Make me comparative table for all rickettsiae infection

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I have extensive data from Harrison's block21 already (the large truncated result contained the full disease table). I now have enough information to compile a comprehensive comparative table. Let me now construct it from all the data gathered.

Based on Harrison's 22nd edition, Goldman-Cecil, Jawetz, and Henry's Lab Diagnosis, here is the comprehensive comparative table:

Comparative Table of All Rickettsial Infections

The organisms below belong to 7 genera: Rickettsia, Orientia, Ehrlichia, Anaplasma, Neorickettsia, "Candidatus Neoehrlichia", and Coxiella.

Group 1: Spotted Fever Group Rickettsiae (SFGR)

Feature	Rocky Mountain Spotted Fever (RMSF)	Mediterranean Spotted Fever (MSF) / Boutonneuse Fever	African Tick-Bite Fever	Rickettsialpox	R. parkeri Infection	Pacific Coast Tick Fever
Organism	R. rickettsii	R. conorii	R. africae	R. akari	R. parkeri	R. philipii
Vector	Dermacentor ticks (wood/dog tick); also Amblyomma cajennense	Rhipicephalus sanguineus (brown dog tick)	Amblyomma hebraeum, A. variegatum	Liponyssoides sanguineus (mouse mite)	Amblyomma maculatum (Gulf Coast tick)	Dermacentor occidentalis (Pacific Coast tick)
Reservoir	Ticks (transovarial); small mammals	Dog tick; dogs, rodents	Cattle, ruminants	House mice	Rodents, cattle	Unknown
Geography	Americas (SE/SC USA most common; Brazil, Colombia, Mexico, Argentina)	Mediterranean basin, Southern Europe, Africa, Middle East, India	Sub-Saharan Africa, Caribbean	Eastern USA, former USSR	SE USA, Gulf Coast	Pacific Coast USA
Incubation	2-14 days (mean 7 days)	5-7 days	5-7 days	10-17 days	~7 days	~7 days
Fever	Yes, abrupt onset	Yes, high	Yes	Yes	Yes	Yes
Rash	Maculopapular → petechial; starts wrists/ankles → trunk; involves palms/soles	Maculopapular; involves palms/soles	Multiple vesicular/papular lesions; often multiple eschars	Papulovesicular rash (like chickenpox)	Maculopapular/vesicular	Maculopapular
Eschar	Rarely present	Often single eschar ("tache noire")	Multiple eschars (hallmark)	Papule → eschar at bite site	Eschar present	Variable
Severity	Most severe SFGR; case fatality ~20-25% untreated; up to 73% in some outbreaks	Moderate-severe; ~2-3% CFR	Usually mild-moderate	Mild, self-limited	Mild-moderate	Mild
Pathology	Endothelial cell invasion → vasculitis, microvascular injury, increased permeability	Endothelial vasculitis	Endothelial vasculitis	Endothelial vasculitis	Endothelial vasculitis	Endothelial vasculitis
Intracellular location	Cytoplasm and nucleus	Cytoplasm and nucleus	Cytoplasm and nucleus	Cytoplasm and nucleus	Cytoplasm and nucleus	Cytoplasm and nucleus
Lab findings	Thrombocytopenia, hyponatremia, elevated LFTs, normal/low WBC	Thrombocytopenia, elevated LFTs	Usually mild changes	Mild thrombocytopenia	Similar to RMSF but milder	Similar to RMSF
Diagnosis	Clinical + DFA on skin biopsy; PCR; serology (IFA - 4-fold rise)	IFA serology; PCR; skin biopsy	Clinical + IFA; PCR from eschar swab	IFA serology; PCR	PCR; IFA serology	PCR; IFA serology
Treatment	Doxycycline 100 mg BID x 5-7 days (DOC); chloramphenicol in pregnancy	Doxycycline 100 mg BID x 5-7 days	Doxycycline 100 mg BID x 5-7 days	Doxycycline	Doxycycline	Doxycycline
Notes	Sulfonamides worsen disease; do not delay treatment; bioterrorism agent	"Tache noire" is pathognomonic	Multiple bite sites, multiple eschars distinguish from MSF	Vesicular rash mimics varicella	Milder phenotype vs. RMSF	Pacific Coast only

