Rickettsialpox
Encyclopedia
Rickettsialpox is an illness caused by bacteria of the Rickettsia
genus (Rickettsia akari
). Physician Robert Huebner
and self-trained entomologist Charles Pomerantz
played major roles in identifying the etiology
of the disease after an outbreak in 1946 in a New York City apartment complex, documented in medical writer Berton Roueché
's short story, "The Alerting of Mr. Pomerantz."
Although it is not transmitted by a tick
(a characteristic of spotted fever
), the bacteria is a part of the spotted fever group of Rickettsia, and so this condition is often classified with that group.
, in the New York City borough
of Queens
. Physicians who had seen patients starting in early 1946 had assumed that they were dealing with an atypical form of chickenpox
, but the realization was made that they were dealing with a localized epidemic of unknown origins starting in the summer of that year. Physicians canvassed the residents of the building and found that there had been 124 cases of this disease from January through October among the 2,000 people living in the complex, reaching a peak of more than 20 cases reported in July. Individuals afflicted with the condition ranged in age from 3 months to 71, males and females were equally affected and the incidence among adults (6.5% of the 1,400 above age 15) exceeded that of children 14 and under (5.3%).
Individuals would first have a small lesion at the site of the insect bite, which would eventually leave a small scar. Lymph node
s would become enlarged and about a week after the initial bite patients would start to experience chills, fever and headaches, accompanied by a maculopapular rash
. The rash would last for about a week, with the full progress from the lesion being encountered until recovery typically being three weeks. Several characteristics were considered from an epidemiological perspective as being correlated with the condition. Men and women were equally affected and there was no apparent connection to occupation or school attended. The individuals obtained their meals at several different sources, and other individuals who lived elsewhere and purchased their food at these same places had not been affected. The water supply and milk consumed there were tested, with no unusual findings. There were dog kennels in the area and some tenants had dogs as pets, but an inspection of the animals found no ticks or insects.
Many residents had reported the presence of mice in and around the apartments, especially in the basements of the buildings near the incinerators, where living and dead mice were found. Garbage disposed of through incinerator chutes was to be burned on a daily basis, with the ashes carted off by the New York City Department of Sanitation
. Due to labor shortages, the material was not burned regularly, leaving ample food for the rodents. Mice were trapped in apartments and near the incinerators and antibodies to the rickettsialpox were found in their blood. Visiting the complex with pest-control specialist and self-trained entomologist Charles Pomerantz
, the two peeled back wallpaper to find the walls swarming with mites, so much so that tenants had said that "the walls had movement". The mites were collected and rickettsial strains were isolated from some of them, with the name Rickettsia akari
given to the organism.
Public health officials took steps to prevent further outbreaks of the disease. The building operators were told to ensure that the incinerators were fired on a regular basis to ensure that food available to the mice that harbored the disease was eliminated as quickly and thoroughly as possible. Pest control measures were undertaken through the New York City Department of Health and its commissioner Israel Weinstein to eliminate the mice in and around the buildings with the cooperation of property owners.
Another 20 cases of rickettsialpox were discovered elsewhere in New York City during the investigation of the Queens outbreak, including 10 cases found in an apartment building in the Bronx
that had originally been diagnosed as atypical chickenpox. Mice were found in the basement of this building, as well as mites belonging to the same class found in Queens. In addition to the initial cases from the first outbreak in Queens, over 500 cases of the disease were diagnosed in New York City from 1947 to 1951.
, not from the mice themselves.
The mite is Liponyssoides sanguineus
, which was previously known as Allodermanyssus sanguineus.
areas (which typically experience rodent problems) have a higher risk of contracting Rickettsialpox.
Rickettsia
Rickettsia is a genus of non-motile, Gram-negative, non-sporeforming, highly pleomorphic bacteria that can present as cocci , rods or thread-like . Being obligate intracellular parasites, the Rickettsia survival depends on entry, growth, and replication within the cytoplasm of eukaryotic host cells...
genus (Rickettsia akari
Rickettsia akari
Rickettsia akari is a species of Rickettsia which causes rickettsialpox.After a 1946 outbreak of a rickettsial-type disease at an apartment complex in Kew Gardens, Queens, an investigation was performed to identify the source of the infections...
