Keywords
Rickettsial infections
SENLAT
Coxiella burnetii
Q fever
epidemiology
risk factors
clinical picture
prevention
How to Cite
Abstract
Rickettsial diseases and Q fever are infectious zoonoses that are rarely considered in the differential diagnosis in everyday medical practice. Improperly collected epidemiological interview and a relatively uncharacteristic clinical picture result in significant diagnostic difficulties and underestimated assessment of its frequency in the human population. The paper describes the nature of the aetiological factors of these unusual infections, discusses the transmission routes of the pathogens, as well as clinical expression and principles of diagnostic and therapeutic procedures. The publication is a review based on the analysis of available scientific literature. Microorganisms of the genus Rickettsia, for which ticks are vectors, cause spotted fevers in humans. R. slovaca and R. raoultii are responsible for SENLAT (scalp eschar and neck lymphadenopathy after tick bite) while R. monacensis causes a disease similar to Mediterranean spotted fever. Typical symptoms of SENLAT include eschar at the site of the tick bite, lymphadenopathy, and local alopecia. R. helvetica infection can have a mild course with fever, headache, and muscle pain. The disease can also manifest with spotted skin rash, persistent muscle weakness, pericarditis or meningitis. Frequent R. monacensis symptoms include fever, headache, rash, and an inoculation eschar. Bacteria belonging to the genus Rickettsia can be classified into the following phylogenetic groups: ancestral, spotted fever group, typhus group, and a relatively recently identified transitional group. According to another systematic classification, these microorganisms can also be assigned to the following categories: spotted fever group, typhus group, Rickettsia bellii group, and R. canadensis group. The spotted fever group Rickettsia species found in Poland include R. slovaca, R. raoultii, R. helvetica, and R. monacensis. Vectors for these bacteria include ticks such as Ixodes ricinus and Dermacentor reticulatus. It is suggested that humans are incidental hosts of spotted fever group (SFG) rickettsiae. Infection is believed to occur during tick feeding on the patient's blood. Some SFG rickettsiae species are transmitted transovarially and transstadially in ticks, e.g., R. parkeri in the tick Amblyomma americanum and R. helvetica in I. ricinus. Therefore, ticks are also considered reservoirs for these microorganisms. However, the tick must be capable of maintaining the infection within its body. Environmental studies suggest that reservoirs of rickettsiae also include some animals such as Cervus nippon yesoensis (a subspecies of the eastern deer), European roe deer, and even mice. Besides tick-borne rickettsiae, other species require different vectors for transmission. Rickettsia prowazekii, causing epidemic typhus, is transmitted by the human louse (Pediculus humanus), with humans as the sole reservoir and source of infection. Infection occurs during louse feeding or by accidental inoculation of louse feces into damaged skin. Rickettsia typhi, responsible for endemic typhus, is transmitted by fleas, with rats, mice, and cats as natural reservoirs. According to the Polish Act on the Prevention and Control of Infections and Infectious Diseases in Humans of December 5, 2008 (Journal of Laws 2008, No. 234, item 1570, as amended), spotted fevers and other rickettsioses are subject to mandatory registration in Poland. According to annual epidemiological reports from the National Institute of Public Health in Warsaw, 10 cases were reported in 2023, including 6 requiring hospitalization (60%), corresponding to an incidence rate of 0.027 per 100,000 inhabitants. Patients mostly originated from the Mazowieckie Voivodeship.
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