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ABSTRACT Background: We evaluated the predictive factors for case confirmation and death from Brazilian spotted fever in an endemic area of Southeastern Brazil. Methods: A cross-sectional study was conducted. All suspected cases reported between 2007 and 2021 were analyzed using two logistic regression models. Results: 60 cases were confirmed. Male sex, age group of 40-59 years, tick parasitism, presence of capybaras or horses, exanthema and hospitalization were positively associated with confirmation. Death was associated with a longer period between first symptom-hospitalization and shorter treatment. Conclusions: Complete clinical evaluation and information on risk exposure are key to early suspicion, diagnosis, treatment and prevention of deaths.