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  lüll Rickettsial infections: Indian perspective Rathi N; Rathi AIndian Pediatr  2010[Feb]; 47 (2): 157-64CONTEXT: Underdiagnosed and misdiagnosed rickettsial infections are important  public health problems. They also lead to extensive investigations in children  with fever of undetermined origin contributing to financial burden on families.  The present review addresses the epidemiology, clinical features, diagnosis and  management issues of these infections, primarily for a practicing clinician.  EVIDENCE ACQUISITION: We did a PubMed, Medline and Cochrane library search for  literature available in last 40 years. RESULTS: Rickettsial infections are  re-emerging and are prevalent throughout the world. In India, they are reported  from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal,  Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of  suspicion, nonspecific signs and symptoms, and absence of widely available  sensitive and specific diagnosic test, these infections are notoriously difficult  to diagnose. Failure of timely diagnosis leads to significant morbidity and  mortality. With timely diagnosis, treatment is easy, affordable and often  successful with dramatic response to antimicrobials. As antimicrobials effective  for rickettsial disease are usually not included in empirical therapy of  nonspecific febrile illnesses, treatment of rickettsial disease is not provided  unless they are suspected. Knowledge of geographical distribution, evidence of  exposure to vector, clinical features like fever, rash, eschar, headache and  myalgia alongwith high index of suspicion are crucial factors for early  diagnosis.|Adult[MESH]|Animals[MESH]|Child[MESH]|Humans[MESH]|India/epidemiology[MESH]|Infant[MESH]|Rickettsia Infections/*diagnosis/*drug therapy/epidemiology/microbiology[MESH] |