Community Transmission of Extended-Spectrum β-Lactamase

land. Furthermore, Ct. felis often feeds on humans. Clinicians encountering patients with fever or rash (or both) and a history of cat contact or flea bites should consider a diagnosis of R. felis. Laboratory confirmation of infection is not easy, but in vitro culture of R. felis, and hence material for a serologic assay for the diagnosis of human R. felis infections, has recently been described, and serology appears to be an accurate indicator of exposure (9). As with other spotted fever group rickettsial infections, molecular diagnostics may provide a useful alternative approach to detecting and identifying R. felis in infected tissues. In culture, R. felis has been shown to be resistant to erythromycin (unlike other rickettsia), gentamicin, amoxicillin, and trimethoprim-sulfamethoxazole. Thus, infection with this bacterium should be considered in cases of antibiotic-insensitive fever with a rash, especially in young, old, and immunosuppressed persons. The organism is sensitive to doxycycline, rifampicin, thiamphenicol, and fluoroquinolones (10) Acknowledgments We thank Alex Davies and Anne Seabright for assistance with collecting and processing the fleas and D. Raoult for providing Rickettsia felis.