United States: Recommendations and Reports / May 13, 2016 / 65(2);1–44
This is an excellent and detailed review of Rickettsial diseases. Doxycycline is the drug of choice and can be used in most case, even in pregnancy and young children.
Mediterranean spotted fever is endemic in the Mediterranean basin, Middle East, parts of Africa, and the Indian subcontinent. This infection can be severe or fatal; in Portugal, a case-fatality rate of 21% among hospitalized adults has been described.
Onset of Mediterranean spotted fever typically occurs abruptly with fever, myalgia, headache, eschar (usually singular), and maculopapular or petechial rash that can involve the palms and soles. Severe manifestations including neurologic, cardiac, and renal complications have been described. The mean incubation period is 6 days (range: 1–16 days) after being bitten by an infected tick. Rh. sanguineus is the principal tick vector in Europe, Israel, and North Africa.
Dogs can serve as reservoir hosts for R. conorii, and infected Rh. sanguineus ticks can transfer from dogs to humans during interactions. Other tick vectors might play a role in transmission in sub-Saharan Africa. Like other tickborne rickettsial diseases, Mediterranean spotted fever and African tick bite fever respond readily to antibacterial treatment with doxycycline.