Rickettsioses: Difference between revisions

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!Disease
  
!Disease
 
!Vector
  
!Vector
  +
!Geographic Area
−
!Clinical Clues
  
  +
!Eschar
  +
!Rash
  +
!Lymphadenopathy
  +
!Other Symptoms
  +
!Mortality
 
|-
  
|-
−
! colspan="4" |Rickettsiae: Spotted fever group
 +
! colspan="9" |Rickettsiae: Spotted Fever Group (Tick-Borne)
 
|-
  
|-
 
|''[[Rickettsia rickettsii]]''
  
|''[[Rickettsia rickettsii]]''
−
|Rocky Mountain spotted fever
 +
|[[Rocky Mountain spotted fever]]
−
|Multiple ''[[Dermacentor]]'', ''[[Amblyomma]]'', and ''[[Rhipicephalus]]'' ticks
 +
|Multiple ''[[Dermacentor]]'', ''[[Amblyomma]]'', and ''[[Rhipicephalus]]''
  +
|Americas
−
|Centripetal rash without eschar in the Americas
  
  +
|rare
  +
|yes; centripetal
  +
|no
  +
|fever
  +
|>15%
 
|-
  
|-
 
|''[[Rickettsia conorii]]''
  
|''[[Rickettsia conorii]]''
−
|Boutonneuse fever, Mediterranean spotted fever
 +
|[[Boutonneuse fever]], [[Mediterranean spotted fever]]
−
|''[[Rhipicephalus sanguineus]]'' ticks
 +
|''[[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
  +
|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]]''
  
|''[[Rickettsia japonica]]''
−
|Oriental spotter fever
 +
|[[oriental spotted fever]]
−
|''[[Dermacentor]]'', ''[[Haemaphysalis]]'', or ''[[Ixodes]]'' ticks
 +
|''[[Dermacentor]]'', ''[[Haemaphysalis]]'', or ''[[Ixodes]]''
  +
|Asia
−
|Rash with eschar, acquired in Asia
  
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia sibirica]] mongolitimonae''
  
|''[[Rickettsia sibirica]] mongolitimonae''
 
|
  
|
 
|[[Rhipicephalus sanguineus]]
  
|[[Rhipicephalus sanguineus]]
−
|Rash with eschar, acquired in Europe, Africa, or Asia
 +
|Europe, Africa and Asia
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia sibirica]] sibirica''
  
|''[[Rickettsia sibirica]] sibirica''
 
|
  
|
−
|''[[Dermacentor]]'' ticks
 +
|''[[Dermacentor]]''
−
|Rash with eschar, acquired in Asia or southern Russia
 +
|Asia or southern Russia
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia australis]]''
  
|''[[Rickettsia australis]]''
 
|
  
|
−
|''[[Ixodes]]'' ticks
 +
|''[[Ixodes]]''
  +
|Australia
−
|Vesicular rash with eschar, acquired in Australia
  
  +
|yes
  +
|yes, vesicular
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia slovaca]]''
  
|''[[Rickettsia slovaca]]''
−
|Tick-borne lymphadenopathy
 +
|[[tick-borne lymphadenopathy]]
 
|''[[Dermacentor marginatus]]''
  
|''[[Dermacentor marginatus]]''
  +
|Europe
−
|Eschar (often scalp) with regional lymphadenopathy, acquired in Europe
  
  +
|yes, often on scalp
−
|-
  
  +
|
−
|''[[Rickettsia africae]]''
  
  +
|regional lymphadenopathy
−
|African tick-bite fever
  
  +
|
−
|''[[Amblyomma hebraeum]]'' and ''[[Amblyomma variegatum]]''
  
