoea
  • positive Kernig's/Brudzinski's sign, stiff neck

Risk factors

  • tick exposure
  • biting fly exposure
  • contact with infected animals
  • outdoor work in areas where infected animals live

Diagnostic investigations

1st investigations to order

  • serology
  • blood culture
  • specimen culture
  • PCR of ulcer swab or lymph node aspirate
Full details

Investigations to consider

  • chest x-ray
  • lumbar puncture
  • histopathology
Full details

Emerging tests

  • antigen detection in urine
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

William A. Petri, Jr.

Wade Hampton Frost Professor of Epidemiology

Professor of Medicine, Microbiology, and Pathology

Chief, Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

CH declares that he has no competing interests.

Assistant Professor

Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

BK declares that she has no competing interests.

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