Clinical lessons from a five-year retrospective study of spotted fever at a rural secondary-care hospital, South India
Priyanjali V. Chode, Renju M. Alex, Thomas V. Thomas, Beryl I. Prasantha, Supriya Jangala, Mercy T. Kakileti, Alex Reginald George T, John J. Prakash, Karthik Gunasekaran
A
BSTRACT
Introduction:
Fever with rash has a broad differential diagnosis, and diagnostic evaluation is often constrained in resource-limited settings, necessitating a high reliance on clinical acumen and pattern recognition. Spotted fever is an underrecognized but potentially severe cause, with varied clinical presentations and poor outcomes if diagnosis is delayed. This case series from a rural South Indian hospital spanning 5 years highlights the spectrum of disease and emphasizes the importance of early clinical recognition to reduce morbidity and mortality.
Methodology:
This retrospective observational study included adult patients (≥18 years) admitted to the Medicine Department of our Secondary-care hospital between October 2019 and October 2024, who had clinical suspicion of Rickettsial infection and were tested positive for Spotted Fever serology during hospitalization. Clinical records were reviewed to analyse demographic characteristics, clinical presentation, disease course, and outcomes.
Results:
A total of eight cases were diagnosed and treated as spotted fever. The mean (standard deviation) age at presentation was 46.5 (16.2) years, with a female preponderance (5 of 8 patients). The average duration of illness prior to presentation was more than 6 days. Rash was observed in seven patients. The median hospitalisation duration was 5.5 days (IQR: 4–11 days). Two patients required intensive care support; however, there were no fatalities, and all patients had a favourable outcome during post-discharge follow-up.
Conclusion:
Our findings reinforce the need for heightened clinician awareness of the varied and potentially severe presentations of spotted fever to facilitate early and appropriate intervention with doxycycline, particularly in resource-limited rural settings.