The name rickettsialpox is derived from the causative organism Rickettsia akari and the similarity of the cutaneous lesions to chickenpox [1]. The disease can affect all ages and has an equal incidence in men and women [1]. Cases of rickettsialpox, infected mites, and R.akari reservoirs have been reported from countries like the United States, Turkey, Croatia, and Ukraine [2] [3] [4] [5] [6].

The rickettsia proliferates at the site of the mite bite with symptoms appearing up to two weeks later. Initially, a tiny, non-tender papule or vesicle is seen at the site of the bite. It soon forms an ulcer with eschar which heals with a scar. This may or may not be associated with regional lymphadenopathy [7]. A week later constitutional symptoms like fever, chills, headaches, myalgias, photophobia, diaphoresis and a generalized maculopapular rash with papulovesicular lesions sparing the palms and soles appears. The pruritic lesions can be seen on the trunk, limbs, face, lingual, buccal and pharyngeal mucosa. They last for approximately a week and heal without scarring. Rarely there may be associated neurological symptoms like photophobia, vertigo, retro-orbital pain, neck stiffness [3]. Cases of hepatitis have also been reported [8]. Rickettsialpox is a self-limiting disease and not associated with mortality. However, severe hemorrhage in a patient with rickettsia and variations in clinical presentations amongst patients in different parts of the world is known to exist [9].

• Fever

  She later developed a maculopapular rash completing the classic triad for rickettsialpox: black eschar, papular rash, and fever. [einstein.pure.elsevier.com]

  […] spotted fever, boutonneuse fever, louse-borne typhus fever, and murine typhus. [ncbi.nlm.nih.gov]

  (inanition) (of unknown origin) (persistent) (with chills) (with rigor) R50.9 ICD-10-CM Diagnosis Code R50.9 Fever, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Fever NOS Fever of unknown origin [FUO] Fever with chills Fever with [icd10data.com]

  References Old-World Spotted Fevers: Global Status includes separate sections on African tick bite fever, Astrakhan fever, Israeli spotted fever, Rickettsia sibirica mongolotimonae infection, Spotted fevers - Old World, and Rickettsialpox. [books.google.com]

• Chills

  1. rickettsialpox (n.) mild infectious rickettsial disease caused by a bacterium of the genus Rickettsia transmitted to humans by the bite a mite that lives on rodents; characterized by chills and fever and headache and skin lesions that resemble chickenpox [synonym.com]

  Rat-bite fever It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques. [wikidoc.org]

  Definitions of rickettsialpox 1 n mild infectious rickettsial disease caused by a bacterium of the genus Rickettsia transmitted to humans by the bite a mite that lives on rodents; characterized by chills and fever and headache and skin lesions that resemble [vocabulary.com]

  […] fuente: Wikipedia English - The Free Encyclopedia Más: Traductor de Inglés a Inglés Noun 1. mild infectious rickettsial disease caused by a bacterium of the genus Rickettsia transmitted to humans by the bite a mite that lives on rodents; characterized by chills [traductor.babylon-software.com]

  […] rick·ett·si·al·pox | \ ri-ˌket-sē-əl-ˈpäks \ Medical Definition of rickettsialpox : a disease characterized by fever, chills, headache, backache, and a spotty rash and caused by a bacterium of the genus Rickettsia ( R. akari ) transmitted to humans by [merriam-webster.com]

• Lymphadenopathy

  There is fever, a dark spot that becomes a small ulcer at the site of the bite, swollen glands (lymphadenopathy) in that region, and a raised blistery (vesicular) rash. Also known as vesicular rickettsiosis. [traductor.babylon-software.com]

  Skin eruptions may be subtle and asymptomatic It is classically described as: Non-pruritic bilateral symmetrical mucocutaneous rash Non-tender regional lymphadenopathy Condylomata lata and Patchy alopecia. [wikidoc.org]

  Regional lymphadenopathy is present. An intermittent fever lasts about 1 week, with chills, profuse sweating, headache, photophobia, and muscle pains. [msdmanuals.com]

  This may or may not be associated with regional lymphadenopathy. [symptoma.com]