Group 2: Typhus Group Rickettsiae

Feature	Epidemic (Louse-borne) Typhus	Brill-Zinsser Disease	Murine (Endemic) Typhus	Scrub Typhus
Organism	R. prowazekii	R. prowazekii (reactivation)	R. typhi	Orientia tsutsugamushi
Vector/Transmission	Human body louse (Pediculus humanus) - feces inoculated by scratching	Reactivation (no vector needed)	Oriental rat flea (Xenopsylla cheopis) - feces inoculated	Larval trombiculid mites (Leptotrombidium spp.) - chigger bite
Reservoir	Humans (only rickettsial disease where humans are primary reservoir)	Previous host (the patient themselves)	Rats (Rattus spp.)	Rodents; mites serve as reservoir AND vector (transovarial)
Geography	Africa, South America, Asia; war/famine/disaster zones; cold climates	Worldwide (prior louse typhus areas)	Worldwide; seaports, tropical/subtropical	Asia-Pacific region ("scrub typhus belt"); NE Australia; parts of Africa
Incubation	7-14 days	Weeks to decades after primary episode	7-14 days (mean 11 days)	6-21 days (mean 10-12 days)
Fever	Sudden onset, high (39-41°C), sustained	Milder than primary episode	Gradual onset (3-day prodrome)	Abrupt onset, high
Rash	Maculopapular → petechial; starts trunk → extremities; spares face/palms/soles	Macular or maculopapular, milder	Maculopapular; similar to epidemic typhus but milder	Maculopapular (in ~50%); trunk → extremities
Eschar	Absent	Absent	Absent	Present at chigger bite site (pathognomonic when found, ~50% of cases)
Severity	Severe; CFR 10-40% without treatment; higher in elderly	Milder than primary; CFR <1%	Moderate; CFR <1% with treatment; ~1-4% untreated	Moderate-severe; variable by strain; CFR 1-30% without treatment
Complications	Meningoencephalitis, pneumonitis, myocarditis, vasculitis, gangrene	Same complications as primary, but milder	Pneumonitis, hepatitis, meningoencephalitis	Interstitial pneumonitis, meningoencephalitis, myocarditis, acute renal failure
Pathology	Vasculitis, endothelial involvement, grows in cytoplasm	Same as epidemic typhus	Vasculitis; grows in cytoplasm	Endothelial cell invasion; lymphadenopathy (generalized)
Intracellular location	Cytoplasm	Cytoplasm	Cytoplasm	Cytoplasm
Lab findings	Thrombocytopenia, elevated LFTs, hyponatremia, elevated ESR	Mild thrombocytopenia, elevated ESR	Thrombocytopenia, elevated LFTs, anemia	Thrombocytopenia, elevated LFTs, hyponatremia, hypoalbuminemia
Serology	Weil-Felix (OX-19 positive); IFA (gold standard)	IFA (lower titers than primary)	Weil-Felix (OX-19 positive); IFA	Weil-Felix (OX-K positive); IFA (limited by antigenic variation of O. tsutsugamushi)
Diagnosis	Clinical + IFA; PCR; skin biopsy	Clinical history of prior typhus + milder illness; IFA	IFA serology; PCR	Eschar + clinical picture; IFA; PCR from eschar or blood
Treatment	Doxycycline 100 mg BID x 7-14 days (single 200 mg dose also effective); chloramphenicol	Doxycycline; single dose often sufficient	Doxycycline 100 mg BID x 7 days; also responds to azithromycin	Doxycycline 100 mg BID x 7-15 days; azithromycin (preferred in pregnancy & children)
Notes	Only rickettsial disease transmitted human-to-human (via lice); bioterrorism threat; associated with war/poverty/crowding	Latent form of epidemic typhus reactivated by stress/immunosuppression (recrudescence after years)	Flying squirrels also reservoir in SE USA (R. prowazekii variant)	Largest rickettsial disease burden globally; azithromycin emerging for doxycycline-resistant strains

Group 3: Ehrlichioses & Anaplasmosis (Family Anaplasmataceae)

