The rickettsias are a family of microorganisms named for American pathologist Howard T. Ricketts, who died of typhus in 1910 while investigating the spread of the disease. The rickettsias, which range in size from 250 nanometers to more than 1 micrometer and have no cell wall but are surrounded by a cell membrane, cause a group of diseases characterized by fever and a rash. Except for Coxiella burnetii, the cause of Q fever, they are intracellular parasites, most of which are transmitted to humans by an arthropod carrier such as a louse or tick. C. burnetii, however, can survive in milk, sewage, and aerosols and can be transmitted to humans by a tick or by inhalation, causing pneumonia in the latter case. Rickettsial diseases can be treated with antibiotics.

Humans contract most rickettsial diseases only when they break into a cycle in nature in which the rickettsias live. In murine typhus, for example, Rickettsia mooseri is a parasite of rats conveyed from rat to rat by the Oriental rat flea, Xenopsylla cheopis; it bites humans if they intrude into its environment. Scrub typhus is caused by R. tsutsugamushi, but it normally parasitizes only rats and mice and other rodents, being carried from one to the other by a small mite, Leptotrombidium (previously known as Trombicula). This mite is fastidious in matters of temperature, humidity, and food and finds everything suitable in restricted areas, or “mite islands,” in South Asia and the western Pacific. It rarely bites humans in their normal environment, but if people invade its territory en masse it will attack, and outbreaks of scrub typhus will follow.

The spotted fevers are caused by rickettsias that spend their normal life cycles in a variety of small animals, spreading from one to the other inside ticks; these bite human intruders and cause African, North Asian, and Queensland tick typhus, as well as Rocky Mountain spotted fever. One other spotted fever, rickettsialpox, is caused by R. akari, which lives in the body of the ordinary house mouse, Mus musculus, and spreads from one to another inside the house mite Liponyssoides sanguineus (formerly Allodermanyssus sanguineus). This rickettsia is probably a parasite of wild field mice, and it is perhaps only when cities push out into the countryside that house mice catch the infection.

Mycoplasmas and ureaplasmas

Mycoplasmas and ureaplasmas, which range in size from 150 to 850 nanometers, are among the smallest known free-living microorganisms. They are ubiquitous in nature and capable of causing widespread disease, but the illnesses they produce in humans are generally milder than those caused by bacteria. Diseases due to mycoplasmas and ureaplasmas can be treated with antibiotics.

Mycoplasma pneumoniae is the most important member of its genus. M. pneumoniae is associated with 20 percent of all cases of pneumonia in adults and children over five years of age. Patients have fever, cough, headache, and malaise and, upon physical examination, may be found to have pharyngitis (inflamed throat), enlarged lymph nodes, ear or sinus infection, bronchitis, or croup. Diagnosis is established by chest X-rays and blood tests. Although treatment with erythromycin or tetracycline may shorten the illness, it can last for weeks.

Mycoplasmas may also cause a red, bumpy rash—usually on the trunk or back—that is occasionally vesicular (with blisters). Inflammation of the heart muscle and the covering of the heart (pericardium) is rare but can be caused by mycoplasmas. About one-fourth of the people infected with these organisms experience nausea, vomiting, diarrhea, and cramping abdominal pain. Inflammation of the pancreas (pancreatitis) or the liver (hepatitis) may occur, and infection of the brain and spinal cord is a serious complication.

Ureaplasmas can be recovered frequently from the genital areas of healthy persons. The organism can cause inflammation of the urethra and has been associated with infertility, low birth weight of infants, and repeated stillbirths. In general, however, ureaplasma infections are mild. Tetracycline is the preferred treatment once the organism has been established as the cause of infection by microscopic examination of urethral secretions.