Cutaneous manifestations of spotted fever rickettsial infections in the Central Province of Sri Lanka: a descriptive study.

Rickettsial organisms infect humans causing a wider array of clinical features and have re-emerged in Sri Lanka where three known disease entities; spotted fever group, murine typhus and scrub typhus do exist. These diseases cause clinical illnesses varying from mild febrile illness to severe multiple organ involvement even leading to fatal outcomes when there is a delay in diagnosis. Occasionally, clinical features could be nonspecific or atypical. Nevertheless, detection of skin lesions mostly facilitates the clinical diagnosis. Hence, clinicians need to be familiar with common as well as uncommon variations of skin manifestations. Being a treatable infection, early diagnosis is important and is heavily based on clinical features in settings where laboratory diagnostics are unavailable; at the same time delaying of treatment could lead to high morbidity and mortality. We identified some important variations of skin lesions associated with spotted fever group rickettsial infections which include fern leaf type skin necrosis mainly involving superficial skin with blackish discoloration which dries up with time and peels off. In addition, mild cutaneous oedema is seen over the face and ankles especially in older patients. Acute arthritis involving ankle joints were common manifestations which together with typical skin lesions facilitate the clinical diagnosis.