Last Updated: 2019-08-26
Rickettsiosis caused by Rickettsia acarii.
- Especially in New York there were several smaller endemic cases.
- 800 cases were registered by 2010.
- Rickettsia acarii.
- Transmission is by mouse and rat mites. R. acarii belongs to the "Spotted fever group.
- Unspecific early stage (cephalgia, exhaustion).
- In the course of fever, somnolence: Fever, somnolence.
- 3-6 days after onset of fever, appearance of roseoles with partially punctiform haemorrhages on the stem, which spread centrifugally. Palmoplantar involvement.
- Muscle twitching, pressure sensitivity of peripheral nerves, motor restlessness.
- Bronchitis, conjunctivitis, splenomegaly.
- Usually lice (pediculosis corporis) can be detected.
- Facies typhosa: Livid-red face.
- In the area of the inoculation site a partially ulcerating papulovesicle appears.
- Medical history.
- Lice infestation.
- Blood count (leukopenia, eosinophilia, thrombopenia, ESR ↑), liver and kidney values (Transaminasen↑), electrolytes.
- From the 2nd week of the disease Weil-Felix reaction (agglutination test).
- From the 3rd week of illness, complement fixation reaction.
- Indirect immunofluorescence test from the 3rd week of the disease.
Back, forearms, lower legs, ankles.
- Temperatures are declining under antibiotic therapy after 1-2 days.
- If necessary, intensive medical measures and transfer to the intensive care unit.
- Control of vital parameters, fluid balance, electrolytes and protein replacement.
- Jacutin® gel (lindane) 0.3%. Use not recommended due to neurotoxicological side effects. Jacuin® is no longer on the market in Switzerland.
- Loxazole Lot. 1% (reapply after 1 and 2 weeks).
- Permethrin 5% in e.g.: Excipial U Lipolotio.
- Prioderm® Shampoo (reapply after 1 and 2 weeks).
- Paranix® Sprax (Dimeticon), application time: 15 min., if necessary repeat after 7 days.
- Lausweg® foam solution, contact time: 15 min. Repeat after 7 and 14 days.
- Rausch Laus stop® cream, application time: 20 min., repetition after 7 and 14 days.
- Doxycycline p.o. 100 mg 2x per day for 8-10 days.
- Alternative: Ciprofloxacin p.o. 500 mg 2x per day.
- In pronounced cases intravenously glucocorticoids 100 mg/d for 2-3 days if necessary.
- Paddock, C.D., et al., Rickettsialpox in New York City: a persistent urban zoonosis. Ann N Y Acad Sci, 2003. 990: p. 36-44.
- Madison, G., et al., Hepatitis in association with rickettsialpox. Vector Borne Zoonotic Dis, 2008. 8(1): p. 111-5.
- Boyd, A.S., Rickettsialpox. Dermatol Clin, 1997. 15(2): p. 313-8.
- Heymann, W.R., Rickettsialpox. Clin Dermatol, 1996. 14(3): p. 279-82.
- Valbuena, G. and D.H. Walker, Infection of the endothelium by members of the order Rickettsiales. Thromb Haemost, 2009. 102(6): p. 1071-9.