Rickettsialpox in North Carolina: A Case Report

Allan Krusell, James A. Comer, and Daniel J. Sexton


Emerging Infectious Diseases. 2002;8(7) 

In This Article

Abstract and Introduction

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.

Rickettsialpox is caused by infection with Rickettsia akari. Disease in humans was first described in 1946 in residents of apartments clustered in a three-block area in the borough of Queens, New York City.[1] Subsequently, small outbreaks of rickettsialpox were recognized in several U.S. cities, including Boston, Cleveland, Philadelphia, Pittsburgh, and West Hartford.[2] Most cases to date have occurred in large metropolitan areas of the northeastern United States; about half the described cases have occurred in New York City. However, rickettsialpox is likely more common in the United States than suggested by the relatively small number of reported cases during the past 50 years.[3,4]

R. akari is transmitted among house mice (Mus musculus) and to humans by the house mouse mite (Liponyssoides sanguineus).[2] Recently, cases of rickettsialpox have been reported in residents of the Ukraine[5] and Croatia.[6] Isolations have also been made from Korean voles in an area where rickettsialpox has not been reported.[7] These data suggest that silent sylvan cycles of R. akari infection exist and that the organism is more widely distributed than currently appreciated. To our knowledge, rickettsialpox has not previously been reported in patients in the southern United States. We describe a recently diagnosed R. akari infection in a man who resides in a suburban area of North Carolina.