ID Flashcards
Acute, localized stage
Manifestations of lyme disease and management
Within 30 days
erythema migrans, fever, fatigue, headache, arthralgia, myalgia
Treat without serologic confirmation **
Acute, disseminated lyme disease and management
Weeks to months after exposure
multiple erythema migrans lesions, heart conduction block, cranial neuropathy, radiculoneuropathy, lymphocytic meningitis, acute attacks of monoarticular or oligoarticular arthritis
Treat if ELISA +
Obtain Western blot if ELISA indeterminate
Late lyme disease
Months to years after exposure: attacks of monoarticular or oligoarticular arthritis and/or chronic monoarthritis or oligoarthritis, peripheral neuropathy or encephalomyelitis
Treat if ELISA +
Obtain Western blot if ELISA indeterminate
Therapies for lyme:
- erythema migrans and early disease
- late carditis or neurologic disease
- arthritis and facial nerve palsy
- doxycycline, amoxicillin, OR cefuroxime (for 28 days)
- ceftriaxone
- doxycycline
Tick borne malaria like illness endemic to NE coast of US; mild cases present with febrile illness with myalgia, headache, and fatigue. Severe hemolytic anemia, jaundice, kidney failure and death more common in immunocompromised, older or asplenic patients
Babesiosis
Wright or Giemsa stain with intraerythrocytic parasites in ring (Maltese cross)
Babesiosis
Treatment of babesiosis in
- asymptomatic patient
- mild to moderate disease
- severe disease
- monitor for resolution
- atovaquone + azithromycin
- clindamycin + quinine
HME
Human monocytic ehrlichiosis
Ehrlichia chaffeensis
HGA
Human granulocytic anaplasmosis
Anaplasma phagocytophilum
HME and HGA vectors and presentations
Spread by ticks
fever, headaches, myalgias
multiorgan failure
fever of unknown origin
elevated aminotransferases with normal alk phosphatases and bilirubin
leukopenia, thrombocytopenia
**presence of morulae clumps of organisms in cytoplasm of appropriate leukocyte)
Best test for HME/HGA
Whole blood PCR to test for acute infection
Treatment of choice for HME/HGA
IV or oral doxycycline
Tick borne illness of SE and south central states
Hx of tick bite, and recent travel. Febrile illness in spring or summer months
Nausea, myalgia, dyspnea, cough, and headache
Macular rash starting on ankles and wrists
Lesions spread centripetally and become petechial
Thrombocytopenia and elevated aminotransferases
Rocky Mountain Spotted Fever
Treatment of Rocky Moutain Spotted Fever
What if pregnant?
doxycycline
Pregnant -> chloramphenicol
what populations do you screen for and treat asymptomatic bacteriuria?
pregnant females or those about to undergo invasive urologic procedure
