- Brain/meninges, heart, liver, kidney, skin, and generally systemic
- Rickettsial infection (obligate intracellular bacteria)
- Can occur in most states in US, most commonly: North Carolina, Arkansas, Tennessee, Oklahoma, Missouri
- Incubation 2d to 2w
- Then often generalized erruption 2-5d after fever
- Can be severe/fatal
- Skin findings of red, non-puritic, blanching macules, typically starting around wrists/ankles; then progresses to trunk and sometimes soles/palms
- Then often petechiae
- Often thrombocytopenia, hyponatremia, elevated transaminases