Tick Born Illnesses Flashcards by Jennifer McKeown

What illness are rickettsial?

RMSF
Ehrlichiosis
Anaplasmosis

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What is the treatment for rickettsial infections?

Doxy

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How is babesiosis transmitted?

deer tick and blood transfusions, mother to fetus

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What are risk factors for babesiosis?

> 50yo

Immunocompromised

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What are the symptoms of babesiosi?

May be asymptomatic (50% of kids)
Flu-like symptoms, muscle aches
Fatigue
Nausea and vomiting
Thrombocytopenia
Hemolytic anemia
Elevated liver enzymes
Proteinuria or hematuria

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What is the recommended diagnostic test for babesiosis?

PCR

- blood smear will look like malaria and can lead to a misdiagnosis

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What diagnostic labs are helpful in detecting babesiosis? (3)

CBC w/ diff – hemolytic anemia, thrombocytopenia
LFT elevated
Urine – proteinuria/hematuria

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What is the treatment for mild to moderate babesiosis?

• Oral atovaquone (antimalarial) plus azithromycin

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What is the treatment for asymptomatic babesiosis?

No treatment

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What is the treatment for severe babesiosis?

Hospitalization with IV antibiotics
RBC exchange transfusion - rare
High grade parasitemia

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When should you begin to see improvement of babesiosis?

Should see improvement within 3 days. If not, consult ID or consider Lyme’s Disease.

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How is anaplasmosis transmitted?

Deer tick

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What are the symptoms for anaplasmosis?

Flu like symptoms – fever, chills, malaise
GI symptoms – n/v
No Rash

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What is the recommended diagnostic test for anaplasmosis?

PCR

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What lab tests are helpful in anaplasmosis?

CBC - low WBC and platelets

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What is the treatment for anaplasmosis?

Doxy

How is ehrlichiosis transmitted?

Lone Star tick

What are the symptoms of ehrlichiosis?

Similar to anaplasmosis but 1/3 have the rash.

What is the treatment for ehrilichiosis?

Doxy even if PG or <8yo
Benefit outweighs the risk.
EARLY TX is key to prevent complications.
2nd line: rifampin

How is Lyme disease transmitted?

Borriela burgdorferi organism. 
Ixodes genus (deer tick, blacklegged tick, I. scapularis)

Must be attached and feeding at least 36 hours.

Most common April-December in the Northeast, Mid-Atlantic and upper Midwest

What education do you give patients about Lyme disease?

Tick checks, lymphs can go unnoticed, use insect repellant.

Redness around the bite is a hypersensitivity reaction that can last 1-2 days.

F/u if rash is getting bigger.

What is the treatment for early Lyme disease?

1st line Doxy.

If PG/<8yo=Amoxicillin or cefuroxime.

What is the main symptom in the early localized stage?

Stage I

erythema migrans rash - starts small and expands.

How is Lyme disease diagnosed?

Diagnosis is based on clinical presentation - lab tests can be negative early on.
Diagnose when lesion >5cm.
Look for expansion of the rash (not everyone gets the rash so look for fever, fatigue, headache, myalgias)

What are the symptoms of early disseminated? (7)

multiple rashes cardiac (endocarditis, AVB) flu like sx lymphadenopathy (lymphatic meningitis – HA and neck stiffness) facial palsies arthralgia motor/sensory neuritis (radiculoneuritis)

What is the treatment for early disseminated?

IV ceftriaxone

What are the symptoms of late disseminated?

50% have arthralgia neuro (peripheral neuropathy, encephalomyelitis) subtle memory and cognitive changes

What is the treatment for late disseminated?

IV Ceftriaxone or oral Doxy.

What is the testing for stages II and II Lyme disease?

ELISA: Enzyme linked immunosorbent assay (Sen 100% Sp 98%) If ELISA ispositive test IgM and IgG western blot (WB) assays Antibodies can persist for weeks to months to years No test of cure

When do symptoms of early localized Lyme disease appear?

Days to weeks

When do symptoms of early disseminated Lyme disease appear?

Weeks

When do symptoms of late disseminated Lyme disease appear?

Weeks to months

A patient presents with fever, severe headache, and rash and has a history of tick bite. Which tick-borne illness is suspected? a. Babesiosis b. Erlichiosis c. Lyme disease d. Rocky Mountain spotted fever

ANS: D | The classic triad of fever, severe headache, and rash is consistent with Rocky Mountain spotted fever.

A patient with mild symptoms of babesiosis is diagnosed with a positive PCR assay. What is the recommended treatment for this patient? a. Atovaquone and azithromycin for 7 to 10 days b. Clindamycin and quinine for 10 to 14 days c. Intravenous clindamycin and hospitalization d. Symptomatic therapy with observation

ANS: A Patients with mild to moderate symptoms and a positive PCR assay should be treated. Atovaquone plus azithromycin is the treatment of choice. Clindamycin and quinine are effective, but have more adverse effects. IV clindamycin is given for severe symptoms. Patients without positive assays who have mild symptoms may be observed.

A parent brings a child to clinic and reports pulling a tick off of the child after being outdoors that day. The parent is concerned that the child may have Lyme disease. What will the provider tell this parent? a. A laboratory test today will help identify the presence of the disease. b. Antibiotic prophylaxis is necessary to prevent development of symptoms. c. Transmission of the organism only occurs with prolonged attachment of the tick. d. Unless the child develops systemic symptoms, treatment is not indicated.

ANS: C To transmit the spirochete to humans, the tick must be attached for an extended period of time of 36 to 72 hours. Serologic testing early in the disease may not be helpful. Antibiotic prophylaxis is not recommended. Treatment may begin with the presence of a localized rash.

How is RMSF transmitted?

Wood tick and dog tick | Southeastern and South Central US

What are the symptoms of RMSF?

Severe headache, fever, and frequently nausea, vomiting, or abdominal pain. A maculopapular rash appears on the wrists and ankles 2 to 5 days later, usually spreads to involve the trunk, palms, and may become petecheal.

What is the treatment for RMSF?

Oral Doxycycline

How do you diagnose RMSF?

Don't wait for diagnosis. Treat early w/ doxy. IgG at 2-4 weeks will increase two fold.