Rickettsioses: Difference between revisions
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{| class="wikitable" |
{| class="wikitable" |
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− | ! |
+ | !Species |
− | ! |
+ | !Disease |
− | ! |
+ | !Vector |
+ | !Geographic Area |
||
− | ! Clinical Clues |
||
+ | !Eschar |
||
+ | !Rash |
||
+ | !Lymphadenopathy |
||
+ | !Other Symptoms |
||
+ | !Mortality |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Rickettsiae: Spotted Fever Group (Tick-Borne) |
|- |
|- |
||
− | | |
+ | |''[[Rickettsia rickettsii]]'' |
− | | |
+ | |[[Rocky Mountain spotted fever]] |
− | | |
+ | |Multiple ''[[Dermacentor]]'', ''[[Amblyomma]]'', and ''[[Rhipicephalus]]'' |
+ | |Americas |
||
− | | Centripetal rash without eschar in the Americas |
||
+ | |rare |
||
+ | |yes; centripetal |
||
+ | |no |
||
+ | |fever |
||
+ | |>15% |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia conorii]]'' |
− | | |
+ | |[[Boutonneuse fever]], [[Mediterranean spotted fever]] |
− | | |
+ | |''[[Rhipicephalus sanguineus]]'' |
+ | |Southern Europe, Africa, and southern Asia |
||
− | | Rash with eschar, predominantly Mediterranean and Black Sea |
||
+ | |frequent |
||
+ | |maculopapular |
||
+ | |no |
||
+ | |fever |
||
+ | |2-7% |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia africae]]'' |
− | | |
+ | |[[African tick-bite fever]] |
− | | |
+ | |''[[Amblyomma hebraeum]]'' and ''[[Amblyomma variegatum]]'' |
+ | |Africa and the West Indies |
||
− | | Rash with eschar, acquired in Asia |
||
+ | |frequent and often multiple |
||
+ | |papular or vesicular; may be absent |
||
+ | |yes |
||
+ | |fever |
||
+ | |≤1% |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia parkeri]]'' |
+ | |[[maculatum disease]] |
||
− | | |
||
− | | |
+ | |''[[Amblyomma maculatum]]'' |
+ | |Americas |
||
− | | Rash with eschar, acquired in Europe, Africa, or Asia |
||
+ | |yes |
||
+ | |often |
||
+ | |yes |
||
+ | |fever |
||
+ | |≤1% |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia japonica]]'' |
+ | |[[oriental spotted fever]] |
||
− | | |
||
− | | |
+ | |''[[Dermacentor]]'', ''[[Haemaphysalis]]'', or ''[[Ixodes]]'' |
+ | |Asia |
||
− | | Rash with eschar, acquired in Asia or southern Russia |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia sibirica]] mongolitimonae'' |
− | | |
+ | | |
+ | |[[Rhipicephalus sanguineus]] |
||
− | | ''[[Ixodes]]'' ticks |
||
+ | |Europe, Africa and Asia |
||
− | | Vesicular rash with eschar, acquired in Australia |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia sibirica]] sibirica'' |
+ | | |
||
− | | Tick-borne lymphadenopathy |
||
− | | |
+ | |''[[Dermacentor]]'' |
+ | |Asia or southern Russia |
||
− | | Eschar (often scalp) with regional lymphadenopathy, acquired in Europe |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia australis]]'' |
+ | | |
||
− | | African tick-bite fever |
||
+ | |''[[Ixodes]]'' |
||
− | | ''[[Amblyomma hebraeum]]'' and ''[[Amblyomma variegatum]]'' |
||
+ | |Australia |
||
− | | Vesicular rash with eschar, acquired in Africa or the Caribbean |
||
+ | |yes |
||
+ | |yes, vesicular |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia slovaca]]'' |
+ | |[[tick-borne lymphadenopathy]] |
||
− | | |
||
+ | |''[[Dermacentor marginatus]]'' |
||
− | | ''[[Bothriocroton]]'', ''[[Haemaphysalis]]'', ''[[Ixodes]]'', or ''[[Rhipicephalus]]'' ticks |
||
+ | |Europe |
||
− | | Rash with eschar acquired in Flinders Islands, eastern Australia, Thailand, or Nepal |
||
+ | |yes, often on scalp |
||
+ | | |
||
+ | |regional lymphadenopathy |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia honei]]'' |
− | | |
+ | | |
− | | ''[[ |
+ | |''[[Bothriocroton]]'', ''[[Haemaphysalis]]'', ''[[Ixodes]]'', or ''[[Rhipicephalus]]'' |
+ | |Flinders Islands, eastern Australia, Thailand, or Nepal |
||
− | | Rash with eschar, acquired in Africa or Europe |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia aeschlimanii]]'' |
+ | | |
||
+ | |''[[Hyalomma]]'' or ''[[Rhipicephalus]]'' |
||
