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Initial signs and symptoms in patients with spotted fever rickettsiosis include fever, headache, rash, nausea and vomiting, and myalgias. Symptom onset is typically five to seven days after inoculation. Less than 50% of patients present with rash initially, although 90 % eventually develop a rash. The latter starts as macules on the wrists, forearms, and ankles. It spreads to the trunk, and sometimes the palms and soles, and ultimately becomes petechial. In the time of COVID-19, patients with fever,

 

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