At a glance
- Spotted fever rickettsioses (spotted fevers) occur worldwide and result in a broad range of illnesses, from relatively mild to life-threatening.
- People may become exposed to these tickborne bacteria when traveling outside of the United States.
- Healthcare providers should be aware of these illnesses in patients who have signs and symptoms common to other spotted fevers and history of travel within 2 weeks of illness onset.
Tickborne spotted fevers found outside of the United States
The most commonly reported spotted fever reported among United States patients following international travel is African tick bite fever, caused by Rickettsia africae. Almost 90 percent of imported spotted fevers occur among travelers to sub-Saharan Africa. Another frequently identified spotted fever rickettsiosis is Mediterranean spotted fever, caused by Rickettsia conorii.
Commercial antibody tests for RMSF can be used to confirm any spotted fever infection. However, most commercial tests are unable to distinguish among the different species of spotted fever group Rickettsia. More specialized tests can be performed at CDC laboratories. See the For Public Health Officials Page for further instructions. Spotted fever infections can range from mild to life-threatening. Doxycycline is the treatment of choice for all spotted fever infections.
Below is a table of selected tickborne spotted fevers found outside of the United States:
| Disease | Geographic distribution of human cases | Pathogen | Signs and symptoms |
|---|---|---|---|
| African tick bite fever | Sub-Saharan Africa, Caribbean (French West Indies), and Oceania | Rickettsia africae |
Fever, headache, muscle pain, eschar (sometimes multiple), regional swelling of lymph nodes, rash; typically mild or moderately severe illness |
| Mediterranean spotted fever (also known as boutonneuse fever) | Europe (Mediterranean basin), Middle East, Indian subcontinent, and Africa | Rickettsia conorii |
Fever, headache, muscle pain, eschar (usually single), and rash; typically moderately severe illness, can be severe or fatal |
| Queensland tick typhus | Eastern Australia, including Tasmania | Rickettsia australis |
Fever, headache, muscle pain, eschar, regional swelling of lymph nodes, and rash; typically mild or moderately severe illness, can be severe or fatal |
| Flinders Island spotted fever | Australia, southeast and south Asia | Rickettsia honei | Fever, headache, muscle pain, eschar in minority of patients, and rash; typically mild or moderately severe illness |
| Japanese spotted fever | Japan, South Korea | Rickettsia japonica |
Fever, headache, eschar, and rash; can be severe or fatal |
| Siberian tick typhus (also known as North Asian tick typhus) | North Asia | Rickettsia sibirica |
Fever, eschar, regional swelling of lymph nodes, and rash; typically mild or moderately severe illness |
| Lymphangitis associated rickettsiosis* | Southern Europe, Africa | Rickettsia sibirica mongolitimonae |
Fever, eschar (single or multiple), regional swelling of lymph nodes, and rash; typically mild or moderately severe illness |
| Tickborne lymphadenopathy, TIBOLA, (also known as Dermacentor-borne necrosis and lymphadenopathy, DEBONEL, or scalp eschar and neck lymphadenopathy after tick bite, SENLAT) | Europe | Rickettsia slovaca Rickettsia raoultii |
Eschar (typically on the scalp), painful regionally swollen lymph nodes, balding or thinning of hair surrounding eschar, low fever in <50%, rash (rare), and weakness; typically mild illness |
| Rickettsia massiliae spotted fever* | Europe, South America | Rickettsia massiliae | Fever, rash, and eschar; typically mild to moderately severe illness |
*Few cases are described in the peer-reviewed literature, and the clinical picture and geographic distribution might be incomplete.