The
rickettsioses continue to constitute major health problems in many areas of the world. Unlike those diseases that are transmissible directly from man to man, the
rickettsioses are closely associated with man's environment and are therefore difficult to recognize and require complex strategies for their control. This article is concerned mainly with means for recognition and surveillance of these diseases, since only with reliable background information can a reasonable strategy for prevention and control be developed. Clinical information, while helpful, is insufficient for the identification of
rickettsial diseases and for their differentiation from other
pyrexias. The need for laboratory support, particularly serological tests, is emphasized. The indirect fluorescent antibody technique (IFA) is at present the most broadly applicable to all of the
rickettsioses under the circumstances that exist in problem areas.Therapy of the
rickettsioses is based on the use of specific
antibiotics, including the
tetracyclines and
chloramphenicol, but
antibiotics should not be used routinely for prophylaxis. Immunization with a live
attenuated vaccine is effective against outbreaks of
louse-borne typhus. Experimental
Q fever vaccines have also given protection against disease but side-effects have limited their use. Action against the arthropod vectors is also important and may consist of
insecticide dusting of persons at risk (lice), dusting of rat burrows (fleas), treatment of dogs carrying ticks, or appropriate measures to reduce mite populations. Repellants are also useful against ticks and mites.