  Generalized lymphadenopathy, which was described in a few patients in earlier case series, was not seen in any of our patients (Table 1). [slideshare.net]

• High Fever

  Patients may have high fever fluctuating between 101- 104oF. The maculopapulovesicular exanthema is usually comprised of 20-40 lesions but may range from 5-100. [thebacteriathatbites.weebly.com]

  Meningococcemia It commonly presents with rash, petechiae, headache, confusion, and stiff neck, high fever, mental status changes, nausea and vomiting. [wikidoc.org]

  Patients subsequently develop the abrupt onset of high fever, headache, and systemic symptoms, followed by a sparse, disseminated, papulovesicular rash. [slideshare.net]

  High-risk areas for acquiring the infection include bamboo plantations, crop fields, and coastal hills and forests. Japanese spotted fever has an abrupt onset with headache, high fever (39 to 40°C), and chills. [cmr.asm.org]

• Asymptomatic

  The lesions are typically asymptomatic but can be pruritic. Rashes last a week. Scabs form but do not leave scars. At the time of presentation, an eschar is present in at least 95% of affected individuals. [thebacteriathatbites.weebly.com]

  It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth ( herpangina ), on the palms and fingers of the hand, or on the soles of the feet. [wikidoc.org]

  During the summer of 2001, French United Nations troops in Kosovo collected ticks on asymptomatic soldiers and dogs in the Morina region. [cmr.asm.org]

• Lesion of the Tongue

  Lesions are usually scattered on the face, trunk, and extremities with no particular sequence of involvement.Patients may present with lesions on the tongue, buccal mucosa, and pharynx. Lesions may also be present on palms and soles. [thebacteriathatbites.weebly.com]

• Photophobia

  A week later constitutional symptoms like fever, chills, headaches, myalgias, photophobia, diaphoresis and a generalized maculopapular rash with papulovesicular lesions sparing the palms and soles appears. [symptoma.com]

  An intermittent fever lasts about 1 week, with chills, profuse sweating, headache, photophobia, and muscle pains. Early in the febrile course, a generalized maculopapular rash with intraepidermal vesicles appears, sparing the palms and soles. [msdmanuals.com]

  Other symptoms may include: Discomfort in bright light ( photophobia ) Fever and chills Muscle pain Rash that looks like chickenpox Sweating The rash is not painful and usually clears within a week. [huronregional.org]

  Other symptoms may include: Discomfort in bright light ( photophobia ) Fever and chills Headache Muscle pain Rash that looks like chickenpox Sweating Runny nose Sore throat Cough Enlarged lymph nodes Loss of appetite Nausea or vomiting The rash is not [medlineplus.gov]

  Photophobia and neck stiffness were described by 2 patients, but no severe neurological manifestations were identified on physical examination. [doi.org]

• Myalgia

  A week later constitutional symptoms like fever, chills, headaches, myalgias, photophobia, diaphoresis and a generalized maculopapular rash with papulovesicular lesions sparing the palms and soles appears. [symptoma.com]

  Final diagnosis 1 35 F Fever Headache Rash Eschar Leucopenia Thrombocytopenia ELT None Italy Skin biopsy 7886 (31.4) Negative NA MSF 2 41 F Fever Headache Eschar NA None South Africa Skin biopsy 791 (35.9) Negative Negative ATBF 3 43 M Fever Headache Myalgia [doi.org]

  Monkeypox The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. [wikidoc.org]

  All rights reserved. on November 10, 2010www.archdermatol.comDownloaded from 6. tionshouldalertclinicianstoconsiderrickettsialpox.Head- ache was common (89%), and myalgias were seen in more than one third (39%) of our patients. [slideshare.net]

• Papule

  Papule — A bump on the skin. Vesicle — A fluid-filled head on a papule. [encyclopedia.com]

  A crusted, ulcerated papule (eschar) with a red halo resembling a cigarette burn at the site of a tick bite. [medicinenet.com]

  The vesicle which is only the central part of the papule 6. Definite prodrome 7. Rash is evenly distributed except for palms, soles, and mucous membranes 8. [atsu.edu]

