Rickettsiae and rickettsial diseases.

This paper summarizes present knowledge on rickettsiae and rickettsial diseases, and on their epidemiological characteristics, control, and public health significance. There are many natural foci of rickettsial diseases, from where the disease may spread to other areas in the world under changing socioeconomic conditions. Because of rapid long-distance travel, sporadic cases of serious rickettsial diseases may today appear far from endemic areas where the infection occurred. Even in endemic areas the disease may be misdiagnosed and deaths may occur as a result of inadequate treatment. Rapid treatment of rickettsial infections (preferably with tetracyclines) is therefore most important. Epidemic louse-borne typhus, though no longer subject to the International Health Regulations, remains one of the diseases in the WHO epidemiological surveillance programme. This disease continues to be a major cause of morbidity and mortality in some parts of Africa and it is present also in parts of the Americas and of Asia. Scrub typhus remains a continuing and serious public health problem in areas of South-East Asia and in the Western Pacific. The annual number of reported cases of Rocky Mountain spotted fever in the USA showed an increase during the last two decades, which may be due to improved recognition as well as to increased outdoor activities and migration of people from the city centres to the suburbs. Related forms of tick-borne typhus occur in South America, the Mediterranean region, Africa, South-East Asia, the Far East, and the Western Pacific. Increasing in number, though still sporadic, are reports of serious illness from chronic Q fever infection in many parts of the world.