Rickettsialpox-like illness in a traveler

A patient presented after a trip to South Africa with a febrile illness and rash that was consistent with either rickettsialpox or mild boutonneuse fever. The clinical, laboratory, and geographic overlap of these diseases makes differentiation difficult in certain situations. Several different rickettsial infections may cause an eschar and a rash that may be papulovesicular. From a clinical perspective, distinguishing these diseases is not critically important as long as therapy with tetracycline is implemented. More precise identification of the etiologic agent could be required in certain military situations because the preventive measures employed for some of these diseases may be significantly different.