Rickettsial pox

Shankmann 1946.

Rickettsiosis caused by Rickettsia acarii.

• In New York in particular, several smaller endemics appeared.
• 800 cases had been registered by 2010.

• Pathogen
  • Rickettsia acarii.
• Transmission occurs through mouse and rat mites. R. acarii belongs to the "spotted fever group".

• Unspecific early stage (cephalgia, exhaustion).
• In the course: Fever, somnolence.
• 3rd-6th days after onset of fever Appearance of roseolae with partly punctate haemorrhages on the trunk, which spread centrifugally. Palmoplantar involvement.
• Muscle twitching, tenderness of peripheral nerves, motor restlessness.
• Hypotonia.
• Bronchitis, conjunctivitis, splenomegaly.
• Mostly lice can be detected (pediculosis corporis).
• Facies typhosa: Livid-reddish face.
• Apartially later ulcerating papulovesicles are seen in the area of the inoculation site.

• Anamnesis.
• Clinical.
• Lice infestation.
• BB (leukopenia, eosinophilia, thrombocytopenia, ESR ↑), liver and kidney values (transaminases↑), electrolytes.
• From 2. Week of illness Weil-Felix reaction (agglutination test).
• From the 3rd week of illness complement fixation reaction.
• From the 3rd week of illness indirect immunofluorescence test.

• Favourable.
• Temperatures are regressive under antibiotic therapy after 1-2 days.

• If necessary, intensive medical measures and transfer to the intensive care unit.
• Control of vital signs, fluid balance, electrolytes and protein replacement.

   

  Topical therapy

• Jacutin® gel (lindane) 0.3%. Use not recommended due to neurotoxicological side effects. In Switzerland, Jacuin® is no longer on the market.
• 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 (dimeticone), exposure time: 15 min., repeat after 7 days if necessary
• Lausweg® foam solution, exposure time: 15 min. , repeat after 7 and 14 days.
• Rausch Laus stop® cream, exposure time: 20 min., repeat after 7 and 14 days.

   

  Systemic therapy

• Doxycycline p.o. 100 mg 2x tgl. for 8-10 days.
• Alternatively: Ciprofloxacin p.o 500 mg 2x tgl.
• In severe cases, if necessary, i.v. glucocorticoids 100 mg/d for 2-3 days.

1. Paddock, C.D., et al., Rickettsialpox in New York City: a persistent urban zoonosis. Ann N Y Acad Sci, 2003. 990: p. 36-44.
2. Madison, G., et al., Hepatitis in association with rickettsialpox. Vector Borne Zoonotic Dis, 2008. 8(1): p. 111-5.
3. Boyd, A.S., Rickettsialpox. Dermatol Clin, 1997. 15(2): p. 313-8.
4. Heymann, W.R., Rickettsialpox. Clin Dermatol, 1996. 14(3): p. 279-82.
5. Valbuena, G. and D.H. Walker, Infection of the endothelium by members of the order Rickettsiales. Thromb Haemost, 2009. 102(6): p. 1071-9.