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Occurrence and Risk for Travelers

The geographic distribution and the risks for exposure to rickettsial agents are described below, by disease.

Table 4-18. Epidemiologic features and symptoms of rickettsial diseases

Antigenic group Disease Agent Predominant symptoms1 Vector or Acquisition mechanism Animal reservoir Geographic distribution outside the US
Typhus fevers Epidemic typhus, Sylvatic typhus Rickettsia prowazekii Headache, chills, fever, prostration, confusion, photophobia, vomiting, rash (generally starting on trunk) Human body louse, squirrel flea and louse Humans, flying squirrels (US) Cool mountain- ous regions of Africa, Asia, and Central and South America
Murine typhus R. typhi As above, generally less severe Rat flea Rats, mice Worldwide
Spotted fevers Rocky Mountain spotted fever R. rickettsii Headache, fever, abdominal pain, rash (generally starting on extremities) Tick Rodents Mexico, Central and South America
Mediter- ranean spotted fever2 R. conorii Fever, eschar, regional adenopathy, rash on extremities Tick Rodents Africa, India, Europe, Middle East, Mediter- ranean
African tick-bite fever R. africae Fever, eschar(s), regional adenopathy, rash subtle or absent Tick Rodents Sub- Saharan Africa
North Asian tick typhus R. sibirica As above Tick Rodents Russia, China, Mongolia
Oriental spotted fever R. japonica As above Tick Rodents Japan
Rickett- sialpox R. akari Fever, eschar, adenopathy, disseminated vesicular rash Mite House mice Russia, South Africa, Korea
Tick-borne disease R. slovaca Necrosis erythema, lymphad- enopathy Tick Lago- morphs, rodents Europe
Aneruptive fever R. helvetica Fever, headache, myalgia Tick Rodents Old World
Cat flea rickett- siosis R. felis As murine typhus, generally less severe Cat and dog flea Domestic cats, opossums Europe, South America
Queens- land tick typhus R. australis Fever, eschar, regional adenopathy, rash on extremities Tick Rodents Australia, Tasmania
Flinders Island spotted fever, Thai tick typhus R. honei As above but milder, eschar and adenopathy are rare Tick Not defined Australia, Thailand
Orientia Scrub typhus Orientia tsutsuga- mushi Fever, headache, sweating, conjunctival injection, adenopathy, eschar, rash (starting on trunk), respiratory distress Mite Rodents Indian Sub- continent, Central, Eastern, and Southeast Asia and Australia
Coxiella Q fever Coxiella burnetii Fever, headache, chills, sweating, pneumonia, hepatitis, endocarditis Most human infections are acquired by inhalation of infectious aerosols. Tick3 Goats, sheep, cattle, domestic cats, other Worldwide
Bartonella Cat- scratch disease Bartonella henselae Fever, adenopathy, neuroretinitis, encephalitis Cat flea Domestic cats Worldwide
Trench fever B. quintana Fever, headache, pain in the shins, spleno- megaly, disseminated rash Human body louse Humans Worldwide
Oroya fever B. bacilliformis Fever, headache, anemia, shifting joint and muscle pain, nodular dermal eruption Sand fly Unknown Peru, Ecuador, Colombia
Ehrlichia Ehrlich- iosis Ehrlichia chaffeensis4 Fever, headache, nausea, occasionally rash Tick Various large and small mammals, including deer and rodents Worldwide
Anaplasma Anaplas- mosis Anaplasma phago- cytophilum4 Fever, headache, nausea, occasionally rash Tick Small mammals, and rodents Europe, Asia, Africa
Neo- rickettsia Sennetsu fever Neorickett- sia sennetsu Fever, chills, headache, sore throat, insomnia Fish, fluke Fish Japan, Malaysia

                                                                        

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