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To the Editor: Israeli spotted fever (ISF) is caused by Rickettsia conorii subsp. israelensis. This recently described subspecies is genetically close to R. conorii subsp. conorii, the agent of Mediterranean spotted fever (MSF) (1,2). ISF is likely transmitted by the dog tick Rhipicephalus sanguineus (3). This tick, which is also the vector of R. conorii subsp. conorii, has low affinity for hosts other than dogs. Therefore, like MSF, cases of ISF will likely be sporadic (4,5). ISF was first reported in Israel (1) and was also recently described in Portugal and Italy (6–8). The clinical manifestations of ISF are similar to those of other spotted fever group infections, but an inoculation eschar is rarely observed and a history of tick exposure is not always present (4–6,9). The incubation period is ≈7–8 days after the tick bite (4).

Fatal Case of Israeli Spotted Fever after Mediterranean Cruise