Queensland tick typhus in rural New South Wales.
We report five cases of Rickettsia australis infection from southern coastal New South Wales, Australia. All patients presented with a cutaneous eruption of erythematous papules and pustules and systemic features of malaise, headache, lymphadenopathy and myalgia. Acute kidney injury (AKI) was present in two of five cases and one of five cases had acute delirium. Improvement was only seen after treatment with doxycycline 100 mg b.i.d. Positive serology for R. australis was present in four of five cases and a positive polymerase chain reaction (PCR) was seen in one of five cases. Histology showed varying features, from neutrophilic vasculitis to Sweet's syndrome and lymphocytic vasculitis. Recent significant advances in the diagnosis of R. australis infection include an eschar swab or biopsy PCR and isolation of specific Rickettsia on serology. These investigations should be considered in the presence of any of the following features: eschar at site of a tick bite or lymphadenopathy and fever with an eruption of erythematous papules and pustules.
Department of Dermatology, Royal Newcastle Centre, Newcastle, New South Wales, Australia.
Bonnie
B
Fergie
Orange Health Service, NSW Health, Orange, New South Wales, Australia.
James
J
Basha
Orange Dermatology, Orange, New South Wales, Australia.
Michelle
M
McRae
Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.
Ian
I
McCrossin
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012424:Rural Population; D000073605:Spotted Fever Group Rickettsiosis / Q000175:diagnosis* / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D004318:Doxycycline

Rickettsia australis
; New South Wales; Queensland tick typhus; spotted fever