Diagnosis can be made by ELISA. Treatment options are tetracycline, doxycycline, or macrolides; fluoroquinolone are to be considered in meningitis [55] . Treatment should be continued until the fever has subsided for 1 week [52] . Postexposure prophylaxis with a 5-day course of tetracycline or doxycycline may be effective if initiated within 8 to 12 days of exposure [52] .