This is a tick-borne illness of acute onset and characterized by headache, myalgia, fever, and petechial rash that appears on the palms and soles in two-thirds of patients. Laboratory diagnosis may be made by one of several methods: (1) a fourfold or greater rise in antibody titer to Rickettsia rickettsi. antigen by immunofluorescence antibody, complement fixation, latex agglutination, microagglutination, or indirect hemagglutination antibody test in acute and convalescent specimens taken 4 weeks apart, (2) positive polymerase chain reaction to R. rickettsii, (3) positive immunofluorescence of skin lesion (biopsy) or organ tissue (autopsy), or (4) isolation of R. rickettsii from a clinical specimen.
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