Like Lyme disease, Rickettsia also causes a rash to develop on the skin of infected patients, although the incidence of this macular rash is higher, at 90% or so, than the presentation of erythema migrans in Lyme disease. This rash usually begins on the wrists and ankles, spreading inwards to the torso, as well as affecting the palms of the hands and soles of the feet. The rash can become papular, petechial, or purpuric, i.e. hard raised lumps, flat red dots (up to 3mm in size) that do not disappear under pressure, or larger flat red or purple dots of 3mm-1cm that also do not blanch under pressure. Patients will often experience a fever over 102°F, with a headache, and the development of the rash. These initial flu-like symptoms and skin rashes can cause difficulty in diagnosing Lyme disease and Rickettsia, or both as co-infections.
More Rickettsia Symptoms
Patients infected with Rickettsia may also experience abdominal pain, diarrhoea, cognitive deficits such as memory problems and confusion, conjunctivitis, breathing difficulties, and even respiratory failure. Some of those infection with Rickettsia rickettsiae go on to develop renal failure, myocarditis, and meningismus and test results may show a depressed leukocyte (white blood cell) count, thrombocytopenia, hyponatremia, and elevated liver enzymes, although these are not specific to Rocky Mountain Spotted Fever. In progressive, severe cases of untreated or unresponsive Rickettsia infection the patient may develop vasculitis throughout the body leading to blood clots and even death.
Differences Between Rickettsia and Lyme Disease
Lyme disease symptoms that differ from Rickettsia symptoms include arthritis, myalgia, and the type of rash occurring with infection. The neurological symptoms of Lyme disease are also different to those of Rocky Mountain Spotted Fever as they can begin early as Bell’s palsy (cranial neuritis), and may develop into meningitis, and encephalitis, with subacute encephalopathy, axonal polyneuropathy, and even leukoencephalopathy possible. The symptoms of neuroborreliosis may look remarkably similar to diseases or conditions such as Multiple Sclerosis, depression, Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, and even schizophrenia, which can lead to misdiagnosis, especially if a co-infection such as Rickettsia clouds the issue. Some sleep disturbances and mood disorders can also occur with Lyme disease and symptoms may persist for several years if untreated. Patients with Rickettsia will usually recover within weeks to months, whereas Lyme disease can cause symptoms of arthritis for years, with or without being treated.