Spotted Fever Rickettsiosis

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent: Rickettsia parkeri, Rickettsia philipii, Rickettsia akari

Description of illness: Symptoms include fever, chills, severe headache, malaise, myalgia, gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia, abdominal pain, diarrhea, abdominal tenderness), photophobia, focal neurologic deficits, including cranial or peripheral motor nerve paralysis or sudden transient deafness, maculopapular rash, or petechial rash. Few people will develop all symptoms, and the number and combination of symptoms vary greatly from person to person. Similar symptoms are seen with ehrlichiosis, but they occur in different regions of the U.S., with anaplasmosis most frequently reported in the upper Midwest and northeastern U.S. in areas that correspond with the known geographic distribution of Lyme disease. Petechial rash is considered a sign of progression to severe disease. Every attempt should be made to begin treatment before petechiae develop.

Interactive Disease Data

Laboratory Reporting for this Disease

Rickettsia PCR

TEST NAME	Rickettsia PCR
DISEASE/DISORDER	Rocky Mountain Spotted Fever
ALTERNATE NAME(S)	Rickettsia rickettsii, Rickettsia prowazekii
METHODOLOGY	PCR
SPECIAL INSTRUCTIONS	PRIOR CONSULTATION REQUIRED. REQUESTED THROUGH CONSULTATION WITH EPIDEMIOLOGY ONLY (VBD.HEALTH@TN.GOV) OR 615-262-6356
ORDERING INSTRUCTIONS	TDH DLS Requisition: PH-4182 Clinicial Submission Form AND Travel history (domestic or international) to areas where RMSF is endemic must be documented on the requisition

Specimen Requirements

Patient Preparation	Submit specimens prior to treatment within 14 days of illness onset or within 48 hours of initial treatment.
Specimen Collection	At least 1 mL of venous, whole blood preserved with EDTA or Acid Citrate Dextrose Solution A (ACD-A)
Specimen Labeling	Specimen must be labeled with at least two unique patient identifiers and match accompanying PH-4182 Clinical Submission Form.
Specimen Processing	None
Specimen Storage and Preservation	Store specimens at 2 - 8°C prior to shipping.
Specimen Transportation	Ship specimes at 2 - 8°C within 48 hrs of collection. All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180).
Specimen Acceptability and Rejection	Unsatisfactory specimens include, but may not be limited to: - The specimen was broken or leaked in transit - No specimen was in the container submitted - Improper specimen type submitted - Specimens received at improper temperature Specimens received without documentation of consultation and travel history will not be tested.
Testing Location	Nashville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Manually report results to TDH by faxing or mailing a completed PH-1600 form to your local health department, or faxing to the state health office at (615) 741-3857
Automatically submit results to TDH via electronic laboratory reporting (ELR), which automates the process of sharing data with TDH using interoperability standards.
- See the ELR Onboarding Handbook for details on the onboarding process, checklist, frequently asked questions, business rules, message format, and vocabulary.
- To initiate the ELR onboarding process with TDH, register in the Trading Partner Registration (TPR) system TPR provides documentation for Promoting Interoperability (PI) attestation and milestone letters to document onboarding progress. Contact MU.Health@tn.gov for assistance.
Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

Spotted fever rickettsioses (SFR) are tick-borne bacterial illnesses caused by Rickettsia species; Tennessee’s reportable “Spotted Fever Rickettsiosis” includes infections such as Rickettsia parkeri, R. philipii, and R. akari.
Clinical presentation is typically an acute febrile illness with symptoms such as fever/chills, severe headache, malaise, myalgias, and sometimes GI symptoms; rash may be maculopapular or petechial, and some SFR (e.g., R. parkeri) often have an eschar at the bite site.
Do not delay treatment for lab confirmation. CDC emphasizes empiric therapy because early disease can be nonspecific, and severe disease can occur; laboratory tests may be negative early.
Doxycycline is the treatment of choice for suspected rickettsial infections in patients of all ages, and it is most effective at preventing severe illness when started early (ideally within the first 5 days of symptoms).
Diagnosis may use PCR and/or serology depending on timing; CDC also notes eschars can be useful diagnostic samples when present. Coordinate reporting/testing with public health per Tennessee requirements.

Clinical Links & Info

Clinical information about this disease | CDC

Review the case definition | CDC

Access the case report form (2017) | TDH

Disease Surveillance and Trends | CDC

Diagnosis and Management of Tickborne Rickettsial Diseases | MMWR

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.

Information about this Reportable Disease for the Public

What It Is

Spotted fever rickettsiosis is a group of illnesses caused by Rickettsia bacteria that are usually spread through tick bites.

Signs and Symptoms

Symptoms can include fever, chills, severe headache, tiredness, muscle aches, and sometimes stomach symptoms (nausea, vomiting, diarrhea). Some people develop a rash, and certain types can cause a dark scab at the bite site (an eschar).

How It Spreads

People most often get infected from the bite of an infected tick. These illnesses are not typically spread through casual person-to-person contact.

Diagnosis and Treatment

Healthcare providers diagnose SFR based on symptoms, possible tick exposure, and lab testing. Treatment is most effective when started early, so providers may begin antibiotics before test results return.

Prevention

Prevent tick bites by using repellent, wearing protective clothing, doing tick checks after outdoor activities, and removing ticks promptly.

This Page Last Updated: March 25, 2026 at 8:53 PM