IMPORTED RICKETTSIOSES IN GERMAN TRAVELERS

Twenty-two cases of rickettsiosis imported to Germany (13 men, nine wo men, average age 42 years) in a 5-year period were analyzed retrospect ively regarding the travel histories, symptoms and clinical findings, laboratory features and course of the disease, The two primary rickett sial diseases were boutonneuse fever (18 patients) and scrub typhus (t hree patients). One patient had murine typhus, The main symptom was fe ver in 91% followed by headache (64%), myalgia (40%), arthralgia (50%) and diarrhea (36%). The most frequent clinical finding was lymphadeno pathy in 65%, Eschar was detectable in 55% of patients with Rickettsia conori infection and in one patient,vith Rickettsia tsutsugamushi inf ection. All patients with R. tsutsugamushi infection as well as 33% of the patients with R. conori infection had a macular exanthema. One pa tient with scrub typhus had pleural and pericardial effusions. Seventy -three percent had an increased ESR, Three patients had leucocytosis, three increased transaminases and two normochromic anemia. The incubat ion period for R. conori infection was 5 to 28 days (average 14 days), for R. tsutsugamushi infection 7 to 21 days (average 16 days). Twenty -one patients were treated with tetracycline or doxycycline, one with erythromycin, All patients were cured, One patient had a relapse, Due to the fact that the symptoms are often not characteristic and that th e routine laboratory findings are of only marginal help, the diagnosis of rickettsial diseases is often not easy. A detailed travel history sometimes gives an important hint for diagnosis.