+ | |Africa and Europe |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia helvetica]]''|| ||ticks |
− | | |
+ | | |
+ | | |
||
− | | ''[[Amblyomma maculatum]]'' ticks |
||
+ | | |
||
− | | Rash with eschar, acquired in the Americas |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia heilongjianghensis]]'' |
− | | |
+ | | |
− | | |
+ | |''[[Dermacentor]]'' or ''[[Haemaphysalis]]'' |
+ | |Asia |
||
− | | Rash with eschar, acquired in Asia |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia raoultii]]'' |
− | | |
+ | | |
− | | |
+ | |''[[Dermacentor]]'' |
+ | |Europe |
||
− | | Eschar (often scalp) with regional lymphadenopathy, acquired in Europe |
||
+ | |yes, often on scalp |
||
+ | | |
||
+ | |regional lymphadenopathy |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia massiliae]]'' |
− | | |
+ | | |
+ | |[[Rhipicephalus sanguineus]] |
||
− | | ''[[Rickettsia sanguineous]]'' |
||
− | | |
+ | |Europe, Africa, and the Americas |
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia amblyommii]]''|| ||ticks |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia monacensis]]''|| ||ticks |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia philipii]]'' strain 364D |
− | | |
+ | | |
− | | |
+ | |''[[Dermcentor occidentalis]]'' |
+ | |California |
||
− | | Eschar (often scalp) with regional lymphadenopathy, acquired in California |
||
+ | |yes, often on scalp |
||
+ | | |
||
+ | |regional lymphadenopathy |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
+ | ! colspan="9" |Rickettsiae: Spotted Fever Group (Flea-, Louse, and Mite-Borne) |
||
− | | ''[[Rickettsia felis]]'' |
||
+ | |- |
||
+ | |''[[Rickettsia felis]]'' |
||
+ | | |
||
+ | |Flea |
||
+ | |flea exposure |
||
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
| |
| |
||
− | | Flea |
||
− | | Rash with eschar and flea exposure |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia akari]]'' |
+ | |[[rickettsialpox]] |
||
− | | Rickettsialpox |
||
− | | |
+ | |''[[Liponyssoides sanguineus]]'' house mouse mites |
− | | |
+ | |worldwide |
+ | |yes |
||
+ | |yes, vesicular |
||
+ | |yes |
||
+ | |fever |
||
+ | |≤1% |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Rickettsiae: Typhus Group |
|- |
|- |
||
− | | |
+ | |''[[Rickettsia typhi]]'' |
− | | |
+ | |[[Endemic typhus|endemic (murine) typhus]] |
− | | |
+ | |''[[Xenopsylla cheopis]]'' (rat flea) and ''[[Ctenocephalides felis]]'' (cat flea) |
− | | |
+ | |tropics or subtropics, with flea exposure |
+ | |may or may not |
||
+ | |yes, centrifugal |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Rickettsia prowazekii]]'' |
− | | |
+ | |[[Epidemic typhus|epidemic (louse-borne) typhus]] |
− | | |
+ | |''[[Pediculus humanus humanus]]'' (human body louse) and the fleas and live of flying squirrels |
+ | |United States, especially homeless shelters |
||
− | | Centrifugal rash without eschar, with exposure to flying squirrel or other |
||
+ | |no |
||
+ | |yes, centrifugal |
||
+ | |no |
||
+ | |fever |
||
+ | |≤1% to >15% |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Rickettsiae: Scrub Typhus Group |
|- |
|- |
||
− | | |
+ | |''[[Orientia tsutsugamushi]]'' |
− | | |
+ | |[[scrub typhus]] |
− | | |
+ | |[[Leptotrombidium]] mites (chiggers, trombiculid mites) |
− | | |
+ | |Asian Pacific, Chile, and Dubai |
+ | |yes |
||
+ | |yes |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Anaplasma |
|- |
|- |
||
− | | |
+ | |''[[Amblyomma phagocytophilum]]'' |
− | | |
+ | |[[human granulocytotropic anaplasmosis]] |
+ | |ticks |
||
− | | Tick |
||
− | | |
+ | | |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Ehrlichia |
|- |
|- |
||
− | | |
+ | |''[[Ehrlichia chaffeensis]]'' |
+ | |[[human monocytotropic ehrlichiosis]] |
||
− | | Human granulocytotropic anaplasmosis |
||
− | | |
+ | |''[[Amblyomma americanum]]'' ticks (the Lone Star tick) |
− | | |
+ | | |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Ehrlichia ewingii]]'' |
+ | |[[human monocytotropic ehrlichiosis]] |
||
− | | Human granulocytotropic anaplasmosis |
||
− | | |
