Last reviewed: February 2018
Last updated: February  2018



History and exam

Key diagnostic factors

  • fever >38°C
  • rash
  • eschar
  • lymphadenopathy associated with eschar

Risk factors

  • exposure to human body lice
  • exposure to rodents (rats and mice) and their fleas
  • tick bites
  • mite bites (Southeast Asia, Oceania, northern Australia)
  • travel to the tropics
  • exposure to natural vegetation, forests, scrub, bush
  • exposure to cat or dog fleas

Diagnostic investigations

1st investigations to order

  • full blood count
  • liver function tests (LFTs)
  • serum electrolytes
  • C-reactive protein (CRP)
  • serology
  • polymerase chain reaction (PCR)
Full details

Investigations to consider

  • chest x-ray
  • trial of doxycycline therapy
Full details

Treatment algorithm


Authors VIEW ALL

Professor of Medicine

Section on Infectious Diseases

Wake Forest University School of Medicine




CAO declares that he has no competing interests.

Professor Christopher A. Ohl would like to gratefully acknowledge Dr Stephen R. Graves, a previous contributor to this topic. SRG is the author of a reference cited in this topic.

Peer reviewers VIEW ALL


Department of Medicine

University of Peradeniya


Sri Lanka


SAMK declares that he has no competing interests.

Professor of Medicine and Pathology

Albert Einstein College of Medicine

New York City



LW's laboratory research programme is supported by NIH (NIAID) grants. He performs infectious diseases consultation at Montefiore (Weiler Hospital).

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