  The lesions typically begin as papules with subsequent vesiculation, but may remain avesicular. [thebacteriathatbites.weebly.com]

• Eruptions

  Rickettsialpox is easily treated and may resemble more serious cutaneous eruptions in patients infected with HIV. This diagnosis should be considered in immunocompromised city-dwellers, with fever and a papulovesicular rash. [ncbi.nlm.nih.gov]

  Several days after an eschar appears, the following can develop: Fever Headache Rash (sparse maculopapular or papulovesicular eruptions on the trunk and extremities) Muscle aches NOTE: R. parkeri rickettsiosis can be difficult to distinguish from RMSF [cdc.gov]

  Skin eruptions may be subtle and asymptomatic It is classically described as: Non-pruritic bilateral symmetrical mucocutaneous rash Non-tender regional lymphadenopathy Condylomata lata and Patchy alopecia. [wikidoc.org]

• Sweating

  Patents experience fevers, sweats, headaches, and a vesicular eruption over the trunk and extremities. The palms and soles are spared. An eschar results at the spot of the mite bite. Tetracycline is the treatment of choice. [ncbi.nlm.nih.gov]

  Rickettsialpox causes rash, fever, chills, heavy sweating, headache, eye pain (especially when exposed to light), weakness, and achy muscles. [encyclopedia.com]

  Fever, chills, swollen lymph nodes, rash, muscle pain, headache, and sweating may be associated with the condition. [emedicinehealth.com]

  An intermittent fever lasts about 1 week, with chills, profuse sweating, headache, photophobia, and muscle pains. Early in the febrile course, a generalized maculopapular rash with intraepidermal vesicles appears, sparing the palms and soles. [msdmanuals.com]

• Petechiae

  Meningitis It commonly presents with headache, nuchal rigidity, fever, petechiae and altered mental status. [wikidoc.org]

  These lesions are 0.5–1.5 cm wide, with a central area of ulcerated or scabbed skin surrounded by a halo of erythema ( A and B ) or petechiae (C). Panel D shows multiple eschars on patient 4. [doi.org]

  Hemorrhagic manifestations, including petechiae and suffusions, were frequent (69.5%). The case fatality rate was 30% (R. N. Angerami, M. R. Resende, S. B. Stuchi Raquel, G. Katz, E. Nascimento, and L. J. Silva, Abstr. 4th Int. Conf. [cmr.asm.org]

• Blister

  There can also be blisters in the throat or above the tonsils. Adults can also be affected. [wikidoc.org]

  The nodule develops into a fluid-filled blister that bursts and crusts over. This lump may be up to 1 inch (2.5 centimeters) wide. Symptoms usually develop 6 to 15 days after coming in contact with the bacteria. [ufhealth.org]

  The nodule develops into a fluid-filled blister that bursts and crusts over. This lump may be up to 1 inch (2.5 centimeters) wide. These lumps usually appear on the face, trunk, arms, and legs. [medlineplus.gov]

• Suggestibility

  Records of the New York City Health Department showed that serum samples from only six patients were submitted for serological testing for rickettsialpox during the past ten years, suggesting that although the disease is uncommon now, clinicians may be [ncbi.nlm.nih.gov]

  This group of diseases is important globally, and the experience of the last 30 years suggests that new emerging diseases are likely to bedevil us. [books.google.com]

  Although the prevalence of confirmed cases is very low, several reports suggest the disease is more common than previously thought. [thebacteriathatbites.weebly.com]

  General Laboratory Findings Mildly elevated hepatic transaminases Mild leukopenia Mild thrombocytopenia, less common CONFIRMATION OF THE DIAGNOSIS IS BASED ON LABORATORY TESTING, BUT ANTIBIOTIC THERAPY SHOULD NOT BE DELAYED IN A PATIENT WITH A SUGGESTIVE [cdc.gov]

• Headache

  Meningitis It commonly presents with headache, nuchal rigidity, fever, petechiae and altered mental status. [wikidoc.org]

  Patents experience fevers, sweats, headaches, and a vesicular eruption over the trunk and extremities. The palms and soles are spared. An eschar results at the spot of the mite bite. Tetracycline is the treatment of choice. [ncbi.nlm.nih.gov]