+ | |''[[Amblyomma americanum]]'' and ''[[Dermacentor variabilis]]'' ticks |
− | | |
+ | | |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Ehrlichia canis]]''|| ||ticks |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | ! colspan= |
+ | ! colspan="9" |Other Related Organisms |
|- |
|- |
||
− | | |
+ | |''[[Neoehrlichia mikurensis]]''|| ||ticks |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Neorickettsia sennetsu]]''|| ||raw fish |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|- |
|- |
||
− | | |
+ | |''[[Wolbachia]]''|| ||helminths |
+ | | |
||
+ | | |
||
+ | | |
||
+ | | || |
||
+ | | |
||
|} |
|} |
||
− | == |
+ | ==Diagnosis== |
+ | |||
− | * First-line for essentially all infections is [[Is treated by::doxycycline]] 100 mg po BID, continue for 3 days following resolution of symptoms |
||
+ | *The mainstay of diagnosis is '''serology''' |
||
− | * Alternatives include [[Is treated by::azithromycin]] and [[Is treated by::chloramphenicol]] |
||
+ | **Indirect immunofluorescence antibody assays of IgG antibodies |
||
+ | ***IgM do not appear any earlier in the course of disease and are less specific |
||
+ | **Usually as acute and convalescent titres drawn 2 to 4 weeks apart showing a 4-fold increase in titres |
||
+ | ***[[Rickettsia africae]] may take up to 4 weeks after onset of illness to seroconvert |
||
+ | **Cross-reactivity is common within each group |
||
+ | ***Serologic tests for [[Rickettsia conorii]] or [[Rickettsia rickettsii]] may be used to diagnosis other spotted fever group diseases such as [[Rickettsia africae]], [[Rickettsia akari]], [[Rickettsia australis]], and [[Rickettsia sibirica]] |
||
+ | ***Serologic tests for [[Rickettsia typhi]] may be used to diagnose other typhus group diseases such as [[Rickettsia prowazekii]] |
||
+ | ***Cross-reactivity also common between the two groups, but the titres will usually be highest in the group containing the causative organism |
||
+ | *'''PCR''' is becoming more widely available |
||
+ | **Blood and tissue (e.g. eschar biopsy) |
||
+ | **Done as PCR for the group followed by species-specific sequencing |
||
+ | |||
+ | ==Management== |
||
+ | |||
+ | *First-line for essentially all infections is [[Is treated by::doxycycline]] 100 mg po BID, continue for 3 days following resolution of symptoms |
||
+ | *Alternatives include [[Is treated by::azithromycin]] and [[Is treated by::chloramphenicol]] |
||
+ | |||
+ | ==Further Reading== |
||
+ | *Syndromic classification of rickettsioses: an approach for clinical practice. ''Int J Infect Dis''. 2014;28:126-39. doi: [https://doi.org/10.1016/j.ijid.2014.05.025 10.1016/j.ijid.2014.05.025] |
||
− | == Further Reading == |
||
− | * Syndromic classification of rickettsioses: an approach for clinical practice. ''Int J Infect Dis''. 2014;28:126-39. doi: [https://doi.org/10.1016/j.ijid.2014.05.025 10.1016/j.ijid.2014.05.025] |
||
[[Category:Rickettsioses]] |
[[Category:Rickettsioses]] |
Latest revision as of 00:37, 8 February 2022
Species | Disease | Vector | Geographic Area | Eschar | Rash | Lymphadenopathy | Other Symptoms | Mortality |
---|---|---|---|---|---|---|---|---|
Rickettsiae: Spotted Fever Group (Tick-Borne) | ||||||||
Rickettsia rickettsii | Rocky Mountain spotted fever | Multiple Dermacentor, Amblyomma, and Rhipicephalus | Americas | rare | yes; centripetal | no | fever | >15% |
Rickettsia conorii | Boutonneuse fever, Mediterranean spotted fever | Rhipicephalus sanguineus | Southern Europe, Africa, and southern Asia | frequent | maculopapular | no | fever | 2-7% |
Rickettsia africae | African tick-bite fever | Amblyomma hebraeum and Amblyomma variegatum | Africa and the West Indies | frequent and often multiple | papular or vesicular; may be absent | yes | fever | ≤1% |
Rickettsia parkeri | maculatum disease | Amblyomma maculatum | Americas | yes | often | yes | fever | ≤1% |
Rickettsia japonica | oriental spotted fever | Dermacentor, Haemaphysalis, or Ixodes | Asia | yes | yes | |||
Rickettsia sibirica mongolitimonae | Rhipicephalus sanguineus | Europe, Africa and Asia | yes | yes | ||||
