A Focus of Rocky Mountain Spotted Fever within New York City

Salgo, Miklos; Telzak, Edward E.; Currie, Brian S.; Perlman, David C.; Litman, Nathan; Levi, Michael H.; Nathenson, Gerald; Benach, Jorge L.; Al-Hafidh, Rafi; Casey, Joan

doi:10.1056/nejm198805263182101

Cited by 78 publications

(32 citation statements)

References 9 publications

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“…21,24 In contrast to rickettsialpox, the greater severity of morbidity 4 and the high case-fatality ratio of Rocky Mountain spotted fever 4,5 suggests that it most likely would be recognized if it occurred routinely among IV drug users. Although both R. akari and R. rickettsii may occur as highly focal zoonoses in urban areas, 8,12 the mite vector of rickettsialpox has a ubiquitous host in the house mouse that allows ample opportunity for human contact throughout the urban environment. 25 Epizootic lymphocytic choriomeningitis virus (LCMV) infections among house mouse populations could result in mice becoming an unsuitable host for mites associated with R. akari transmission.…”

Section: Discussionmentioning

confidence: 99%

“…8 We recently found elevated prevalences of antibodies to three Bartonella species in inner-city Baltimore intravenous (IV) drug users, 10 and the agent responsible for the greatest number of seropositive serum samples (B. elizabethae) has recently been isolated from a Norway rat (Rattus norvegicus) captured in an urban environment in Baltimore (Ellis B, Centers for Disease Control and Prevention [CDC], unpublished data). Recent rickettsialpox infections in New York City, 11 as well as an earlier report of a focus of Rocky Mountain spotted fever in a New York City park, 12 indicated that inner-city residents might be exposed to spotted fever group rickettsiae. Because many of the individuals in the Bartonella study were homeless and therefore potentially at increased risk for exposure to the arthropod vectors and a variety of mammalian reservoirs of rickettsial agents, we included a spotted fever group rickettsial antigen (R. rickettsii) in the testing panel.…”

mentioning

confidence: 98%

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Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Comer

Tzianabos²,

Flynn

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. We tested single serum samples from 631 intravenous (IV) drug users from inner-city Baltimore, Maryland for serologic evidence of exposure to spotted fever group rickettsiae. A total of 102 (16%) individuals had titers Ն 64 to Rickettsia rickettsii by an indirect immunofluorescence assay. Confirmation that infection was caused by R. akari was obtained by cross-adsorption studies on a subset of serum samples that consistently resulted in higher titers to R. akari than to R. rickettsii. Current IV drug use, increased frequency of injection, and shooting gallery use were significant risk factors for presence of group-specific antibodies reactive with R. rickettsii. There was a significant inverse association with the presence of antibodies reactive to R. rickettsii and antibodies reactive to the human immunodeficiency virus. This study suggests that IV drug users are at an increased risk for R. akari infections. Clinicians should be aware of rickettsialpox, as well as other zoonotic diseases of the urban environment, when treating IV drug users for any acute febrile illness of undetermined etiology.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Serologic evidence of rickettsialpox (Rickettsia akari) infection among intravenous drug users in inner-city Baltimore, Maryland.

Comer

Tzianabos²,

Flynn

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…Although most cases are associated with rural or semirural areas, autochthonous cases have been described in large urban centers, including New York City, where rickettsia-infected D. variabilis were found in parks and vacant lots (302 (67). Multiple and diverse factors contribute to the incidence rates of complex zoonoses, including RMSF and other tickborne SFG rickettsioses, and annual case counts are generally subject to wide regional and temporal variabilities.…”

Section: Pathogens Described Prior To 1984mentioning

confidence: 99%

Tick-Borne Rickettsioses around the World: Emerging Diseases Challenging Old Concepts

2005

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SUMMARY During most of the 20th century, the epidemiology of tick-borne rickettsioses could be summarized as the occurrence of a single pathogenic rickettsia on each continent. An element of this paradigm suggested that the many other characterized and noncharacterized rickettsiae isolated from ticks were not pathogenic to humans. In this context, it was considered that relatively few tick-borne rickettsiae caused human disease. This concept was modified extensively from 1984 through 2005 by the identification of at least 11 additional rickettsial species or subspecies that cause tick-borne rickettsioses around the world. Of these agents, seven were initially isolated from ticks, often years or decades before a definitive association with human disease was established. We present here the tick-borne rickettsioses described through 2005 and focus on the epidemiological circumstances that have played a role in the emergence of the newly recognized diseases.

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“…10,[13][14][15] Community health education efforts need to stress that age-specific incidence is high in children, there are effective preventive measures, and treatment needs to begin as early as possible. Otherwise there can be serious sequelae, with the untreated case fatality rate ranging from 15 to 30%.…”

Section: Public Health Considerationsmentioning

confidence: 99%