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For further information, see CMDT Part 32-12: Spotted Fevers

Key Features

  • 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

  • Fever, headache, myalgias, and rash

  • Pathogens usually produce an eschar or black spot (tâche noire); rarely, however, a "spotless" form occurs, termed "spotless boutonneuse fever"

  • 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

  • Rare manifestations include

    • Encephalitis

    • Internuclear ophthalmoplegia

    • Vertebral arteritis with glossopharyngeal nerve-associated dysphagia

    • Coronary involvement

    • Purpura fulminans

    • Hemophagocytic lymphohistiocytosis syndrome


  • Clinical

  • Serologic tests or polymerase chain reaction (PCR) used for confirmation


  • 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

  • The combination of erythromycin and rifampin is effective and safe in pregnancy

  • Severe cases may require ICU care for multiorgan failure (particularly respiratory failure) since fatalities have been reported (more often than with scrub typhus)

  • Prevention entails protective clothing, repellents, and inspection for and removal of ticks

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