Rickettsial infections in the tropics and in the traveler.

PURPOSE OF REVIEW: The purpose of this review is to describe recent advances in our understanding of the pathogenesis, epidemiology, and clinical features of rickettsial diseases with emphasis placed on those relating to travel and tropical medicine. RECENT FINDINGS: Rickettsioses are becoming increasingly recognized as causes of febrile illness in travelers and in those residing in the tropics. In South and Central America, infection with Rickettsia rickettsii continues to have severe consequences. Resurgence of Mediterranean spotted fever in Bulgaria highlights the threat of rickettsial infections when there is a lapse in vector and reservoir control. Similar to African tick-bite fever, Rickettsia parkeri is an emerging cause of eschar-associated infection in Brazil, Argentina, and Uruguay. Several reports of murine typhus requiring hospitalization demonstrate the risk of this infection to the traveler. The use of fluoroquinolones for milder spotted fevers may fall out of favor with evidence of deleterious effects in those treated with ciprofloxacin. SUMMARY: With globalization and increased access to travel, clinical awareness of rickettsial diseases is of increasing importance. Although the growing number of rickettsial species may be daunting to the clinician, recognition of the patterns of rickettsial disease will ensure prompt and effective therapy.