Volume 97, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



, the etiologic agent of Queensland tick typhus (QTT), is increasingly being recognized as a cause of community-acquired acute febrile illness in eastern Australia. Changing human population demographics, climate change, and increased understanding of expanding vector distribution indicate QTT is an emerging public health threat. This review summarizes the epidemiology, pathogenesis, clinical features, treatment principles, and future directions of this disease. Increased recognition of QTT will enable consideration of and prompt treatment of infection by clinicians in Australia.


Article metrics loading...

Loading full text...

Full text loading...



  1. Derne B, Weinstein P, Musso D, Lau C, , 2015. Distribution of rickettsioses in Oceania: past patterns and implications for the future. Acta Trop 143: 121133.[Crossref]
  2. Laboratory Australian Rickettsial Reference, , 2015. Australian Rickettsial Reference Laboratory: Disease Description and/or Epidemiology. Australian Rickettsial Reference Laboratory. Available at: http://www.rickettsialab.org.au. Accessed July 22, 2015.
  3. Baird RW, Lloyd M, Stenos J, Ross BC, Stewart RS, Dwyer B, , 1992. Characterization and comparison of Australian human spotted fever group rickettsiae. J Clin Microbiol 30: 28962902.
  4. Unsworth NB, Stenos J, Faa AG, Graves SR, , 2007. Three rickettsioses, Darnley Island, Australia. Emerg Infect Dis 13: 11051107.[Crossref]
  5. Birch TF, Muller M, , 2009. Severe Queensland tick typhus complicated by diabetes in south-eastern Queensland. Med J Aust 191: 290291.
  6. McBride WJ, Hanson JP, Miller R, Wenck D, , 2007. Severe spotted fever group rickettsiosis, Australia. Emerg Infect Dis 13: 17421744.[Crossref]
  7. NNDSS, 2013. Australia’s Notifiable Disease Status: Annual Report of the National Notifiable Diseases Surveillance System. Department of Health and Aging. Available at: http://www.commcarelink.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-annlrpt-nndssar.htm. Accessed July 22, 2015.
  8. Faa AG, Graves SR, Nguyen C, Stenos J, , 2006. A serological survey of rickettsial infections in the Gazelle Peninsula. East New Britain and a review of the literature. P N G Med J 49: 4346.
  9. Graves SR, Stewart L, Stenos J, Stewart RS, Schmidt E, Hudson S, Banks J, Huang Z, Dwyer B, , 1993. Spotted fever group rickettsial infection in south-eastern Australia: isolation of rickettsiae. Comp Immunol Microbiol Infect Dis 16: 223233.[Crossref]
  10. Derrick EH, , 1957. The challenge of north Queensland fevers. Australas Ann Med 6: 173188.
  11. Kende M, Graves S, , 2003. Survey of rickettsial antibodies at two local sites and review of rickettsiosis in Papua New Guinea. P N G Med J 46: 5362.
  12. Pope JH, , 1955. The isolation of a Rickettsia resembling Rickettsia australis in south-east Queensland. Med J Aust 42: 761763.
  13. Campbell R, Domrow R, , 1974. Rickettsioses in Australia: isolation of Rickettsia tsutsugamushi and Rickettsia australis from naturally infected anthropods. Trans R Soc Trop Med Hyg 68: 397402.[Crossref]
  14. Dwyer BW, Graves SR, McDonald MI, Yung AP, Doherty RR, McDonald JK, , 1991. Spotted fever in East Gippsland, Victoria: a previously unrecognized focus of rickettsial infection. Med J Aust 154: 121125.
  15. Sexton DJ, Dwyer B, Kemp R, Graves S, , 1991. Spotted fever group rickettsial infections in Australia. Rev Infect Dis 13: 876886.[Crossref]
