Last reviewed: 24 Feb 2023
Last updated: 21 May 2020
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- headache
- malaise
- myalgia
- arthralgia
- nausea
- small erythematous lesion with or without necrotic centre
- non-specific rash
More key diagnostic factors
Other diagnostic factors
- vomiting
- diarrhoea
- abdominal pain
- cough
- dyspnoea
- stiff neck
- confusion
- photophobia
- stupor
- coma
- seizures
- lymphadenopathy
- jaundice
- hepatomegaly
- splenomegaly
- secondary infections
Other diagnostic factors
Risk factors
- tick bite/exposure
- immunosuppression
- age over 60 years
- male sex
More risk factors
Diagnostic investigations
1st investigations to order
- FBC
- LFTs
- peripheral blood smear
More 1st investigations to order
Investigations to consider
- immunofluorescence antibody assay
- polymerase chain reaction
More investigations to consider
Emerging tests
- Western immunoblotting
- culture
- immunohistochemistry
Treatment algorithm
INITIAL
adults
children
Contributors
Authors
Juan P. Olano, MD
Professor
Department of Pathology
University of Texas Medical Branch
Galveston
TX
Disclosures
JPO is the author of a number of references cited in this topic.
Peer reviewers
Linda S. Nield, MD
Associate Professor of Pediatrics
West Virginia University School Of Medicine
Morgantown
WV
Disclosures
LSN declares that she has no competing interests.
Richard Reithinger, MD, PhD
Professor
London School of Hygiene and Tropical Medicine
London
UK
Disclosures
RR declares that he has no competing interests.
Differentials
- Pneumonia, bacterial or viral
- Gastroenteritides, bacterial or viral
- Cholecystitis
More DifferentialsGuidelines
- CDC health information for international travel: rickettsial diseases (including spotted fever & typhus fever, rickettsioses, scrub typhus, anaplasmosis, and ehrlichiosis)
- Tickborne diseases of the United States: a reference manual for health care providers
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer