title: Imported rickettsial disease: clinical and epidemiologic features.
abstract: OBJECTIVE
  The rickettsioses continue to constitute major health problems in many parts of the world. With increasing international travel, recognition of rickettsial diseases by physicians is becoming more important. The clinical features of four cases of rickettsial disease imported into Canada over a five-year period are presented; two patients with tick typhus (Rickettsia conorii), one patient with scrub typhus (R. tsutsugamushi), and one patient with murine typhus (R. typhi). We also present the North American data over the past 10 years from the Centers for Disease Control (CDC) (Atlanta).
  
  
  RESULTS
  Since 1983 in the United States, three cases of imported scrub typhus, all after travel to India, were confirmed, as well as six cases of murine typhus after travel to southeast Asia. At the CDC, 67 imported cases of tick typhus have been confirmed by indirect fluorescent antibody test since 1976; most illnesses occurred after travel to Africa.
  
  
  CONCLUSIONS
  Rickettsial diseases are underrecognized by physicians, who should consider these diagnoses in travelers returning from endemic areas. Since effective treatment is available, prompt diagnosis and treatment are important. In all cases, specific serologic confirmation should be obtained.
authors.affiliation: McGill University Center for Tropical Disease, Montreal, Quebec, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: McDonald
authors.forename: J D
authors.initials: JD
authors.lastname: MacLean
authors.forename: J E
authors.initials: JE
authors.lastname: McDade
mesh_terms: D000328:Adult; D000349:Africa; D001907:Boutonneuse Fever / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012612:Scrub Typhus / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D014195:Travel; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D014481:United States