  1. rickettsialpox (n.) mild infectious rickettsial disease caused by a bacterium of the genus Rickettsia transmitted to humans by the bite a mite that lives on rodents; characterized by chills and fever and headache and skin lesions that resemble chickenpox [synonym.com]

  PCR, DNA copies mL −1 (mean C t value) Typhus group PCR, DNA copies mL −1 (mean C t value) Serology Final diagnosis 1 35 F Fever Headache Rash Eschar Leucopenia Thrombocytopenia ELT None Italy Skin biopsy 7886 (31.4) Negative NA MSF 2 41 F Fever Headache [doi.org]

Clinical suspicion, the geographical residence of the patient and a history of recent travel to areas known to have a high incidence of rickettsial infection is essential for diagnosis. Although laboratory tests are not diagnostic, a complete blood count with differential count may reveal leukopenia with relative lymphocytosis, and thrombocytopenia while urinalysis may show mild proteinuria. The diagnosis is established with indirect immunofluorescence assay (IFA) and polymerase chain reaction (PCR) of a biopsy specimen of the rash at a special reference laboratory [10] as only they can differentiate between the various rickettsial species [11]. Amplification of the bacterial genome with PCR can be confirmatory if IFA is inconclusive [7].

Cutaneous biopsies are rarely required for diagnosis. But if obtained, then histology of tissues stained with Giemsa may show very tiny coccobacillus intracellular bacteria with mononuclear cells infiltrating the epidermis. There may be dermal and epidermal necrosis, perivascular inflammation, red blood cell extravasation and vacuolar degeneration in the basal cell layers. It is difficult to grow rickettsia in cultures and therefore, cultures are not helpful in the workup.

Imaging studies are not useful in diagnosing rickettsialpox although they may be warranted in the case of suspected organ involvement and if complications of the disease develop.

• Leukopenia

  Although laboratory tests are not diagnostic, a complete blood count with differential count may reveal leukopenia with relative lymphocytosis, and thrombocytopenia while urinalysis may show mild proteinuria. [symptoma.com]

  General Laboratory Findings Mildly elevated hepatic transaminases Mild leukopenia Mild thrombocytopenia, less common CONFIRMATION OF THE DIAGNOSIS IS BASED ON LABORATORY TESTING, BUT ANTIBIOTIC THERAPY SHOULD NOT BE DELAYED IN A PATIENT WITH A SUGGESTIVE [cdc.gov]

  Of these 13 patients, 4 (31%) had mild leukopenia, with a white blood cell count ranging from 2.9 ϫ 103 /µL to 3.3 ϫ 103 /µL (normal range, 3.54ϫ103 /µL-9.06ϫ103 /µL).Twopatients(15%)hadleu- kocytosis. [slideshare.net]

  Mild thrombocytopenia (median platelet count, 145×10 6 platelets/L; range, 122–149×10 6 platelets/L) and leukopenia (median WBC count, 3.4×10 6 cells/L; range, 3.2–4.4×10 6 cells/L) were identified in 4 and 5, respectively, of 10 patients. [doi.org]

  Common nonspecific laboratory abnormalities in rickettsioses include mild leukopenia, anemia, and thrombocytopenia. Hyponatremia, hypoalbuminemia, and hepatic and renal abnormalities may also occur ( 276 ). [cmr.asm.org]

• Lymphocytosis

  Although laboratory tests are not diagnostic, a complete blood count with differential count may reveal leukopenia with relative lymphocytosis, and thrombocytopenia while urinalysis may show mild proteinuria. [symptoma.com]

• Rickettsia Typhi

  We developed a duplex real-time PCR that amplifies (1) DNA of any rickettsial species and (2) DNA of both typhus group rickettsia, that is, Rickettsia prowazekii and Rickettsia typhi. [doi.org]

  External links [ edit ] v t e Infectious diseases Bacterial disease : Proteobacterial G− primarily A00–A79, 001–041, 080–109 α Rickettsiales Rickettsiaceae / ( Rickettsioses ) Typhus Rickettsia typhi Murine typhus Rickettsia prowazekii Epidemic typhus [en.wikipedia.org]

