Rickettsialpox in North Carolina: A Case Report

Abstract

We report a case of rickettsialpox from North Carolina confirmed by serologic testing. To our knowledge, this case is the first to be reported from this region of the United States. 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.

The Expanding Spectrum of Eschar-Associated Rickettsioses in the United States

“…1 were attributed only to infections caused by R rickettsii 11 and R akari, the cause of rickettsialpox. 12 More recently, it has become apparent that a broader collection of Rickettsia species indigenous to the Western Hemisphere cause eschar-and rash-associated illnesses in US patients. There are many similar clinical characteristics among the various imported and domestic eschar-associated rickettsioses encountered by clinicians in the United States (Table 1).…”

Molecular screening of ticks for the presence of Rickettsia species: A public health concern

“…R. akari, a well characterized member of the spotted fever group Rickettsia is the ethiologic agent of rickettsialpox, a benign zoonotic illness which has similar clinical manifestation like that of murine typhus. R. akari has been reported to be very common in metropolitan cities of eastern United States, Argentina, Eastern European countries like Turkey, Croatia, Ukraine, Russia, Mexico, and Asia where they have been severally reported [16][17][18][19][20][21][22][23][24][25][26][27]. To the best of our knowledge, the presence of R. akari and its closest relatives R. felis and R. australis has not been reported anywhere in the African continent.…”

Increased Detection of Rickettsialpox in a New York City Hospital Following the Anthrax Outbreak of 2001

“…1,16 Mild leukopenia and mild thrombocytopenia have been described during the acute phase of the disease 9,11,15,16,20,22 and were seen in approximately one third of the patients we examined. In our series, the most dramatic laboratory abnormalities (a markedly elevated white blood cell count and erythrocyte sedimentation rate) were seen in the youngest patient.…”

“…1,2 Rickettsialpox has been described primarily in New York City, but it has also been reported in large cities in the eastern United States (in Massachusetts, Connecticut, Maryland, Ohio, and Pennsylvania) [2][3][4][5][6][7][8] and in rural North Carolina, 9 Utah, 8 Russia, 10 Korea, 2 and South Africa. 2,11 The disease has been reported in patients ranging in age from 6 months to 72 years.…”

“…16 Since the 1960s, only single case reports and small case series have been published, and most of these cases have occurred in New York City. 1,9,11,15,[17][18][19] The largest of these series described 13 patients examined during a 10-year period.…”