Rickettsial diseases are vector-borne illnesses usually carried by ticks, lice, fleas, or mites, and they are widely distributed throughout the world. Tick typhus (also known as Mediterranean spotted fever or boutonneuse fever) is the most common imported rickettsial disease in returning travelers. It is endemic in southern Europe and the Middle East, where it is caused by Rickettsia conorii, and in southern Africa, where Rickettsia africae is the etiologic agent. After a 5- to 7-day incubation period, fever, headaches, and myalgias may occur. A maculopapular rash involving the palms, soles, and face may accompany the illness. There is usually an eschar, called a tache noire (“black spot”) at the tick bite site. The diagnosis is usually confirmed serologically. Doxycycline is the treatment of choice. Depending on the area visited, other rickettsial infections, such as Rocky Mountain spotted fever, epidemic typhus, endemic typhus, or scrub typhus, should be considered.