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Description

Rickettsialpox is a mite-borne infectious illness transmitted by Liponyssoides sanguineus, and presents with fever, scabby sore and a rash.[1]It is caused by bacteria of the genus Rickettsia (Rickettsia akari).Physician Robert Huebner and self-trained entomologist Charles Pomerantz played major roles in identifying the cause of the disease after an outbreak in 1946 in a New York City apartment complex.[2][3]Although it is not transmitted by a tick, the bacterium is a part of the spotted fever group of Rickettsia.[4]Doxycycline is the treatment of choice.[5]

Presentation

The first symptom is a bump formed by the bite, eventually resulting in a black, crusty scab. Many of the symptoms are flu-like including fever, chills, weakness and achy muscles but the most distinctive symptom is the rash that breaks out, spanning the infected person's entire body.[6][3]

Cause

The cause of Rickettsialpox is R. akari.Rickettsia species are gram negative, intracellular bacilli that multiply inside cytosol of endothelial cells. Rickettsia akari is classified in spotted fever group rickettsiae.[3][7]

Transmission

The bacteria are originally found in mice and cause mites feeding on the mice to become infected. Humans will get rickettsialpox when receiving a bite from an infected mite, not from the mice themselves.[3][8]The mite is Liponyssoides sanguineus, which was previously known as Allodermanyssus sanguineus.[9]

Diagnosis

The diagnosis of this infection in an individual is done via the following: swabbing rash, test of blood serum, and physical exam.[10]

Differential diagnosis

The differential diagnosis for Rickettsialpox, in the affected individual is as follows: Infectious mononucleosis, Chickenpox, Lyme disease and streptococcal infection.[3]

Treatment

Rickettsialpox is treated with tetracyclines (doxycycline is the drug of choice). Chloramphenicol is a suitable alternative.[11]Treatment involves taking doxycycline for five days, which helps the duration of systemic symptoms in the affected individual.[12]

Epidemiology

In terms of epidemiology, we find that Rickettsialpox has been reported in New York, Pittsburgh, Cleveland, Boston, Arizona, Utah, and North Carolina (in the U.S.). It has also been detected in other countries like South Africa, Ukraine, and Croatia.[3][13]

History 1

The initial outbreak of the disease took place in the Regency Park complex which had 69 apartment units organized in three groups each three stories in height, located in Kew Gardens, in the New York City borough of Queens. Physicians who had seen patients starting in early 1946 had assumed that they were dealing with an atypical form of chickenpox, but the realization was made that they were dealing with a localized epidemic of unknown origins starting in the summer of that year. [14]

History 2

Physician Robert Huebner and entomologist Charles Pomerantz had roles in identifying the cause of the disease. In one visit Huebner peeled back wallpaper to find the walls swarming with mites, so much so that tenants had said that "the walls had movement". The mites were collected and rickettsial strains were isolated from some of them, with the name Rickettsia akari given to the organism.[15][14]

References

  1. Adem, Patricia V. (May 2019). "Emerging and re-emerging rickettsial infections". Seminars in Diagnostic Pathology. 36 (3): 146–151. doi:10.1053/j.semdp.2019.04.005. ISSN 0740-2570. PMID 31101391. Archived from the original on 2022-06-09. Retrieved 2022-06-06. Archived 2022-06-09 at the Wayback Machine
  2. Roueché, Berton (22 August 1947). "THE ALERTING OF MR. POMERANTZ". The New Yorker. Archived from the original on 22 August 2023. Retrieved 12 January 2025.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Akram, Sami M.; Jamil, Radia T.; Gossman, William (2025). "Rickettsia akari (Rickettsialpox)". StatPearls. StatPearls Publishing.
  4. "eMedicine - Rickettsialpox : Article by Julie A Ake". 2019-07-10. Archived from the original on 2008-09-24. Retrieved 2021-06-03. {{cite journal}}: Cite journal requires |journal= (help) Archived 2008-09-24 at the Wayback Machine
  5. Pedro-Pons, Agustín (1968). Patología y Clínica Médicas. Vol. 6 (3rd ed.). Barcelona: Salvat. p. 844. ISBN 84-345-1106-1.
  6. "Rickettsialpox". Red book Rickettsialpox. 1 January 2021. doi:10.1542/9781610025782-S3_117 (inactive 14 January 2025). Archived from the original on 20 January 2022. Retrieved 10 January 2025.{{cite journal}}: CS1 maint: DOI inactive as of January 2025 (link)
  7. Eremeeva, Marina E.; Dasch, Gregory A. (1 January 2008). "Other Rickettsia Species". Principles and Practice of Pediatric Infectious Disease (Third ed.). W.B. Saunders. pp. 919–927. ISBN 978-0-7020-3468-8.
  8. Department of Health. Victoria, Australia. "Rickettsial infections". www.health.vic.gov.au. Retrieved 14 January 2025.
  9. "Rickettsialpox: eMedicine Infectious Diseases". Archived from the original on 2010-11-29. Retrieved 2010-04-26. Archived 2010-11-29 at the Wayback Machine
  10. "Rickettsialpox: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 29 July 2021. Retrieved 24 February 2022. Archived 29 July 2021 at the Wayback Machine
  11. Pedro-Pons, Agustín (1968). Patología y Clínica Médicas. Vol. 6 (3rd ed.). Barcelona: Salvat. p. 844. ISBN 84-345-1106-1.
  12. "Rickettsialpox - Infectious Diseases". Merck Manual Professional Edition.
  13. Paris, Daniel H.; Day, Nicholas P. J. (1 January 2024). "29 - Tropical Rickettsial Infections". Manson's Tropical Diseases (Twenty-Fourth ed.). Elsevier. pp. 326–343. ISBN 978-0-7020-7959-7.
  14. 14.0 14.1 Greenberg, Morris; Pellitteri, Ottavio J.; and Jellison, William L. "Rickettsialpox - A Newly Recognized Rickettsial Disease", American Journal of Public Health, July 1947. Accessed July 25, 2009.
  15. Beeman, Edward A. "Robert J. Huebner, M.D.:A Virologist's Odyssey" Archived 2015-02-13 at the Wayback Machine, National Institutes of Health, 2005. Accessed July 23, 2009.