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Specialty Infectious disease

Rickettsialpox is a mite-borne infectious illness caused by bacteria of the genus Rickettsia ( Rickettsia akari ). [1] 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, documented in "The Alerting of Mr. Pomerantz," a short story by medical writer Berton Roueché.

<i>Rickettsia</i> type of bacteria that causes typhus, among other diseases

Rickettsia is a genus of nonmotile, Gram-negative, nonspore-forming, highly pleomorphic bacteria that may occur in the forms of cocci 0.1 μm in diameter, rods 1–4 μm long, or threads of up to about 10 μm long. The term "rickettsia" has nothing to do with rickets, which is a deficiency disease resulting from lack of vitamin D; the bacterial genus Rickettsia was named after Howard Taylor Ricketts, in honour of his pioneering work on tick-borne spotted fever.

Rickettsia akari is a species of Rickettsia which causes rickettsialpox.

Robert Joseph Huebner, was an American physician and virologist whose research into viruses, their causes and treatment that led to his breakthrough insights into the connections between viruses and cancer, leading to new treatments, as well as his hypothesized oncogene, which was discovered to be a trigger for normal cells turning cancerous.


Although it is not transmitted by a tick (a characteristic of spotted fever), the bacterium is a part of the spotted fever group of Rickettsia, and so this condition is often classified with that group. [2]

Tick order of arachnids

Ticks are small arachnids, typically 3 to 5 mm long, part of the order Parasitiformes. Along with mites, they constitute the subclass Acari. Ticks are ectoparasites, living by feeding on the blood of mammals, birds, and sometimes reptiles and amphibians. Ticks had evolved by the Cretaceous period, the most common form of fossilisation being immersed in amber. Ticks are widely distributed around the world, especially in warm, humid climates.

A spotted fever is a type of tick-borne disease which presents on the skin. They are all caused by bacteria of the genus Rickettsia. Typhus is a group of similar diseases also caused by Rickettsia bacteria, but spotted fevers and typhus are different clinical entities.

Signs and symptoms

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.


The bacteria are originally found in mice and cause mites feeding on the mice (usually the house mouse) to become infected. Humans will get rickettsialpox when receiving a bite from an infected mite, not from the mice themselves.

House mouse species of mammal

The house mouse is a small mammal of the order Rodentia, characteristically having a pointed snout, large rounded ears, and a long and hairy tail. It is one of the most abundant species of the genus Mus. Although a wild animal, the house mouse has benefited significantly from associating with human habitation to the point that truly wild populations are significantly less common than the semi-tame populations near human activity.

Mite common name for small arachnids

Mites are small arthropods belonging to the class Arachnida and the subclass Acari. The term "mite" refers to the members of several groups in Acari but it is not a clade, and excludes the ticks, order Ixodida. Mites and ticks are characterised by the body being divided into two regions, the cephalothorax or prosoma, and an opisthosoma. The scientific discipline devoted to the study of ticks and mites is called acarology.

The mite is Liponyssoides sanguineus , which was previously known as Allodermanyssus sanguineus. [3]

Liponyssoides sanguineus is a species of mite that infests the house mouse.


Rickettsialpox is treated with tetracyclines (doxycycline is the drug of choice). Chloramphenicol is a suitable alternative. [4]

Tetracycline antibiotics type of broad-spectrum antibiotic

Tetracyclines are a group of broad-spectrum antibiotic compounds that have a common basic structure and are either isolated directly from several species of Streptomyces bacteria or produced semi-synthetically from those isolated compounds. Tetracycline molecules comprise a linear fused tetracyclic nucleus to which a variety of functional groups are attached. Tetracyclines are named for their four ("tetra-") hydrocarbon rings ("-cycl-") derivation ("-ine"). They are defined as a subclass of polyketides, having an octahydrotetracene-2-carboxamide skeleton and are known as derivatives of polycyclic naphthacene carboxamide. While all tetracyclines have a common structure, they differ from each other by the presence of chloride, methyl, and hydroxyl groups. These modifications do not change their broad antibacterial activity, but do affect pharmacological properties such as half-life and binding to proteins in serum.

