Rickettsialpox is a mite-borne infectious illness caused by bacteria of the genus Rickettsia (Rickettsia akari). Physician Robert Huebner and self-trained entomologist Charles Pomerantz played major roles in identifying the cause of the disease after an outbreak in 1946 in a New York City apartment complex, documented in "The Alerting of Mr. Pomerantz," an article by medical writer Berton Roueché. Although it is not transmitted by a tick (a characteristic of spotted fever), the bacterium is a part of the spotted fever group of Rickettsia, and so this condition is often classified with that group. Signs and 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 persons entire body. Transmission
The bacteria are originally found in mice and cause mites feeding on the mice (usually the house mouse) to become infected. Humans will get rickettsialpox when receiving a bite from an infected mite, not from the mice themselves.The mite is Liponyssoides sanguineus, which was previously known as Allodermanyssus sanguineus. Treatment
Rickettsialpox is treated with tetracyclines (doxycycline is the drug of choice). Chloramphenicol is a suitable alternative. 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 urban areas (which typically experience rodent problems) have a higher risk of contracting rickettsialpox.
With too little tryptophan in the blood, the body is unable to make a sufficient amount of the B-complex vitamin niacinamide, particularly under stress when more vitamins are needed.In Hartnup disease, urinary excretion of proline, hydroxyproline, and arginine remains unchanged, differentiating it from other causes of generalized aminoaciduria, such as Fanconi syndrome. With urine chromatography, increased levels of neutral amino acids (e.g., glutamine, valine, phenylalanine, leucine, asparagine, citrulline, isoleucine, threonine, alanine, serine, histidine, tyrosine, tryptophan) and indican are found in the urine. Increased urinary Indican can be tested by Obermeyer test. Treatment
A high-protein diet can overcome the deficient transport of neutral amino acids in most patients. Poor nutrition leads to more frequent and more severe attacks of the disease, which is otherwise asymptomatic. All patients who are symptomatic are advised to use physical and chemical protection from sunlight: avoid excessive exposure to sunlight, wear protective clothing, and use  chemical sunscreens with a SPF of 15 or greater. Patients also should avoid other aggravating factors, such as photosensitizing drugs, as much as possible. In patients with niacin deficiency and symptomatic disease, daily supplementation with nicotinic acid or nicotinamide reduces both the number and severity of attacks. Neurologic and psychiatric treatment is needed in patients with severe central nervous system involvement. See also
Citrullinemia
Cystinosis
Cystinuria

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