Rickettsial diseases in travelers

Often undiagnosed in travelers with acute nonspecific febrile illness, gastrointestinal, abdominal, pulmonary, neurologic, or cutaneous signs and symptoms, rickettsial diseases are transmitted in particular geographic and ecologic settings by ticks, fleas, chiggers, and lice. Recognition of an eschar at the vector inoculation site can be a key diagnostic clue for scrub typhus, African tick bite fever, and other tick-borne spotted fevers. Although laboratory confirmation is necessary, usually during convalescence, for an accurate diagnosis, a clinical diagnosis and empiric treatment with doxycycline are the standard practical approach. Knowledge of potential exposure, the natural history of the infection, and incubation periods of each rickettsiosis assist in considering particular rickettsioses.