). Physician Robert Huebner
Robert Huebner
Robert Joseph Huebner , was an American physician and virologist whose research into viruses, their causes and treatment that led to his breakthrough insights into the connections between viruses and cancer, leading to new treatments, as well as his hypothesized oncogene, which was discovered to be...
and self-trained entomologist Charles Pomerantz
Charles Pomerantz
Charles Pomerantz was a pest control expert and self-trained entomologist who played a pivotal role in identifying the etiology of a 1946 outbreak in New York City of what was later named rickettsialpox...
played major roles in identifying the etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
of the disease after an outbreak in 1946 in a New York City apartment complex, documented in medical writer Berton Roueché
Berton Roueché
Berton Roueché was a medical writer who wrote for The New Yorker magazine for almost fifty years. He also wrote twenty books including Eleven Blue Men , The Incurable Wound , Feral , and The Medical Detectives...
's short story, "The Alerting of Mr. Pomerantz."
Although it is not transmitted by a tick
Tick
Ticks are small arachnids in the order Ixodida, along with mites, constitute the subclass Acarina. Ticks are ectoparasites , living by hematophagy on the blood of mammals, birds, and sometimes reptiles and amphibians...
(a characteristic of spotted fever
Spotted fever
A spotted fever is a type of tick-borne disease which presents on the skin.Types include:* Mediterranean spotted fever* Rocky Mountain spotted fever* Queensland tick typhus...
), the bacteria is a part of the spotted fever group of Rickettsia, and so this condition is often classified with that group.
Diagnosis of the initial outbreak
The initial outbreak of the disease took place in the Regency Park complex which had 69 apartment units organized in three groups each three stories in height, located in Kew GardensKew Gardens, Queens
Kew Gardens is a triangular-shaped neighborhood in central Queens bounded to the north by the Jackie Robinson Parkway , to the east by Van Wyck Expressway and 131st Street, to the south by Hillside Avenue, and to the west by Park Lane, Abingdon Road and 118th Street...
, in the New York City borough
Borough (New York City)
New York City, one of the largest cities in the world, is composed of five boroughs. Each borough now has the same boundaries as the county it is in. County governments were dissolved when the city consolidated in 1898, along with all city, town, and village governments within each county...
of Queens
Queens
Queens is the easternmost of the five boroughs of New York City. The largest borough in area and the second-largest in population, it is coextensive with Queens County, an administrative division of New York state, in the United States....
. Physicians who had seen patients starting in early 1946 had assumed that they were dealing with an atypical form of chickenpox
Chickenpox
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus . It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring...
, but the realization was made that they were dealing with a localized epidemic of unknown origins starting in the summer of that year. Physicians canvassed the residents of the building and found that there had been 124 cases of this disease from January through October among the 2,000 people living in the complex, reaching a peak of more than 20 cases reported in July. Individuals afflicted with the condition ranged in age from 3 months to 71, males and females were equally affected and the incidence among adults (6.5% of the 1,400 above age 15) exceeded that of children 14 and under (5.3%).
Individuals would first have a small lesion at the site of the insect bite, which would eventually leave a small scar. Lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s would become enlarged and about a week after the initial bite patients would start to experience chills, fever and headaches, accompanied by a maculopapular rash
Maculopapular rash
A maculopapular rash is a type of rash characterized by a flat, red area on the skin that is covered with small confluent bumps. The term "maculopapular" is a compound: macules are small, flat discolored spots on the surface of the skin; and papules are small, raised bumps...
. The rash would last for about a week, with the full progress from the lesion being encountered until recovery typically being three weeks. Several characteristics were considered from an epidemiological perspective as being correlated with the condition. Men and women were equally affected and there was no apparent connection to occupation or school attended. The individuals obtained their meals at several different sources, and other individuals who lived elsewhere and purchased their food at these same places had not been affected. The water supply and milk consumed there were tested, with no unusual findings. There were dog kennels in the area and some tenants had dogs as pets, but an inspection of the animals found no ticks or insects.