Feature	Human Monocytotropic Ehrlichiosis (HME)	Human Granulocytotropic Anaplasmosis (HGA)	Ehrlichia ewingii Infection	Neoehrlichiosis
Organism	Ehrlichia chaffeensis	Anaplasma phagocytophilum	Ehrlichia ewingii	"Candidatus Neoehrlichia mikurensis"
Target cell	Monocytes/macrophages (morulae in cytoplasm)	Granulocytes/neutrophils (morulae in cytoplasm)	Granulocytes	Endothelial cells / macrophages
Vector	Amblyomma americanum (lone star tick)	Ixodes scapularis (black-legged tick); I. pacificus (West Coast)	Amblyomma americanum	Ixodes ricinus (Europe)
Reservoir	White-tailed deer	White-footed mouse, white-tailed deer	White-tailed deer	Rodents
Geography	SE and SC USA (overlaps with Lone Star tick range)	NE and Upper Midwest USA; Pacific Coast; Europe; Asia	SE USA	Europe (esp. immunocompromised patients)
Incubation	5-21 days (mean 9 days)	5-21 days (mean ~9 days)	5-21 days	Variable (weeks)
Fever	Abrupt, high	Abrupt, high	Yes	Yes
Rash	In ~36% (more common than HGA)	In <10% (rare - should prompt reconsidering diagnosis)	Occasional	Rare
Eschar	Absent	Absent	Absent	Absent
Morulae on smear	Present in monocytes (~4%)	Present in neutrophils (~20-80%)	Present in granulocytes	Not typically seen
Severity	Moderate-severe; CFR ~2-3%; severe in immunocompromised	Moderate; CFR <1%; can be severe in elderly/immunocompromised	Mild-moderate	Severe in immunocompromised; can be fatal
Complications	Meningoencephalitis, respiratory failure, opportunistic infections (due to immunosuppression of monocytes)	DIC, respiratory failure; may unmask HIV; rarely neurologic	Usually mild	Thromboembolic events, fever, weight loss
Lab findings	Leukopenia, thrombocytopenia, elevated LFTs, elevated ESR	Leukopenia + neutropenia, thrombocytopenia, elevated LFTs, anemia	Leukopenia, thrombocytopenia	Elevated inflammatory markers; variable cytopenias
Serology	IFA (paired sera); PCR on blood (gold standard in acute phase)	IFA; PCR on blood (gold standard); blood smear	PCR; IFA	PCR; 16S rRNA gene sequencing
Treatment	Doxycycline 100 mg BID x 5-10 days	Doxycycline 100 mg BID x 5-10 days	Doxycycline	Doxycycline; rifampin alternative
Notes	No rash: "spotless" infection; common in immunocompromised; can cause life-threatening opportunistic infections	Ixodes tick also transmits Lyme disease and babesiosis - co-infection possible	Clinically mild vs. HME	Mainly in splenectomized or immunocompromised patients in Europe

Group 4: Q Fever (Family Coxiellaceae)

Feature	Acute Q Fever	Chronic Q Fever
Organism	Coxiella burnetii	Coxiella burnetii
Transmission	Inhalation of aerosols from infected animals (especially parturient livestock - cattle, sheep, goats); raw milk; rarely tick bite (Amblyomma, Dermacentor)	Persistence of primary infection
Reservoir	Cattle, sheep, goats; cats; ticks	Same host
Geography	Worldwide (except New Zealand)	Worldwide
Incubation	2-6 weeks (dose-dependent)	Months to years after acute infection
Fever	Yes, abrupt, high	Low-grade or absent
Rash	In ~17% (maculopapular)	Rare
Eschar	Absent	Absent
Clinical Presentation	Self-limited febrile illness; atypical pneumonia (50-60%); hepatitis (granulomatous hepatitis with "doughnut granuloma"); can present as isolated fever	Endocarditis (most common - ~60-70% of chronic Q fever); hepatitis; osteomyelitis; vascular infections; chronic fatigue syndrome
Severity	Usually self-limited; <1% CFR	High mortality (25-65%) without treatment; requires prolonged therapy
Pathology	Intracellular in phagolysosome (acidic vacuole - unique among rickettsiae); induces phase variation (Phase I - virulent; Phase II - avirulent)	Endovascular infection; immune complex deposition
Lab findings	Elevated LFTs, elevated ESR, thrombocytopenia; CXR: patchy consolidation	Elevated Phase I IgG (≥1:800 by IFA) - diagnostic hallmark
Serology	Phase II antibodies predominate in acute; Phase I antibodies predominate in chronic	Phase I IgG ≥1:800 (diagnostic of chronic Q fever)
Diagnosis	Clinical + PCR (acute phase); serology (acute vs. convalescent IFA); Weil-Felix negative	Serology (Phase I IgG ≥1:800); PCR; echocardiography
Treatment (Acute)	Doxycycline 100 mg BID x 14 days	-
Treatment (Chronic)	-	Doxycycline 100 mg BID + hydroxychloroquine 200 mg TID x 18-24 months (DOC); monitor doxycycline levels; ophthalmology follow-up
Notes	Single organism can cause infection; bioterrorism threat; "atypical" appearance on CXR; granulomatous hepatitis ("doughnut granuloma" or fibrin-ring granuloma is hallmark); sulfonamides NOT harmful (unlike other rickettsiae)	Prophylaxis with doxycycline + hydroxychloroquine in patients with valvular disease after acute Q fever; check Phase I serology at 6 months post-acute

