CDC Travelers' Health Information on Rickettsial Infections

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**Table 3–17. Epidemiologic features, symptoms, and treatment of rickettsial diseases**
Antigenic group	Disease	Agent	Predominant symptoms*	Arthropod vector	Animal reservoir	Geographic distribution outside the US	Treatment^†
Typhus fevers	Epidemic typhus	Rickettsia prowazekii	Headache, chills, fever, prostration, confusion, photophobia, vomiting, rash (generally starting on trunk)	Human body louse	Humans, Eastern flying squirrels (US)	Cool mountainous regions of Africa, Asia, and Central and South America	Doxycycline (continue until patient afebrile for >72 hours)
Typhus fevers	Murine typhus	R. typhi	As above, generally less severe	Rat flea	Rats, mice	Worldwide	As above
Spotted fevers‡	Rocky Mountain spotted fever	R. rickettsii	Headache, fever, abdominal pain, rash (generally starting on extremities)	Tick	Rodents	North, Central, and South America	As above
	Mediterranean spotted fever§	R. conorii	Fever, eschar, regional adenopathy, rash on extremities	Tick	Rodents	Africa, India, Europe, Middle East, Mediterranean	As above
	African tick-bite fever	R. africae	Fever, eschar(s), regional adenopathy, rash subtle or absent	Tick	Rodents	Sub-Saharan Africa	As above
	Queensland tick typhus	R. australis	Fever, eschar, regional adenopathy, rash on extremities	Tick	Rodents	Australia, Tasmania	As above
	North Asian tick fever	R. sibirica	As above	Tick	Rodents	Russia, China, Mongolia	As above
	Oriental spotted fever	R. japonica	As above	Tick	Rodents	Japan	As above
	Rickettsialpox	R. akari	Fever, eschar, adenopathy, disseminated vesicular rash	Mite	House mice	Russia, South Africa, Korea	As above
	Cat flea typhus	R. felis	As above, generally less severe	Cat flea	Domestic cats, opossums	Europe, South America	As above
Orientia	Scrub typhus	Orientia tsutsugamushi	Fever, headache, sweating, conjunctival injection, adenopathy, eschar, rash (starting on trunk), respiratory distress	Mite	Rodents	Central, Eastern, and Southeast Asia	As above, but if treatment begins early, a second cycle of treatment may be necessary
Q Fever	Q fever	Coxiella burnetii	Fever, headache, chills, sweating, pneumonia, hepatitis, endocarditis	Most human infections are acquired by inhalation of infectious aerosols	Goats, sheep, cattle, domestic cats, other	Worldwide	Doxycycline, 2–3 weeks for acute illness
Bartonellosis	Cat-scratch disease	Bartonella henselae	Fever, adenopathy, neuroretinitis, encephalitis	Cat flea (zoonotic)	Domestic cats	Worldwide	Rifampin, erythromycin, doxycycline, azithromycin
	Trench fever	B. quintana	Fever, headache, pain in the shins, splenomegaly, disseminated rash	Human body louse	Humans	Worldwide	Doxycycline, 2–4 weeks for acute illness
	Oroya fever/ Verruga peruana	B. bacilliformis	Fever, headache, anemia, shifting joint and muscle pain, nodular dermal eruption	Sand fly	Unknown	Peru, Ecuador, Colombia	Chloramphenicol, penicillin, doxycycline
Ehrlichiosis	Ehrlichosis	Ehrlichia chaffeensis^# Anaplasma phagacytophilum^#	Fever, headache, nausea, occasionally rash	Tick	Various large and small mammals, including deer and rodents	Worldwide	Doxycycline (continue until patient afebrile for >48 hours)
Ehrlichiosis	Sennetsu fever	Neorickettsia sennetsu	Fever, chills, headache, sore throat, insomnia	Unknown	Unknown	Japan, Malaysia	As above
* This represents only a partial list of symptoms. Patients may have different symptoms or a few of those listed. † For a seriously ill patient, antibiotic therapy should be initiated without waiting for laboratory confirmation. For typhus and spotted-fever group rickettsioses, chloramphenicol may be administered if tetracyclines are contraindicated. An infectious diseases or tropical medicine specialist should be consulted. ‡ For a full review of other, less well-studied diseases in the spotted fever group, see Raoult D, Roux V. Clin Microbiol Rev 1999;10(4):649–719; Parola P, Raoult D. Clin Infect Dis 2001;32(6):897–928. § Also known as Boutonneuse fever, Mediterranean tick fever, Indian tick typhus. ¶ These arthropods can transmit the pathogen from one animal to another, but are probably not involved in transmission to humans. # Organisms antigenically related to these species are associated with ehrlichial diseases outside the continental United States.

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