Japanese spotted fever: report of 31 cases and review of the literature.

Spotted fever group (SFG) rickettsioses, which are transmitted by ticks, were long thought not to exist in Japan. Three clinical cases of Japanese spotted fever (JSF) were first reported in 1984. The causative agent was isolated and named Rickettsia japonica. Through October 1996, 31 cases were diagnosed as JSF in Tokushima Prefecture. Infected patients typically had acute high fever, headache, and characteristic exanthema; eschar was observed in 90%. After the discovery of JSF, more than a hundred cases were reported in southwestern and central Japan. Recent surveys show ticks to be the most probable vectors. As an emerging infectious disease, JSF is not commonly recognized by clinicians; therefore, even though it has not caused fatal cases, it merits careful monitoring.