  Complete genome sequence of Rickettsia typhi and comparison with sequences of other rickettsiae. J. Bacteriol. 186 : 5842 -5855. 204. ↵ McNaught, J. G. 1911. A tick-borne fever in the Union of South Africa. J. R. Army Med. [cmr.asm.org]

If rickettsialpox is suspected, these tests will likely be done: Complete blood count ( CBC ) Tests of blood serum (serologic studies) Swabbing and culture of the rash Treatment The goal of treatment is to cure the infection by taking antibiotics. [huronregional.org]

Culture pos: culture positive skin biopsies, Culture neg: culture negative skin biopsies; No treatment: skin biopsies obtained from patients without treatment, Treatment: skin biopsies obtained from patients receiving a treatment; Marseille: skin biopsies [doi.org]

Rickettsialpox should be considered in the differential diagnosis with other febrile illnesses for the correct diagnosis and accurate treatment of this potential threat to human health. [ncbi.nlm.nih.gov]

Treatment with antibiotics shortens the duration of symptoms usually to 24 to 48 hours. Without treatment, the disease resolves itself within 7 to 10 days. A full recovery is expected when antibiotics are taken as instructed. [medlineplus.gov]

Prognosis Prognosis for full recovery from rickettsialpox is excellent. No deaths have ever been reported from this illness, and even the skin rash heals without scarring. [encyclopedia.com]

Outlook (Prognosis) A full recovery is expected when antibiotics are taken as instructed. Possible Complications There are usually no complications if the infection is treated. [ufhealth.org]

Chloramphenicol is a suitable alternative. [4] Prognosis [ edit ] Rickettsialpox is generally mild and resolves within 2–3 weeks if untreated. There are no known deaths resulting from the disease. [en.wikipedia.org]

Moreover, the recognition of typhus group rickettsiosis is clinically and epidemiologically relevant, as these infections may be associated with a worse prognosis than spotted fevers ( Dumler et al., 1991 ; Bechah et al., 2008). [doi.org]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Including rickettsialpox in the evaluation of patients with eschars or vesicular rashes is likely to extend the recognized geographic distribution of Rickettsia akari, the etiologic agent of this disease. [ncbi.nlm.nih.gov]

Physician Robert Huebner and self-trained entomologist Charles Pomerantz played major roles in identifying the etiology of the disease after an outbreak in 1946 in a New York City apartment complex, documented in medical writer Berton Roueché's short [traductor.babylon-software.com]

We report 3 cases and review the epidemiology, clinical and laboratory findings, differential diagnosis, and management of this disease. [ncbi.nlm.nih.gov]

Descriptive epidemiology 2. Summary of clinical features 3. Global status of the disease 4. Status of the disease in a specific country 5. [books.google.com]

Here, we summarize the clinical and epidemiological characteristics of patients with confirmed or probable R. parkeri rickettsiosis, comment on the clinical differences between this disease and RMSF, and discuss the epidemiological importance of these [doi.org]

How can rickettsialpox be prevented? Rodent control is the most effective way of preventing rickettsialpox. Reducing rodent infestations, removing and securing trash around homes and workplaces also helps to prevent rickettsialpox. [bphc.org]

Both of these cutaneous manifestations may be mimicked by infectious diseases that have been designated as bioterrorist agents by the United States Centers for Diseases Control and Prevention: the former by anthrax, and the latter by smallpox. [ncbi.nlm.nih.gov]

Prevention is the only effective approach to dealing with the illness, which spreads via face-to-face contact and via contact with body fluids and clothes and bedding. [cbsnews.com]

Prevention As with all mite- or tick-borne illnesses, prevention includes avoidance of areas known to harbor the insects, and/or careful application of insect repellents. [encyclopedia.com]

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2. Krusell A, Comer JA, Sexton DJ. Rickettsialpox in North Carolina: a case report. Emerg Infect Dis 2002;8:727–8.
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11. Renvoise A, van't Wout JW, van der Schroeff J-G, et al. A case of rickettsialpox in Northern Europe. International Journal of Infectious Diseases. 2012; 16: e221-e2