Rickettsia sibirica sibirica | Dermacentor | Asia or southern Russia | yes | yes | ||||
Rickettsia australis | Ixodes | Australia | yes | yes, vesicular | ||||
Rickettsia slovaca | tick-borne lymphadenopathy | Dermacentor marginatus | Europe | yes, often on scalp | regional lymphadenopathy | |||
Rickettsia honei | Bothriocroton, Haemaphysalis, Ixodes, or Rhipicephalus | Flinders Islands, eastern Australia, Thailand, or Nepal | yes | yes | ||||
Rickettsia aeschlimanii | Hyalomma or Rhipicephalus | Africa and Europe | yes | yes | ||||
Rickettsia helvetica | ticks | |||||||
Rickettsia heilongjianghensis | Dermacentor or Haemaphysalis | Asia | yes | yes | ||||
Rickettsia raoultii | Dermacentor | Europe | yes, often on scalp | regional lymphadenopathy | ||||
Rickettsia massiliae | Rhipicephalus sanguineus | Europe, Africa, and the Americas | yes | yes | ||||
Rickettsia amblyommii | ticks | |||||||
Rickettsia monacensis | ticks | |||||||
Rickettsia philipii strain 364D | Dermcentor occidentalis | California | yes, often on scalp | regional lymphadenopathy | ||||
Rickettsiae: Spotted Fever Group (Flea-, Louse, and Mite-Borne) | ||||||||
Rickettsia felis | Flea | flea exposure | yes | yes | ||||
Rickettsia akari | rickettsialpox | Liponyssoides sanguineus house mouse mites | worldwide | yes | yes, vesicular | yes | fever | ≤1% |
Rickettsiae: Typhus Group | ||||||||
Rickettsia typhi | endemic (murine) typhus | Xenopsylla cheopis (rat flea) and Ctenocephalides felis (cat flea) | tropics or subtropics, with flea exposure | may or may not | yes, centrifugal | |||
Rickettsia prowazekii | epidemic (louse-borne) typhus | Pediculus humanus humanus (human body louse) and the fleas and live of flying squirrels | United States, especially homeless shelters | no | yes, centrifugal | no | fever | ≤1% to >15% |
Rickettsiae: Scrub Typhus Group | ||||||||
Orientia tsutsugamushi | scrub typhus | Leptotrombidium mites (chiggers, trombiculid mites) | Asian Pacific, Chile, and Dubai | yes | yes | |||
Anaplasma | ||||||||
Amblyomma phagocytophilum | human granulocytotropic anaplasmosis | ticks | ||||||
Ehrlichia | ||||||||
Ehrlichia chaffeensis | human monocytotropic ehrlichiosis | Amblyomma americanum ticks (the Lone Star tick) | ||||||
Ehrlichia ewingii | human monocytotropic ehrlichiosis | Amblyomma americanum and Dermacentor variabilis ticks | ||||||
Ehrlichia canis | ticks | |||||||
Other Related Organisms | ||||||||
Neoehrlichia mikurensis | ticks | |||||||
Neorickettsia sennetsu | raw fish | |||||||
Wolbachia | helminths |
Diagnosis
- The mainstay of diagnosis is serology
- Indirect immunofluorescence antibody assays of IgG antibodies
- IgM do not appear any earlier in the course of disease and are less specific
- Usually as acute and convalescent titres drawn 2 to 4 weeks apart showing a 4-fold increase in titres
- Rickettsia africae may take up to 4 weeks after onset of illness to seroconvert
- Cross-reactivity is common within each group
- Serologic tests for Rickettsia conorii or Rickettsia rickettsii may be used to diagnosis other spotted fever group diseases such as Rickettsia africae, Rickettsia akari, Rickettsia australis, and Rickettsia sibirica
- Serologic tests for Rickettsia typhi may be used to diagnose other typhus group diseases such as Rickettsia prowazekii
- Cross-reactivity also common between the two groups, but the titres will usually be highest in the group containing the causative organism
- Indirect immunofluorescence antibody assays of IgG antibodies
- PCR is becoming more widely available
- Blood and tissue (e.g. eschar biopsy)
- Done as PCR for the group followed by species-specific sequencing
Management
- First-line for essentially all infections is doxycycline 100 mg po BID, continue for 3 days following resolution of symptoms
- Alternatives include azithromycin and chloramphenicol
Further Reading
- Syndromic classification of rickettsioses: an approach for clinical practice. Int J Infect Dis. 2014;28:126-39. doi: 10.1016/j.ijid.2014.05.025