Rickettsial infections: Indian perspective.

CONTEXT Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician. EVIDENCE ACQUISITION We did a PubMed, Medline and Cochrane library search for literature available in last 40 years. RESULTS Rickettsial infections are re-emerging and are prevalent throughout the world. In India, they are reported from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal, Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnosic test, these infections are notoriously difficult to diagnose. Failure of timely diagnosis leads to significant morbidity and mortality. With timely diagnosis, treatment is easy, affordable and often successful with dramatic response to antimicrobials. As antimicrobials effective for rickettsial disease are usually not included in empirical therapy of nonspecific febrile illnesses, treatment of rickettsial disease is not provided unless they are suspected. Knowledge of geographical distribution, evidence of exposure to vector, clinical features like fever, rash, eschar, headache and myalgia alongwith high index of suspicion are crucial factors for early diagnosis.