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and are obligately intracellular bacteria that are transmitted by ticks, mites, fleas, and lice. Disseminated endothelial infection results in febrile illness, often manifesting as headache, myalgia, and rash and, in severe cases, interstitial pneumonia and encephalitis. Rocky Mountain spotted fever, infection, murine typhus, and rickettsialpox are endemic in the United States. Scrub typhus, caused by , is a highly prevalent disease in southern and eastern Asia and islands of the western Pacific and Indian Oceans. African tick bite fever occurs frequently in travelers returning from South Africa. Laboratory-confirmed diagnosis is seldom achieved during the acute stage of illness, when therapeutic decisions are crucial, although effective direct detection of rickettsiae by immunohistochemical and molecular methods is possible. Serologic methods, the mainstay of diagnosis, do not usually detect antibodies until the second week of illness. Seroconversion or a 4-fold rise in titer during convalescence emphasizes that this approach provides a retrospective diagnosis. Cultivation of rickettsiae requires antibiotic-free cell culture and a biosafety level 3 biocontainment facility and procedures and does not provide a timely diagnosis.

Citation: Walker D, Bouyer D. 2015. and , p 1122-1134. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch64
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Phylogeny of and as determined by unweighted maximum parsimony analyses of gene sequences, with as the outgroup (prepared by PAUP 4.0 software). Numerical values on the branches represent quantities of genetic divergence from the nearest nodes. doi:10.1128/9781555817381.ch64.f1

Citation: Walker D, Bouyer D. 2015. and , p 1122-1134. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch64
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Image of FIGURE 2

(Left) Direct immunofluorescence staining of skin biopsy specimens with anti-SFG antibodies facilitates rapid diagnosis. Rickettsiae are present in the vessel wall. (Right) Demonstration of rickettsial organisms in the microvasculature of the dermis in a patient with a history of RMSF. Rickettsiae are seen in the vessel wall. Immunoperoxidase staining was performed using monoclonal antibodies directed against SFG lipopolysaccharide. Skin biopsy magnification, ×800. doi:10.1128/9781555817381.ch64.f2

Citation: Walker D, Bouyer D. 2015. and , p 1122-1134. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch64
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Characteristics of and

Citation: Walker D, Bouyer D. 2015. and , p 1122-1134. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch64
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Etiology, epidemiology, and ecology of rickettsial diseases

Citation: Walker D, Bouyer D. 2015. and , p 1122-1134. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch64

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