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]

  (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]

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

  A spotted fever group rickettsial disease such as Queensland tick typhus, Flinders Island spotted fever, or another undescribed rickettsiosis could explain these findings. [doi.org]

• 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 rigors Hyperpyrexia NOS Persistent fever Pyrexia NOS Kew [icd10data.com]

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

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

  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]

• 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 rigors Hyperpyrexia NOS Persistent fever Pyrexia NOS Kew Garden A79.1 [icd10data.com]

  Because all 4 diseases have similar clinical manifestations, which may include maculopapular rash, fever, headache, rigor, myalgia, and arthralgia ( 1 – 4 ), laboratory investigation is needed to identify the rickettsial etiologic agent. [doi.org]

• Petechiae

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

  This 43-year-old man presented with fever, petechiae, pulmonary infiltrates, acute renal failure, encephalopathy, and hyperbilirubinemia after a stay in Tunisia, where he was in contact with animals in his family farm. [doi.org]

• Eczema

  In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections. [wikidoc.org]

  […] papulovesicular eruption and that may be confused with rickettsialpox include infectious mononucleosis, several enterovirus in- fections (such as echovirus types 9 and 16, coxsackievi- rus A types 9 and 16, and coxsackievirus B type 5), gono- coccemia, and eczema [slideshare.net]

• Headache

  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]

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

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

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

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.

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]

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]

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]

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]

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]

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]

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]

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

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]

The presence of 3 rickettsial diseases on this small island demonstrates the complexity of rickettsial epidemiology in Australia. Dr Unsworth is a postdoctoral research associate at Texas A&M University, College Station, Texas, USA. [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]

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]

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 Controlling mice helps prevent the spread of rickettsialpox. References Paddock CD. Rickettsialpox. In: Magill AJ, Hill DR, Solomon T, Ryan ET, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 9th ed. [ufhealth.org]

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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