  +
|
−
|Vesicular rash with eschar, acquired in Africa or the Caribbean
  
 
|-
  
|-
 
|''[[Rickettsia honei]]''
  
|''[[Rickettsia honei]]''
 
|
  
|
−
|''[[Bothriocroton]]'', ''[[Haemaphysalis]]'', ''[[Ixodes]]'', or ''[[Rhipicephalus]]'' ticks
 +
|''[[Bothriocroton]]'', ''[[Haemaphysalis]]'', ''[[Ixodes]]'', or ''[[Rhipicephalus]]''
−
|Rash with eschar acquired in Flinders Islands, eastern Australia, Thailand, or Nepal
 +
|Flinders Islands, eastern Australia, Thailand, or Nepal
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia aeschlimanii]]''
  
|''[[Rickettsia aeschlimanii]]''
 
|
  
|
−
|''[[Hyalomma]]'' or ''[[Rhipicephalus]]'' ticks
 +
|''[[Hyalomma]]'' or ''[[Rhipicephalus]]''
−
|Rash with eschar, acquired in Africa or Europe
 +
|Africa and Europe
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
−
|''[[Rickettsia helvetica]]''|| ||Tick||
 +
|''[[Rickettsia helvetica]]''|| ||ticks
−
|-
 +
|
  +
|
−
|''[[Rickettsia parkeri]]''
  
  +
|
  +
| ||
 
|
  
|
−
|''[[Amblyomma maculatum]]'' ticks
  
−
|Rash with eschar, acquired in the Americas
  
 
|-
  
|-
 
|''[[Rickettsia heilongjianghensis]]''
  
|''[[Rickettsia heilongjianghensis]]''
 
|
  
|
−
|''[[Dermacentor]]'' or ''[[Haemaphysalis]]'' ticks
 +
|''[[Dermacentor]]'' or ''[[Haemaphysalis]]''
  +
|Asia
−
|Rash with eschar, acquired in Asia
  
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia raoultii]]''
  
|''[[Rickettsia raoultii]]''
 
|
  
|
−
|''[[Dermacentor]]'' ticks
 +
|''[[Dermacentor]]''
  +
|Europe
−
|Eschar (often scalp) with regional lymphadenopathy, acquired in Europe
  
  +
|yes, often on scalp
  +
|
  +
|regional lymphadenopathy
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia massiliae]]''
  
|''[[Rickettsia massiliae]]''
 
|
  
|
 
|[[Rhipicephalus sanguineus]]
  
|[[Rhipicephalus sanguineus]]
−
|Rash with eschar, acquired in Europe, Africa, and the Americas
 +
|Europe, Africa, and the Americas
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
−
|''[[Rickettsia amblyommii]]''|| ||Tick||
 +
|''[[Rickettsia amblyommii]]''|| ||ticks
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|-
  
|-
−
|''[[Rickettsia monacensis]]''|| ||Tick||
 +
|''[[Rickettsia monacensis]]''|| ||ticks
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|-
  
|-
 
|''[[Rickettsia philipii]]'' strain 364D
  
|''[[Rickettsia philipii]]'' strain 364D
 
|
  
|
 
|''[[Dermcentor occidentalis]]''
  
|''[[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
−
|Rash with eschar and flea exposure
 +
|flea exposure
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia akari]]''
  
|''[[Rickettsia akari]]''
  +
|[[rickettsialpox]]
−
|Rickettsialpox
  
 
|''[[Liponyssoides sanguineus]]'' house mouse mites
  
|''[[Liponyssoides sanguineus]]'' house mouse mites
−
|Vesicular rash with eschar, worldwide
 +
|worldwide
  +
|yes
  +
|yes, vesicular
  +
|yes
  +
|fever
  +
|≤1%
 
|-
  
|-
−
! colspan="4" |Rickettiae: Typhus group
 +
! colspan="9" |Rickettsiae: Typhus Group
 
|-
  
|-
 
|''[[Rickettsia typhi]]''
  
|''[[Rickettsia typhi]]''
−
|Endemic (murine) typhus
 +
|[[Endemic typhus|endemic (murine) typhus]]
 
|''[[Xenopsylla cheopis]]'' (rat flea) and ''[[Ctenocephalides felis]]'' (cat flea)
  
|''[[Xenopsylla cheopis]]'' (rat flea) and ''[[Ctenocephalides felis]]'' (cat flea)
−
|Centrifugal rash without eschar in the tropics or subtropics, with flea exposure
 +
|tropics or subtropics, with flea exposure
  +
|may or may not
  +
|yes, centrifugal
  +
|
  +
|
  +
|
 
