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(Vesicular Rickettsiosis)

By William A. Petri, Jr, MD, PhD, Wade Hampton Frost Professor of Medicine and Chief, Division of Infectious Diseases and International Health, University of Virginia School of Medicine

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Rickettsialpox is caused by Rickettsia akari. Symptoms are an initial local lesion and a generalized papulovesicular rash.

Rickettsialpox, a rickettsial disease, occurs in many areas of the US and in Russia, Korea, and Africa. The vector, a small, colorless mite, is widely distributed. It infects the house mouse and some species of wild mice. Humans may be infected by chigger (mite larvae) or adult mite bites.

An eschar appears about 1 wk before onset of fever as a small papule 1 to 1.5 cm in diameter, then develops into a small ulcer with a dark crust that leaves a scar when it heals. Regional lymphadenopathy is present. An intermittent fever lasts about 1 wk, with chills, profuse sweating, headache, photophobia, and muscle pains. Early in the febrile course, a generalized maculopapular rash with intraepidermal vesicles appears, sparing the palms and soles.

The disease is mild; no deaths have been reported.

Treatment is doxycycline 100 mg po bid for 5 days or ciprofloxacin 750 mg po bid for 5 days.

For prophylaxis, mouse harborages must be destroyed, and the vector controlled by residual insecticides.

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