Doxycycline chemical compound

Doxycycline is an antibiotic that is used in the treatment of infections caused by bacteria and certain other parasites. It is useful for bacterial pneumonia, acne, chlamydia infections, early Lyme disease, cholera and syphilis. It is also useful for the treatment of malaria when used with quinine and for the prevention of malaria. Doxycycline can be used either by mouth or intravenously.

Chloramphenicol chemical compound

Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to treat meningitis, plague, cholera, and typhoid fever. Its use by mouth or by injection is only recommended when safer antibiotics cannot be used. Monitoring both blood levels of the medication and blood cell levels every two days is recommended during treatment.


Rickettsialpox is generally mild and resolves within 2–3 weeks if untreated. There are no known deaths resulting from the disease.


Those dwelling in urban areas (which typically experience rodent problems) have a higher risk of contracting rickettsialpox.

Urban area Human settlement with high population density and infrastructure of built environment

An urban area or urban agglomeration is a human settlement with high population density and infrastructure of built environment. Urban areas are created through urbanization and are categorized by urban morphology as cities, towns, conurbations or suburbs. In urbanism, the term contrasts to rural areas such as villages and hamlets and in urban sociology or urban anthropology it contrasts with natural environment. The creation of early predecessors of urban areas during the urban revolution led to the creation of human civilization with modern urban planning, which along with other human activities such as exploitation of natural resources leads to human impact on the environment.


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. Physicians canvassed the residents of the building and found that there had been 124 cases of this disease from January through October among the 2,000 people living in the complex, reaching a peak of more than 20 cases reported in July. Individuals afflicted with the condition ranged in age from 3 months to 71, males and females were equally affected and the incidence among adults (6.5% of the 1,400 above age 15) exceeded that of children 14 and under (5.3%). [5]

Individuals would first have a small lesion at the site of the insect bite, which would eventually leave a small scar. Lymph nodes would become enlarged and about a week after the initial bite patients would start to experience chills, fever and headaches, accompanied by a maculopapular rash. The rash would last for about a week, with the full progress from the lesion being encountered until recovery typically being three weeks. Several characteristics were considered from an epidemiological perspective as being correlated with the condition. Men and women were equally affected and there was no apparent connection to occupation or school attended. The individuals obtained their meals at several different sources, and other individuals who lived elsewhere and purchased their food at these same places had not been affected. The water supply and milk consumed there were tested, with no unusual findings. There were dog kennels in the area and some tenants had dogs as pets, but an inspection of the animals found no ticks or insects. [5]

Many residents had reported the presence of mice in and around the apartments, especially in the basements of the buildings near the incinerators, where living and dead mice were found. Garbage disposed of through incinerator chutes was to be burned on a daily basis, with the ashes carted off by the New York City Department of Sanitation. Due to labor shortages, the material was not burned regularly, leaving ample food for the rodents. Mice were trapped in apartments and near the incinerators and antibodies to the rickettsialpox were found in their blood. [5] Visiting the complex with pest-control specialist and self-trained entomologist Charles Pomerantz, Huebner peeled back wallpaper to find the walls swarming with mites, so much so that tenants had said that "the walls had movement". [6] The mites were collected and rickettsial strains were isolated from some of them, with the name Rickettsia akari given to the organism. [5]

Public health officials took steps to prevent further outbreaks of the disease. The building operators were told to ensure that the incinerators were fired on a regular basis to ensure that food available to the mice that harbored the disease was eliminated as quickly and thoroughly as possible. [5] Pest control measures were undertaken through the New York City Department of Health and its commissioner Israel Weinstein to eliminate the mice in and around the buildings with the cooperation of property owners. [7]

Another 20 cases of rickettsialpox were discovered elsewhere in New York City during the investigation of the Queens outbreak, including 10 cases found in an apartment building in the Bronx that had originally been diagnosed as atypical chickenpox. Mice were found in the basement of this building, as well as mites belonging to the same class found in Queens. [5] In addition to the initial cases from the first outbreak in Queens, over 500 cases of the disease were diagnosed in New York City from 1947 to 1951. [8]

See also


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