LETTERS Rickettsia felis and Changing Paradigms

al. recently reported several features common to the epidemiology of Rick-ettsia felis infection and malaria in Africa (1). Similar to the findings of several other recent studies in Africa (2,3), the authors diagnosed R. felis in-fection in febrile—and to a lesser ex-tent in afebrile—persons by detecting R. felis DNA in human blood samples processed by highly sensitive real-time PCR. These results challenge some paradigms in rickettsiology that need to be more critically evaluated. Because R. felis DNA was detected in circulating blood o