The aim of this study was to describe the clinical and epidemiological features of spotted fever group rickettsiosis acquired in the province of Albacete, Spain.We retrospectively reviewed the clinical records of patients with a diagnosis of spotted fever group rickettsiosis and positive serologic results between 1997 and 2003. Criteria for inclusion were as follows: 1) seroconversion in IgG to Rickettsia conorii by indirect immunofluorescence, or 2) a single titer of 160 dollars with two or three of the following symptoms: fever, eschar, or rash.There were 41 cases in the study period. Mean age was 58 years (range: 14-84). Thirty-seven (90%) patients were 40 or more years old (RR: 10,1; 95% CI: 4,3-24,0). Twenty-five (63%) patients were of rural origin (RR: 3,5; 95% CI: 1,8-6,5). Thirty-six (88%) patients had regular or recent contact with the rural milieu or with animals. Forty patients had fever and 38 (93%) had one or two eschars. There were 32 cases of Mediterranean spotted fever, 2 cases with symptoms consistent with DEBONEL/TIBOLA, and 7 atypical cases with eschar and no rash.Spotted fever group rickettsiosis was mainly found in adults in contact with the rural milieu or with animals. Age over 40 years old and residence in a rural area were risk factors. Mediterranean spotted fever was the most common syndrome.