Group 5: Neorickettsia

Feature	Sennetsu Fever
Organism	Neorickettsia sennetsu
Vector/Transmission	Ingestion of raw fish containing infected metacercariae (fish-borne trematode)
Geography	Japan, Malaysia
Clinical features	Infectious mononucleosis-like illness: fever, lymphadenopathy (posterior cervical most prominent), malaise, anorexia
Rash	Absent
Treatment	Doxycycline
Notes	No arthropod vector; only food-borne rickettsial disease

Quick-Reference Summary Table

Disease	Organism	Group	Vector	Eschar	Rash	Morulae	Weil-Felix	Treatment
RMSF	R. rickettsii	Spotted fever	Tick	Rare	Yes (palms/soles)	No	OX-19, OX-2	Doxycycline
Mediterranean SF	R. conorii	Spotted fever	Tick	Yes (tache noire)	Yes (palms/soles)	No	OX-19, OX-2	Doxycycline
African tick-bite fever	R. africae	Spotted fever	Tick	Multiple	Yes (vesicular)	No	OX-19, OX-2	Doxycycline
Rickettsialpox	R. akari	Spotted fever	Mite	Yes	Yes (vesicular)	No	Negative	Doxycycline
R. parkeri infection	R. parkeri	Spotted fever	Tick	Yes	Yes	No	OX-19, OX-2	Doxycycline
Epidemic typhus	R. prowazekii	Typhus	Body louse	No	Yes (trunk first)	No	OX-19	Doxycycline
Brill-Zinsser	R. prowazekii	Typhus	None (reactivation)	No	Mild/variable	No	OX-19 (low)	Doxycycline
Murine typhus	R. typhi	Typhus	Rat flea	No	Yes (trunk first)	No	OX-19	Doxycycline
Scrub typhus	O. tsutsugamushi	Scrub typhus	Mite (chigger)	Yes (~50%)	Yes (~50%)	No	OX-K	Doxycycline / Azithromycin
HME	E. chaffeensis	Ehrlichiosis	Lone star tick	No	Yes (~36%)	Monocytes	Negative	Doxycycline
HGA	A. phagocytophilum	Anaplasmosis	Ixodes tick	No	Rare (<10%)	Neutrophils	Negative	Doxycycline
E. ewingii	E. ewingii	Ehrlichiosis	Lone star tick	No	Rare	Granulocytes	Negative	Doxycycline
Neoehrlichiosis	"Ca." N. mikurensis	Ehrlichiosis	Ixodes tick	No	Rare	No	Negative	Doxycycline
Q fever (acute)	C. burnetii	Coxiella	Aerosol/tick	No	Rare (17%)	No	Negative	Doxycycline
Q fever (chronic)	C. burnetii	Coxiella	-	No	No	No	Negative	Doxycycline + Hydroxychloroquine
Sennetsu fever	N. sennetsu	Neorickettsia	Raw fish	No	No	No	Negative	Doxycycline

Key Points

Doxycycline is the drug of choice for virtually all rickettsial infections. Delay in treatment significantly worsens outcomes - especially in RMSF and epidemic typhus.
Sulfonamides are contraindicated in most rickettsial infections as they enhance rickettsial growth and worsen disease. Exception: TMP-SMX is used in Q fever during pregnancy (doxycycline is relatively contraindicated in pregnancy for most other rickettsiae; azithromycin is used for scrub typhus in pregnancy).
Weil-Felix reaction (agglutination of Proteus strains): OX-19 & OX-2 positive in spotted fever group and typhus group; OX-K positive in scrub typhus; negative in Q fever, ehrlichioses, rickettsialpox.
Chronic illness occurs only with C. burnetii (Q fever endocarditis). Recrudescence (not true chronicity) occurs with R. prowazekii (Brill-Zinsser disease).
Bioterrorism agents: R. prowazekii, R. rickettsii, R. typhi, R. conorii, and C. burnetii.
Laboratory clues common to most rickettsial infections: thrombocytopenia + elevated LFTs + normal/low WBC + hyponatremia in the right clinical/epidemiological context.

Harrison's Principles of Internal Medicine 22e, Chapter 192 (Rickettsial Diseases)
Goldman-Cecil Medicine, Chapter 302 (Rickettsial Infections)
Jawetz, Melnick & Adelberg's Medical Microbiology 28e, Chapter 26
Henry's Clinical Diagnosis and Management by Laboratory Methods, Chapter 63

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