A case of successfully treated Japanese spotted fever with earlyintervention: A literature review and analysis of a case series on effective clinical symptoms that help early diagnosis and treatment

A 57-year-old woman visited a hillyarea to pursue her hobbyof digging bamboo shoots. She suffered tick bites on her left thigh and right axilla at 16 and 8 days before the first visit, respectively. She started experiencing general malaise at 5 days before the visit and developed spotted erythema on the lower limbs on the day before the visit. She visited a dermatology clinic on the next morning with a bodytemperature of 37°C (which rose to 38.5°C later), and she was referred to our hospital with a clinical diagnosis of Japanese spotted fever on the same day. The disease-related symptoms (malaise, spotted erythema, and fever) and blood test abnormalities subsided with the oral administration of minocycline at a dose of 200 mg/day. The detection of Rickettisia japonica DNA from the black crust on the right axilla and significant elevation of the specific sera IgM and IgG confirmed the clinical diagnosis. The earliest possible treatment is recommended to prevent severe outcomes of Japanese spotted fever. Fever, malaise, erythema, joint pain, and nausea are the early symptoms, the first three of which are the most common ones. We reviewed and analyzed a total of 90 reported cases of Japanese spotted fever from 1989 to 2018 April to find useful related symptoms for the earliest possible treatment. Our analyses indicated that fever and erythema are useful symptoms for preventing severe outcomes with early intervention.