Rickettsial infections are one of the important causes of pyrexia of unknown origin (PUO) and these needs to be differentiated from other febrile illnesses. Rickettsial infections are grossly under-diagnosed in India. All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. All suspected cases were subjected to rickettsial IgM/IgG ELISA test and tests to exclude other diseases. Scrub typhus and Indian tick typhus elisa positive (mixed infection) noted in 14% of cases. Complications like meningoencephalitis (5.8%), shock (5.8%), DIC (2.9%) was observed in the study. There was good clinical response on initiation of doxycycline within 48hrs of initiation of treatment. Case fatality rate of rickettsial disease in this study was 5.8% (n=2). Rickettsial diseases are difficult to diagnose, unless suspected but treatment is easy, affordable and often successful with dramatic response to antimicrobials