Many residents had reported the presence of mice in and around the apartments, especially in the basements of the buildings near the incinerators, where living and dead mice were found. Garbage disposed of through incinerator chutes was to be burned on a daily basis, with the ashes carted off by the New York City Department of Sanitation
New York City Department of Sanitation
The New York City Department of Sanitation, or DSNY, is a uniformed force of unionized sanitation workers in New York City. Their responsibilities include garbage collection, recycling collection, street cleaning, and snow removal...
. Due to labor shortages, the material was not burned regularly, leaving ample food for the rodents. Mice were trapped in apartments and near the incinerators and antibodies to the rickettsialpox were found in their blood. Visiting the complex with pest-control specialist and self-trained entomologist Charles Pomerantz
Charles Pomerantz
Charles Pomerantz was a pest control expert and self-trained entomologist who played a pivotal role in identifying the etiology of a 1946 outbreak in New York City of what was later named rickettsialpox...
, the two peeled back wallpaper to find the walls swarming with mites, so much so that tenants had said that "the walls had movement". The mites were collected and rickettsial strains were isolated from some of them, with the name Rickettsia akari
Rickettsia akari
Rickettsia akari is a species of Rickettsia which causes rickettsialpox.After a 1946 outbreak of a rickettsial-type disease at an apartment complex in Kew Gardens, Queens, an investigation was performed to identify the source of the infections...
given to the organism.
Public health officials took steps to prevent further outbreaks of the disease. The building operators were told to ensure that the incinerators were fired on a regular basis to ensure that food available to the mice that harbored the disease was eliminated as quickly and thoroughly as possible. Pest control measures were undertaken through the New York City Department of Health and its commissioner Israel Weinstein to eliminate the mice in and around the buildings with the cooperation of property owners.
Another 20 cases of rickettsialpox were discovered elsewhere in New York City during the investigation of the Queens outbreak, including 10 cases found in an apartment building in the Bronx
The Bronx
The Bronx is the northernmost of the five boroughs of New York City. It is also known as Bronx County, the last of the 62 counties of New York State to be incorporated...
that had originally been diagnosed as atypical chickenpox. Mice were found in the basement of this building, as well as mites belonging to the same class found in Queens. In addition to the initial cases from the first outbreak in Queens, over 500 cases of the disease were diagnosed in New York City from 1947 to 1951.
Transmission
The bacteria is originally found in mice and cause mites feeding on the mice to become infected. Humans will get rickettsialpox when receiving a bite from an infected miteMite
Mites, along with ticks, are small arthropods belonging to the subclass Acari and the class Arachnida. The scientific discipline devoted to the study of ticks and mites is called acarology.-Diversity and systematics:...
, not from the mice themselves.
The mite is Liponyssoides sanguineus
Liponyssoides sanguineus
Liponyssoides sanguineus is a species of mite. It infests Mus musculus.It can transmit human disease.It can transmit Rickettsia akari, which causes rickettsialpox.It was previously known as Allodermanyssus sanguineus.-References:...
, which was previously known as Allodermanyssus sanguineus.
Symptoms
The first symptom is a bump formed by the bite, eventually resulting in a black, crusty scab. Many of the symptoms are flu-like including fever, chills, weakness and achy muscles but the most distinctive symptom is the rash that breaks out, spanning the infected person's entire body.Prognosis
Rickettsialpox is generally mild and resolves within 2-3 weeks if untreated. There are no known deaths resulting from the disease.Epidemiology
Those dwelling in urbanUrban area
An urban area is characterized by higher population density and vast human features in comparison to areas surrounding it. Urban areas may be cities, towns or conurbations, but the term is not commonly extended to rural settlements such as villages and hamlets.Urban areas are created and further...
areas (which typically experience rodent problems) have a higher risk of contracting Rickettsialpox.