|-
  
|-
 
|''[[Rickettsia prowazekii]]''
  
|''[[Rickettsia prowazekii]]''
−
|Epidemic (louse-borne) typhus
 +
|[[Epidemic typhus|epidemic (louse-borne) typhus]]
−
|''[[Pediculus humanus humanus]]'' (human body louse)
 +
|''[[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="4" |Rickettsiae: Scrub typhus group
 +
! colspan="9" |Rickettsiae: Scrub Typhus Group
 
|-
  
|-
 
|''[[Orientia tsutsugamushi]]''
  
|''[[Orientia tsutsugamushi]]''
−
|Scrub typhus
 +
|[[scrub typhus]]
 
|[[Leptotrombidium]] mites (chiggers, trombiculid mites)
  
|[[Leptotrombidium]] mites (chiggers, trombiculid mites)
−
|Rash with eschar, acquired in Asian Pacific, Chile, or Dubai
 +
|Asian Pacific, Chile, and Dubai
  +
|yes
  +
|yes
  +
|
  +
|
  +
|
 
|-
  
|-
−
! colspan="4" |Anaplasma
 +
! colspan="9" |Anaplasma
 
|-
  
|-
 
|''[[Amblyomma phagocytophilum]]''
  
|''[[Amblyomma phagocytophilum]]''
−
|Human granulocytotropic anaplasmosis
 +
|[[human granulocytotropic anaplasmosis]]
  +
|ticks
−
|Tick
  
  +
|
  +
|
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
−
! colspan="4" |Ehrlichia
 +
! colspan="9" |Ehrlichia
 
|-
  
|-
 
|''[[Ehrlichia chaffeensis]]''
  
|''[[Ehrlichia chaffeensis]]''
  +
|[[human monocytotropic ehrlichiosis]]
−
|Human granulocytotropic anaplasmosis
  
 
|''[[Amblyomma americanum]]'' ticks (the Lone Star tick)
  
|''[[Amblyomma americanum]]'' ticks (the Lone Star tick)
  +
|
  +
|
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
 
|''[[Ehrlichia ewingii]]''
  
|''[[Ehrlichia ewingii]]''
  +
|[[human monocytotropic ehrlichiosis]]
−
|Human granulocytotropic anaplasmosis
  
 
|''[[Amblyomma americanum]]'' and ''[[Dermacentor variabilis]]'' ticks
  
|''[[Amblyomma americanum]]'' and ''[[Dermacentor variabilis]]'' ticks
  +
|
  +
|
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
−
|''[[Ehrlichia canis]]''|| ||Tick||
 +
|''[[Ehrlichia canis]]''|| ||ticks
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|-
  
|-
−
! colspan="4" |Other
 +
! colspan="9" |Other Related Organisms
 
|-
  
|-
−
|''[[Neoehrlichia mikurensis]]''|| ||Tick||
 +
|''[[Neoehrlichia mikurensis]]''|| ||ticks
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|-
  
|-
−
|''[[Neorickettsia sennetsu]]''|| ||Raw fish||
 +
|''[[Neorickettsia sennetsu]]''|| ||raw fish
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|-
  
|-
−
|''[[Wolbachia species]]''|| ||Helminths||
 +
|''[[Wolbachia]]''|| ||helminths
  +
|
  +
|
  +
|
  +
| ||
  +
|
 
|}
  
|}
   
−
== Diagnosis ==
 +
==Diagnosis==
   
−
* The mainstay of diagnosis is '''serology'''
 +
*The mainstay of diagnosis is '''serology'''
−
** Indirect immunofluorescence antibody assays of IgG antibodies
 +
**Indirect immunofluorescence antibody assays of IgG antibodies
−
*** IgM do not appear any earlier in the course of disease and are less specific
 +
***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
 +
**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
 +
***[[Rickettsia africae]] may take up to 4 weeks after onset of illness to seroconvert
−
** Cross-reactivity is common within each group
 +
**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 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]]
 +
***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
 +
***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
 +
*'''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==
  
==Management==

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
    • Cross-reactivity is common within each group
  • 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

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
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