Background: Rickettsial infection is one of the most frequently occurring neglected diseases, which can be life-threatening if left untreated. Hence, it is important to know the burden of the disease for taking appropriate preventive and control measures. This paper focused on the seroprevalence of rickettsial infection among hospitalized patients residing in the coastal area of Teknaf, Cox’s Bazar, Bangladesh. Methods: We retrospectively analyzed the hospital records of Weil-Felix test-positive patients from January to December 2022 at Respiratory Disease Hospital, Teknaf. A rapid slide agglutination assay, colorimetric method, KOVA cell counting, flow cytometry method, and SPSS were used for data analysis. The necessary ethical approval was obtained from the Institutional Reviewer Board for using the hospital records. Results: A total of 91 (16.9%) Rickettsia-positive cases were found out of 538 suspected cases, of which half were male (49.5%). The most predominant age group was 5 to under 18 years of age (41.7%), followed by 18‒30 years of age (23.1%). Fever was the most prominent clinical symptom (97.7%), followed by cough (42.9%), muscle aches (29.7%), and headaches (27.5%). The blood count of the patients showed leukocytosis (53.2%), followed by neutrophilia (23.4%) and thrombocytosis (15.6%). Serum creatinine and C-reactive protein were elevated in 13% and 40% of cases, respectively. Urine analysis detected the presence of high pus cells (83.9%), followed by proteinuria (45.2%) and ketonuria (13.0%). Conclusion: In-depth confirmatory exploration and preventive measures are necessary to manage and mitigate the spread of infections at Teknaf.