Imported Spotted Fevers

Spotted fever group rickettsioses (spotted fevers) occur worldwide and result in a broad range of illnesses, from relatively mild to life-threatening. Below are the details for some of the spotted fevers that occur outside the United States. People may become exposed to these tick borne bacteria when traveling outside of the United States, and health care 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.

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 group 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.