Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 32-12: Spotted Fevers + Key Features Download Section PDF Listen +++ ++ Denotes a variety of spotted rickettsial fevers, often named by their Geographic location (eg, Mediterranean spotted fever, Queensland tick typhus, Oriental spotted fever, African tick bite fever, Siberian tick typhus, North Asian tick typhus) Morphology (eg, boutonneuse fever) Illnesses are caused by various rickettsial organisms (eg, R africae, R australis, R conorii, R japonica, R massiliae, R parkeri, R sibirica, and R 364D) Dogs and wild animals, usually rodents and even reptiles, may serve as reservoirs Travel is a risk factor for disease, particularly among elderly ecotourists + Clinical Findings Download Section PDF Listen +++ ++ Fever, headache, myalgias, and rash Pathogens usually produce an eschar or black spot (tâche noire); however, spotless boutonneuse fever occurs Painful lymphadenopathy or lymphangitis may also occur Rarely, papulovesicular lesions may resemble rickettsialpox Endothelial injury produces perivascular edema and dermal necrosis Regional adenopathy, disseminated lesions, kidney disease, splenic rupture, and focal hepatic necrosis are observed Neurologic manifestations are rare but include Encephalitis Internuclear ophthalmoplegia Coronary involvement Hemophagocytic syndrome + Diagnosis Download Section PDF Listen +++ ++ Clinical Serologic tests or polymerase chain reaction (PCR) used for confirmation + Treatment Download Section PDF Listen +++ ++ Start therapy upon clinical suspicion since delayed therapy is the usual cause of increased morbidity Oral treatment with doxycycline (100 mg/day twice daily) or chloramphenicol (50–75 mg/kg/day in four divided doses) for 7–10 days is indicated Caution is advised with use of ciprofloxacin because it Is associated with a poor outcome Increases the severity of Mediterranean spotted fever Macrolides are often given to manage acute febrile illness in endemic areas The combination of erythromycin and rifampin is effective and safe in pregnancy Prevention entails protective clothing, repellents, and inspection for and removal of ticks