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Other Spotted Fevers

By William A. Petri, Jr, MD, PhD, Wade Hampton Frost Professor of Medicine and Chief, Division of Infectious Diseases and International Health, University of Virginia School of Medicine

Various rickettsiae, transmitted by ticks, cause spotted fevers similar to Rocky Mountain spotted fever. They cause a small sore at the site of the tick bite, swelling in nearby lymph nodes, and a red rash.

  • Spotted fevers develop when a tick carrying the infection bites a person.

  • The infection causes a fever, fatigue, muscle aches, and headaches, usually followed a few days later by a rash.

  • Avoiding tick bites is the best way to prevent the infection.

  • Spotted fevers are treated with an antibiotic.

Rickettsiae are a type of bacteria that can live only inside the cells of other organisms (see also Overview of Rickettsial Infections).

Spotted fevers include the following:

  • African tick bite fever (African tick typhus)

  • Mediterranean spotted fever (boutonneuse fever)

  • North Asian tick-borne rickettsiosis

  • Queensland tick typhus

  • Rickettsialpox

  • Rickettsia parkeri rickettsiosis

Like Rocky Mountain spotted fever, other spotted fevers may occur in the United States and internationally. These infections occur mainly in the spring and summer, when adult ticks are active and people are likely to be in tick-infested areas. In warmer climates, the disease may occur throughout the year. Mediterranean spotted fever can occur year-round in the Mediterranean region because it is transmitted by the brown dog tick and thus may be acquired indoors.


Symptoms of these spotted fevers are similar.

About 5 to 7 days after a bite, a fever, fatigue, muscle aches, and headache develop. The eyes are red, and people feel generally unwell. A small buttonlike sore covered by a black scab (eschar) develops at the site of the bite. Usually, nearby lymph nodes are swollen. About 4 days after the fever starts, a red rash appears on the forearms and spreads to most of the body, including the palms and soles. Fever typically lasts over a week.

When appropriately treated, these infections rarely cause serious problems or death. Problems are more likely to occur in older people and people who already very ill.


  • A doctor's evaluation

  • Blood tests and biopsy of the rash

Symptoms suggest the diagnosis.

Doctors may do blood tests that detect antibodies to the bacteria. However, these test cannot detect the antibodies until at least several days after the illness begins. Thus, these tests do not help doctors diagnose the infection immediately after someone becomes ill but can help confirm the diagnosis.

To confirm the diagnosis, doctors may do an immunofluorescence assay or use the polymerase chain reaction (PCR) technique.


  • Antibiotics

Doctors immediately prescribe an antibiotic, usually doxycycline, if they suspect a spotted fever based on symptoms and the potential for exposure to infected ticks—even if laboratory test results are not yet available. The antibiotic is given for 5 days.

To prevent these infections, people should take measures to prevent tick bites.

Tick Bite Prevention

Preventing tick access to skin includes

  • Staying on paths and trails

  • Tucking trousers into boots or socks

  • Wearing long-sleeved shirts

  • Applying repellents with diethyltoluamide (DEET) to skin surfaces

DEET should be used cautiously in very young children because toxic reactions have been reported. Permethrin on clothing effectively kills ticks. Frequent searches for ticks, particularly in hairy areas and on children, are essential in endemic areas.

Engorged ticks should be removed with care and not crushed between the fingers because crushing the tick may result in disease transmission. The tick’s body should not be grasped or squeezed. Gradual traction on the head with a small forceps dislodges the tick. The point of attachment should be swabbed with alcohol. Petroleum jelly, lit matches, and other irritants are not effective ways to remove ticks and should not be used.

No practical means are available to rid entire areas of ticks, but tick populations may be reduced in endemic areas by controlling small-animal populations.

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