Rickettsiae are pleoniorphocic, obligate intracellular bacteria that occur in the form of cocci and fdaments. They are the cause of widespread disease in tropical and temperate parts of the world. Spotted fever attributable to Rickettsia conorii is a zoonosis transmitted to man by the bite of the dog tick, Rkipicephalus ranpineus. Recently, the incidence in endemic areas has been increasing,'.* and cases have been reported in areas where the disease was previously unusual or unknown. Characteristic features of the disease are fever, headache, myalgia, eschar at the site of the tick bite, and maculopapular rash. The illness is similar to Rocky Mountain spotted fever with two main differences: (1) eschar is present in 30-90% of SFRC patient^,^,^ and (2) SFRC is usually milder, although fatalities have occurred.','. During the period 1991-1993, the authors diagnosed ten patients with SFRC. In all cases, the disease occurred after a recent visit to SubSaharan Africa. The diagnosis was made by consideration of clinical and epidemiologic findings (fever, eschar, rash, and recent travel to an endemic area). Serologic testing revealed positive Igh4 titer or a fourfold titer rise to R. conorii by immunofluorescence assay (IFA). The illness had been acquired in all cases during a trip of G14 days (average 10.8) to SubSaharan Ai it accounts for the majority of imported rickettsioses.' Without efforts at risk reduction, the number of travelers at risk for SFRC is likely to increase as more people go on safari in Africa. The presence of an eschar is valuable in making the diagnosis, and its presence is noticed in 30-90% of reported If an eschar is absent, diagnosis of SFRC is more difficult, and causes of febrile exanthem must be considered in the differential diagnosis.The frequencies of fever, rash, eschar, myalgias, and headaches in our patients were similar to those in other published The patient without fever had two eschars,rash,and positive IgM antibodies. One patient presented with pneumonia, an uncommon complication of SFRC.' The increase in serum aspartate aminotransaminase in 40% of our cases is similar to the frequency reported in other series.' SFRC can be confirmed by the isolation of the organism in an eschar or maculopapular lesion by immunofluorescence or by specific serologic assessment