Abstract
Rickettsialpox is an urban zoonosis caused by Rickettsia akari. To date R. akari is the only well-characterized mite-borne member of the spotted fever group. It is transmitted by the mouse mite, Liponyssoides sanguineus, commonly found on peridomestic rodents. While the disease was first discovered in New York City in 1946, a few years later a similar outbreak occurred in the Ukraine SSR. Numerous serosurveys and diagnosis of sporadic cases of rickettsialpox suggest its global distribution; however, the actual contemporary geography of rickettsialpox and its incidence are unknown. Rickettsialpox is characterized by the classic clinical triad found in rickettsioses of a black eschar, high fever, and rash but the latter is atypical as it is papulovesicular. Dermatological manifestations and the progression of rickettsialpox may mimic other infectious and noninfectious syndromes, including sexually transmitted diseases. The purpose of this review is to increase awareness of this unique disease through reanalysis of classic and contemporary clinical descriptions of rickettsialpox, evaluation of its worldwide distribution, and updates on the public health importance of the disease as well as the ecology and vector associations of R. akari. Our review data suggests that only limited genetic diversity exists among the available isolates of R. akari associated with previous outbreaks; additional effort is still required to define specific genetic markers permitting direct surveillance, accurate and reliable diagnosis, tracking and studying of the vector and host associations of contemporary isolates. The potential of R. akari to cross into other vector species emphasizes the necessity for detection of outbreaks of the disease in new regions of the world and in novel ecological settings. We describe existing gaps and limitations in our current understanding of the pathogenesis of rickettsialpox, the epidemiology of this disease and the genetic diversity of R. akari. We propose research priorities for what is needed to improve our understanding of this neglected rickettsial disease and its etiologic agent.
Highlights
At the time of its discovery, the human disease caused by Rickettsia akari was named rickettsialpox due to its clinical similarity to chickenpox and the close morphological characteristics of its etiological agent to other species of Rickettsia [34, 38, 39]
The purpose of this review is to evaluate the available classical and contemporary information related to the eco-epidemiological and clinical features of rickettsialpox and the biological and genetic characteristics of its etiological agent, R. akari, in order to outline critical gaps in our contemporary understanding of this neglected rickettsiosis and to define priorities for further research studies on this neglected disease and pathogen
Rickettsialpox is an acute illness with clinical symptoms developing after a 9 to 14-day incubation period following the initial bite by an infected mite
Summary
At the time of its discovery, the human disease caused by Rickettsia akari was named rickettsialpox due to its clinical similarity to chickenpox and the close morphological characteristics of its etiological agent to other species of Rickettsia [34, 38, 39]. Following its original discovery rickettsialpox received substantial attention from medical and public health professionals worldwide which progressively diminished, possibly due to the relatively mild course of the illness and decreasing familiarity of clinicians with the disease, the availability of effective antibiotics and the broad use of pesticides for rodent control [1, 74, 75] It was not until 2001 that widespread interest in rickettsialpox reemerged because of differential diagnostic considerations for its cutaneous lesions since the vesicular rash and later scab could lead to its misidentification as chickenpox, herpes, and/or anthrax [12, 41, 42, 58, 60, 84]. The purpose of this review is to evaluate the available classical and contemporary information related to the eco-epidemiological and clinical features of rickettsialpox and the biological and genetic characteristics of its etiological agent, R. akari, in order to outline critical gaps in our contemporary understanding of this neglected rickettsiosis and to define priorities for further research studies on this neglected disease and pathogen
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