  16. Andrew R, Bonnin J, Williams S, , 1946. Tick typhus in north Queensland. Med J Aust 2: 253258.
  17. Graves S, Stenos J, , 2009. Rickettsioses in Australia. Hechemy KE, Brouqui P, Samuel JE, Raoult DA, eds. Annals of New York Academy of Sciences, Wiley Online Library. Rickettsiology and Rickettsial Diseases, Vol. 1166, 151155.
  18. Barker SC, Walker AR, , 2014. Ticks of Australia. The species that infect domestic animals and humans. Zootaxa 3816: 1144.[Crossref]
  19. Graves S, Stenos J, Raoult D, Brouqui P, , 2003. Rickettsioses in Australia. , eds. Rickettsiae and Rickettsial Diseases at the Turn of the Third Millenium. Marseille, France: Elsevier, 244246.
  20. Domrow R, Derrick EH, , 1964. Ixodes holocyclus, the man-biting tick in S.E. Queensland. Aust J Sci 27: 234236.
  21. Brody J, , 1946. A case of tick typhus in north Queensland. Med J Aust 13: 511512.
  22. Fenner F, , 1946. The epidemiology of north Queensland tick typhus: natural mammalian hosts. Med J Aust 2: 666668.
  23. Hardy MC, Cochrane J, Allavena RE, , 2014. Venomous and poisonous Australian animals of veterinary importance: a rich source of novel therapeutics. BioMed Res Int 2014: 671041.[Crossref]
  24. Graves S, , 2013. Management of rickettsial diseases and Q Fever. Med Today 14: 6569.
  25. Azad AF, Beard CB, , 1998. Rickettsial pathogens and their arthropod vectors. Emerg Infect Dis 4: 179186.[Crossref]
  26. Lane AM, Shaw MD, McGraw EA, , O’Niell SL, 2005. Evidence of a spotted fever-like Rickettsia and a potential new vector from northeastern Australia. J Med Entomol 42: 918921.[Crossref]
  27. Unsworth NB, Stenos J, Graves SR, Faa AG, Cox GE, Dyer JR, Boutlis CS, Lane AM, Shaw MD, Robson J, Nissen MD, , 2007. Flinders Island spotted fever rickettsioses caused by “marmionii” strain of Rickettsia honei, eastern Australia. Emerg Infect Dis 13: 566573.[Crossref]
  28. Sexton DJ, Banks J, Graves S, Hughes K, Dwyer B, , 1991. Prevalence of antibodies to spotted fever group Rickettsiae in dogs from south-eastern Australia. Am J Trop Med Hyg 45: 243248.[Crossref]
  29. Huang Z, Graves S, Stewart L, Banks J, Dwyer B, , 1990. Enzyme-linked immunosorbent assays for detecting antibody to Rickettsia australis in sera of various animal species. Comp Immunol Microbiol Infect Dis 13: 119125.[Crossref]
  30. Knyvett AF, Sandars DF, , 1964. North Queensland tick typhus: a case report defining a new endemic area. Med J Aust 2: 592594.
  31. Streeten G, Cohens RS, Gutteridge NM, Wilmer NB, Brown HE, Smith DJW, Derrick EH, , 1948. Tick typhus in south Queensland: report of three cases. Med J Aust 1: 372373.
  32. Pinn TG, Sowden D, , 1998. Queensland tick typhus. Aust N Z J Med 28: 824826.[Crossref]
  33. Ash M, Smithurst BA, , 1995. A case of Queensland tick typhus. Med J Aust 163: 167.
  34. Hudson BJ, McPetrie RA, Kitchener-Smith J, Eccles JE, , 1994. Vesicular rash due to Rickettsia australis . Clin Infect Dis 18: 118119.[Crossref]
  35. Hudson BJ, McPetrie R, Ravich RB, Chambers I, Cross D, , 1993. Queensland tick typhus in Sydney Harbour. Med J Aust 159: 356357.
  36. La Scola B, Bechah Y, Lepidi H, Raoult D, , 2009. Prediction of rickettsial skin eschars in humans using an experimental guinea pig model. Microb Pathog 47: 128133.[Crossref]
  37. Sexton DJ, King G, Dwyer B, , 1990. Fatal Queensland tick typhus. J Infect Dis 162: 779780.[Crossref]
  38. Feng HM, Wen J, Walker DH, , 1993. Rickettsia australis infection: a murine model of a highly invasive vasculopathic rickettsiosis. Am J Pathol 142: 14711482.
