Rickettsial Infection Follow-up

Updated: Nov 22, 2021
  • Author: Mobeen H Rathore, MD, CPE, FAAP, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Inpatient Care

Patients with rickettsial infection may require hospitalization only if they are clinically unstable or have developed complications.

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Transfer

Rickettsial infections with severe complications may require transfer to tertiary care facilities.

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Deterrence/Prevention

Personal avoidance of ticks (wearing proper clothing and use of repellants) remains an integral part of protection against rickettsial infections. In case of bites, prompt removal of ticks might prove extremely beneficial in prevention of infection. Attempting to control the tick reservoir is not usually feasible. Use of antibiotics following tick exposure is not currently indicated to prevent rickettsial infection.

  • Rocky Mountain spotted fever (RMSF): Various vaccines have been developed; however, they have not yet been proven efficacious or safe to recommend for routine use in patients. An improved killed chicken embryo vaccine has shown that it may provide partial protection against RMSF and ameliorate the illness when it occurs. [40]

  • Rickettsialpox: Avoidance of contact with and control of house mouse infestations is important to prevent acquisition of infection.

  • Boutonneuse fever: Natural immunity occurs following infection. Effective vaccines are not yet available.

  • Typhus group (epidemic and endemic typhus): Delousing of individuals and use of insecticides to treat clothing are effective preventive measures against the spread of louse-borne typhus. Killed vaccines that are no longer available in the United States were shown to reduce mortality rates but were not effective in prevention of disease.

  • Brill-Zinsser disease (ie, relapsing louse-borne typhus): This is analogous to primary louse-borne epidemic typhus.

  • Murine (endemic or flea-borne) typhus: Prevention is primarily by controlling the flea and rat populations. Insecticides should be used before rodenticides to prevent rat fleas from seeking alternate hosts if rats are no longer available. As with louse-borne typhus, a vaccine is no longer available in the United States.

  • Tsutsugamushi disease (ie, scrub typhus): Prevention can be achieved by vector control or chemoprophylaxis. The agent of choice for chemoprophylaxis is doxycycline, given as a weekly dose started before exposure to infection and continued for 6 weeks postexposure.

  • Q fever: A whole-cell vaccine for Q fever has been developed in Australia for clinical use in the occupational setting. [5] Control of disease in domestic animal population has been difficult because animals that have no detectable antibodies to C burnetii still shed the organism at parturition. Q fever outbreaks in research laboratories using animals (especially sheep) can be prevented by instituting proper control measures designed to protect the environment from fomite and aerosol transmission.

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