Rickettsial Diseases with Renal Manifestations: A Case Series Highlighting a Typical Presentations in Adults.

Abstract

Background: Rickettsial infections are increasingly recognized causes of undifferentiated febrile illness in India. While renal involvement is a known complication, its clinical variability and diagnostic challenges in adult patients remain underreported.

Objectives: To describe the spectrum of clinical presentations and renal manifestations in adult rickettsial cases managed at a tertiary care centre in North India.

Methods: We retrospectively analysed six adult patients admitted with laboratory-confirmed rickettsial infections. Detailed clinical evaluation, laboratory investigations including serology (IgM ELISA, Weil-Felix test), and imaging findings were recorded. Management strategies, including antimicrobial therapy and supportive care, were reviewed.

Results: All six patients presented with fever and varied systemic symptoms including rash, myalgia, vomiting, and jaundice. Renal involvement ranged from mild azotemia to severe acute kidney injury (AKI). Coexisting comorbidities such as COPD, diabetes, and hypothyroidism complicated clinical courses. Diagnosis was often delayed due to the absence of classical signs like eschar. IgM ELISA was instrumental in confirmation. Doxycycline remained the mainstay of treatment. All patients recovered with appropriate antimicrobial therapy.

Conclusion: This series highlights atypical and renal presentations of rickettsial infections in adults. Absence of pathognomonic signs necessitates heightened clinical suspicion in endemic areas. Early empirical doxycycline therapy and renal monitoring are critical to favourable outcomes.