Rickettsialpox: Report of an Outbreak and a Contemporary Review

Brettman, Lee R.; Lewin, Sharon R; Holzman, Robert S.; Goldman, W.; Marr, John S.; Kechijian, Paul; Schinella, Roger

doi:10.1097/00005792-198109000-00004

Cited by 80 publications

(53 citation statements)

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“…This pattern in differential reduction of titers through cross-adsorption is considered confirmatory evidence for a serologic diagnosis of rickettsialpox. 17 …”

Section: Resultsmentioning

confidence: 99%

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Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Comer

Tzianabos²,

Flynn

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. We tested single serum samples from 631 intravenous (IV) drug users from inner-city Baltimore, Maryland for serologic evidence of exposure to spotted fever group rickettsiae. A total of 102 (16%) individuals had titers Ն 64 to Rickettsia rickettsii by an indirect immunofluorescence assay. Confirmation that infection was caused by R. akari was obtained by cross-adsorption studies on a subset of serum samples that consistently resulted in higher titers to R. akari than to R. rickettsii. Current IV drug use, increased frequency of injection, and shooting gallery use were significant risk factors for presence of group-specific antibodies reactive with R. rickettsii. There was a significant inverse association with the presence of antibodies reactive to R. rickettsii and antibodies reactive to the human immunodeficiency virus. This study suggests that IV drug users are at an increased risk for R. akari infections. Clinicians should be aware of rickettsialpox, as well as other zoonotic diseases of the urban environment, when treating IV drug users for any acute febrile illness of undetermined etiology.

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“…This pattern in differential reduction of titers through cross-adsorption is considered confirmatory evidence for a serologic diagnosis of rickettsialpox. 17 …”

Section: Resultsmentioning

confidence: 99%

“…For confirmation of rickettsialpox, we used the cross-adsorption technique as described. 17 Twelve samples that demonstrated a variety of titers to R. rickettsii were selected for adsorption studies. Titers Ն 256 offered the greatest opportunity to demonstrate significant changes in titer caused by adsorption with the two antigens.…”

Section: Samplesmentioning

confidence: 99%

Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Comer

Tzianabos²,

Flynn

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…For confirmation of rickettsialpox, we used the cross-adsorption technique described by Brettman and others. 11 The six samples that had the highest (Ն 512) titers to R. akari were selected for adsorption studies. Serum samples were adsorbed at a 1/16 dilution (prepared from a master 1/8 dilution) with yolk sac-derived R. akari and R. rickettsii antigens for 5.5 hr at 37ЊC.…”

Section: Methodsmentioning

confidence: 99%

“…This pattern of one-way diminishment is considered definitive for a serologic diagnosis of rickettsialpox. 11 Further analyses were conducted only for individuals reactive to B. elizabethae and R. akari antigens. A primary site of injecting drugs on the street was associated with being seropositive for B. elizabethae (odds ratio …”

Section: Demographic Characteristics Of the Study Populationmentioning

confidence: 99%

Evidence of rodent-associated Bartonella and Rickettsia infections among intravenous drug users from Central and East Harlem, New York City.

Comer

Diaz²,

Vlahov³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. We tested serum samples collected in 1997 and 1998 from a cohort of 204 injection drug users (IDUs) recruited from Central and East Harlem, New York City, New York, for antibodies reactive with seven rickettsial or Bartonella spp. antigens. Rodent-associated Bartonella elizabethae and Rickettsia akari were the primary etiologic agents of interest. The testing panel also included Bartonella henselae, Bartonella quintana, Rickettsia prowazekii, Rickettsia rickettsii, and Rickettsia typhi. The highest prevalence of seroreactive serum samples (46%) was found with B. elizabethae antigens; 10% of the samples reacted with B. henselae antigens, while 2% reacted with B. quintana antigens. Reactivity to the latter two antigens was likely due to cross-reactivity with B. elizabethae antigens in most instances. Among the spotted fever group rickettsiae, 18 (9%) samples reacted with R. akari, including 10 samples (5%) that also reacted with R. rickettsii. Cross-adsorption studies demonstrated that most of the spotted fever group rickettsiae antibodies were due to R. akari infections. Among the typhus group rickettsiae, 5 samples reacted weakly to R. prowazekii antigens, and no samples reacted with R. typhi antigens. These findings suggest that Harlem IDUs are commonly exposed to two rodent-associated zoonotic agents. Further study of IDU populations may help elucidate transmission cycles of these agents in inner cities where higher levels of transmission occur.

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“…2,11 The disease has been reported in patients ranging in age from 6 months to 72 years. 1 In the past, the laboratory diagnosis of rickettsialpox was based on testing of paired serum samples to detect a 4-fold increase in antibodies reactive with R akari, a process requiring several weeks. Because patients often do not return for follow-up after the resolution of their illness, convalescent phase serum samples are frequently unavailable for confirma- tory testing.…”

mentioning

confidence: 99%

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

Koss

Carter²,

Grossman³

et al. 2003

Arch Dermatol

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Rickettsialpox: Report of an Outbreak and a Contemporary Review

Cited by 80 publications

References 0 publications

Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Evidence of rodent-associated Bartonella and Rickettsia infections among intravenous drug users from Central and East Harlem, New York City.

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

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