  39. Holman RC, Paddock CD, Curns AT, Krebs JW, McQuiston JH, Childs JE, , 2010. Analysis of risk factors for fatal Rocky Mountain spotted fever: evidence for superiority of tetracyclines for therapy. J Infect Dis 184: 14371444.[Crossref]
  40. Wilson PA, Tierney L, Lai K, Graves S, , 2013. Queensland tick typhus: three cases with unusual clinical features. Intern Med J 43: 823825.[Crossref]
  41. Walker DH, Mattern WD, , 1979. Acute renal failure in Rocky Mountain spotted fever. Arch Intern Med 139: 443448.[Crossref]
  42. Baird RW, Stenos J, Stewart R, Hudson B, Lloyd M, Aiuto S, Dwyer B, , 1996. Genetic variation in Australian spotted fever group rickettsiae. J Clin Microbiol 34: 15261530.
  43. Dong X, El Karkouri K, Robert C, Raoult D, Fournier PE, , 2012. Genome sequence of Rickettsia australis, the agent of Queensland tick typhus. J Bacteriol 194: 5129.[Crossref]
  44. Stenos J, Graves S, Dwyer B, , 1992. Quantification of Rickettsia australis . Am J Trop Med Hyg 47: 141146.[Crossref]
  45. Eremeeva M, Yu X, Raoult D, , 1994. Differentiation among spotted fever group rickettsiae species by analysis of restriction fragment length polymorphism of PCR-amplified DNA. J Clin Microbiol 32: 803810.
  46. Policastro PF, Munderloh UG, Fischer ER, Hackstadt T, , 1997. Rickettsia rickettsii growth and temperature-inducible protein expression in embryonic tick cell lines. J Med Microbiol 46: 839845.[Crossref]
  47. Heehemy KE, Raoult D, Fox J, Han Y, Elliott LB, Rawlings J, , 1989. Cross-reaction of immune sera from patients with rickettsial diseases. J Med Microbiol 29: 199202.[Crossref]
  48. Neilson GH, , 1955. A case of Queensland tick typhus. Med J Aust 42: 763764.
  49. La Scola B, Raoult D, , 1997. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol 35: 27152727.
  50. Renvoisé A, Rolain JM, Socolovschi C, Raoult D, , 2012. Widespread use of real-time PCR for rickettsial diagnosis. FEMS Immunol Med Microbiol 64: 126129.[Crossref]
  51. Wang JM, Hudson BJ, Watts MR, Karagiannis T, Fisher NJ, Anderson C, Roffey P, , 2009. Diagnosis of Queensland tick typhus and African tick bite fever by PCR of lesion swabs. Emerg Infect Dis 15: 963965.[Crossref]
  52. Antibiotic Expert Groups, 2014. Rickettsial infections. In Therapeutic Guidelines: Antibiotic. Version 15. Melbourne, Australia: Therapeutic Guidelines Limited, 536.
  53. Stenos J, Walker DH, , 2000. The rickettsial outer-membrane protein A and B genes of Rickettsia australis, the most divergent Rickettsia of the spotted fever group. Int J Syst Evol Microbiol 50: 17751779.[Crossref]
  54. Feng HM, Walker DH, , 2003. Cross-protection between distantly related spotted fever group rickettsiae. Vaccine 21: 39013905.[Crossref]
  55. Watts MR, Benn RA, Hudson BJ, Graves SR, , 2008. A case of prolonged fatigue following an acute rickettsial infection. QJM 101: 591593.[Crossref]
  56. Unsworth N, Graves S, Nguyen C, Kemp G, Graham J, Stenos J, , 2008. Markers of exposure to spotted fever rickettsiae in patients with chronic illness, including fatigue, in two Australian populations. QJM 101: 269274.[Crossref]
  57. Knyvett AF, Sandars DF, , 1964. North Queensland tick typhus: a case report defining a new endemic area. Med J Aust 2: 592594.
  58. Kirkland KB, Wilkinson WE, Sexton DJ, , 1995. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis 20: 11181121.[Crossref]

Data & Media loading...

  • Received : 21 Nov 2016
  • Accepted : 26 Mar 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error