Russian Journal of Infection and ImmunityRussian Journal of Infection and ImmunityИнфекция и иммунитет2220-76192313-7398SPb RAACI129410.15789/2220-7619-RAR-1294REVIEWSОБЗОРЫRickettsialpox — a rare but not extinct disease: review of the literature and new directionsОсповидный риккетсиоз — редкое, но не исчезнувшее заболевание: обзор литературы и новые направленияEremeevaM. E.ЕремееваМ. Е.
United States

Eremeeva Marina E., PhD, MD (Bioсhemistry), Professor, Laboratory Director, Jiann-Ping Hsu College of Public Health

PO Box 8015, Statesboro, GA 30458

Еремеева Марина Евгеньевна, доктор биологических наук, профессор, заведующий лабораторией, Колледж народного здравоохранения им. Цзянн-Пин Хсу

30458, Джорджия, Стейтсборо, почтовый ящик 8015

meremeeva@georgiasouthern.eduMuniz-RodriguezK.Мунис-РодригесК.
United States

Muniz-Rodriguez Kamalich, MPH, Graduate Student

 

Мунис-Родригес Камалич, магистр общественного здравоохранения, аспирант

Джорджия, Стейтсборо

km11200@georgiasouthern.eduGeorgia Southern UniversityУниверситет Южной Джорджии070820201034774850111201914032020Copyright ©; 2020, Eremeeva M.E., Muniz-Rodriguez K.Copyright ©; 2020, Еремеева М.Е., Мунис-Родригес К.2020Eremeeva M.E., Muniz-Rodriguez K.Еремеева М.Е., Мунис-Родригес К.https://creativecommons.org/licenses/by/4.0https://iimmun.ru/iimm/article/view/1294

Rickettsialpox is an urban zoonosis caused by Rickettsia akari. To date R. akari is the only well-characterized mite-borne member of the spotted fever group. It is transmitted by the mouse mite, Liponyssoides sanguineus, commonly found on peridomestic rodents. While the disease was first discovered in New York City in 1946, a few years later a similar outbreak occurred in the Ukraine SSR. Numerous serosurveys and diagnosis of sporadic cases of rickettsialpox suggest its global distribution; however, the actual contemporary geography of rickettsialpox and its incidence are unknown. Rickettsialpox is characterized by the classic clinical triad found in rickettsioses of a black eschar, high fever, and rash but the latter is atypical as it is papulovesicular. Dermatological manifestations and the progression of rickettsialpox may mimic other infectious and noninfectious syndromes, including sexually transmitted diseases. The purpose of this review is to increase awareness of this unique disease through reanalysis of classic and contemporary clinical descriptions of rickettsialpox, evaluation of its worldwide distribution, and updates on the public health importance of the disease as well as the ecology and vector associations of R. akari. Our review data suggests that only limited genetic diversity exists among the available isolates of R. akari associated with previous outbreaks; additional effort is still required to define specific genetic markers permitting direct surveillance, accurate and reliable diagnosis, tracking and studying of the vector and host associations of contemporary isolates. The potential of R. akari to cross into other vector species emphasizes the necessity for detection of outbreaks of the disease in new regions of the world and in novel ecological settings. We describe existing gaps and limitations in our current understanding of the pathogenesis of rickettsialpox, the epidemiology of this disease and the genetic diversity of R. akari. We propose research priorities for what is needed to improve our understanding of this neglected rickettsial disease and its etiologic agent.

Осповидный риккетсиоз является городским зоонозом, вызываемым Rickettsia akari. На сегодня R. akari является единственным охарактеризованным представителем группы пятнистых лихорадок, передающихся гамазовым клещом Liponyssoides sanguineus, распространенным среди перидомических грызунов. Впервые это заболевание было описано в Нью-Йорке в 1946 г., а спустя несколько лет подобная вспышка произошла в Украинской ССР. Многочисленные серологические исследования и диагностика спорадических случаев осповидного риккетсиоза предполагают его повсеместное распространение на планете; однако современная география распространения осповидного риккетсиоза и уровень заболеваемости неизвестны. Осповидный риккетсиоз характеризуется классической клинической триадой в виде первичного аффекта, высокой температуры и атипичной папуловезикулезной сыпи. Дерматологические проявления и прогрессирование осповидного риккетсиоза могут напоминать другие инфекционные и неинфекционные синдромы, в том числе венерические заболевания. Настоящий обзор был нацелен на привлечение повышенного внимания в отношении этой уникальной болезни путем анализа классических и современных клинических описаний осповидного риккетсиоза, оценки его глобальной распространенности и новых взглядов на его значимость для здравоохранения, а также экологии и взаимосвязи R. akari с переносчиком. Анализ данных указывает, что среди имеющихся изолятов R. akari, выделенных в процессе предыдущих вспышек, существует лишь ограниченное генетическое разнообразие. Потребуется приложить дополнительные усилия для определения специфических генетических маркеров, позволяющих проведение эпидемиологического надзора, а также точной и надежной диагностики, отслеживания и изучения современных изолятов, переносчиков и взаимодействия с организмом хозяина. Потенциал R. akari передаваться другими переносчиками подчеркивает необходимость идентификации вспышек заболевания в неизученных регионах и в новых экологических условиях. Мы описываем существующие пробелы в современном понимании патогенеза осповидного риккетсиоза, его эпидемиологии и генетического разнообразия R. akari. Мы предлагаем перечень научных исследований, необходимых для улучшения понимания этого забытого риккетсиоза и его этиологического агента.

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