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Clinical Medicine: Infectious Disease (Part 2) > Tick Borne Diseases > Flashcards

Tick Borne Diseases Flashcards

1
Q

What is the most common tick borne disease in the United States?

A

Lyme Disease

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2
Q

What bacteria causes Lyme Disease?

A

Borrelia burgdorgeri

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3
Q

How long must a tick be attached to someone for transmission of Lyme disease to occur?

A

24 - 36 hours

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4
Q

Where is Lyme Disease most common at in the United States?

A

Northeast

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5
Q

Most cases of Lyme Disease are transmitted by what tick?

A

Ixodes scapularis
(Deer Tick)

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6
Q

What are the 3 stages of Lyme Disease?

A

Stage 1: Early Localized
Stage 2: Early Disseminated
Stage 3: Late Persistent

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7
Q

What rash is the hallmark feature of Lyme Disease

A

Erythema Migrans
(Bullseye Rash)

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8
Q

How soon after the tick bite does the bullseye rash (erythema migrans) occur?

A

One Week

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9
Q

What are the signs and symptoms of Lyme disease that is in Stage 1: Early Localized?

A

Erythema Migrans (Bullseye Rash)
Viral Like Illness
- myalgias
- arthralgia
- fatigue
-headache
- with or without fever

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10
Q

How soon after infection of Lyme disease does Stage 2: Early Disseminated infection start?

A

Days - Weeks

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11
Q

How does Stage 2: Early Disseminated infection of Lyme disease spread throughout the body?

A

Hematogenous
(blood)
- causes multiple erythema migrans rash

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12
Q

What is the most common neurological finding in Stage 2 of Lyme disease?

A

Aseptic Meningitis

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13
Q

What is the most common peripheral neurological finding in Stage 2 of Lyme disease?

A

CN - VII Palsy
(bilateral facial palsy is pathognomic)

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14
Q

What are the most common cardiac manifestations of Stage 2 of Lyme disease?

A

Heart Block
Myopericarditis
Arrhythmias

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15
Q

How long does Lyme disease Stage 3: Late Persistent Infection take to develop?

A

Months - Years

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16
Q

What are the signs and symptoms that are seen in Stage 3 Lyme disease?

A

Persistent or Intermittent Arthritis (especially knee)

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17
Q

While chronic arthritis is uncommon due to Lyme disease, what might cause it?

A

Immunologic Cause
(not persistent infection)

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18
Q

Stage 3 Lyme disease rarely presents with neurological symptoms, if it did though, what are some things you might see?

A

Altered Mental Status
Mood Changes
Sleep Disturbance

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19
Q

How is Lyme disease diagnosed?

A

Exposure in an endemic area with:
- physician documented erythema migrans rash
(within 30 days of possible exposure)
- or at least one late manifestation of the disease + lab confirmation

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20
Q

What two lab values could be elevated in a patient with Lyme disease?

A

Liver Enzymes
ESR

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21
Q

What two-test diagnostic approach is recommend for Lyme disease?

A

ELISA antibody (initial)
Western Blot (confirmation)

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22
Q

What percentage of patients with Lyme disease will be antibody negative in the first few weeks?

A

Up to 50%

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23
Q

Should patients with non-specific symptoms without objective signs of Lyme disease have serologic testing done?

A

No
false (+) on screen are more common than true (+)

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24
Q

What is the first line treatment of Lyme disease?

A

Doxycycline (10 days)

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25
Q

What are two second line treatment options for Lyme disease?

A

Amoxicillin (14 days)
Cefuroxime (14 days)

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26
Q

What is the first line treatment for Lyme Arthritis?

A

Doxycycline (28 days)

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27
Q

What is the first line treatment for Cardiac Lyme disease?

A

Doxycycline - outpatient
Ceftriaxone (IV) - inpatient

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28
Q

Fatigue, myalgia, and cognitive difficulty that continues after the successful treatment of Lyme disease.

A

Post or Chronic Lyme Syndrome

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29
Q

Should you re-treat patients with Post or Chronic Lyme Syndrome?

A

No

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30
Q

There is no data to support an ongoing infection as the cause of Post or Chronic Lyme Syndrome. What might you consider in a patient that has successfully been treated but still presents with symptoms?

A

Co-infection
Misdiagnosis
(don’t retest them either fool - antibodies)

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31
Q

What are the four major criteria for Lyme Prophylaxis?

A
  1. Ixodes scapularis attached for 36+ hours
  2. More than 20% of ticks in the area have Lyme
  3. No contraindication to Doxycycline
  4. Prophylaxis can be started within 72 hours of removal
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32
Q

What is the treatment for Lyme disease Prophylaxis?

A

Doxycycline (200mg)
Single Dose

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33
Q

Illness that comes and goes in discrete episodes over several weeks. Characterized by abrupt onset of fever, chills, tachycardia, nausea and vomiting, arthralgia, and severe headache.

A

Relapsing Fever

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34
Q

What are some other signs and symptoms of Relapsing Fever?

A

Hepatomegaly
Splenomegaly
Various Rashes
High Fever + Delirium

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35
Q

How long do Relapsing Fever attacks usually last for?

A

3 - 10 days

36
Q

After what time interval does Relapsing Fever occur again?

A

1 - 2 weeks
(Often more mild)

37
Q

How many relapses might occur of Relapsing Fever due to tick-borne disease?

A

3 - 10 relapses

38
Q

What causes Relapsing Fever?

A

Spirochete of genus Borrelia

39
Q

What are the two forms of Relapsing Fever?

A

Tick-borne
Louse-borne

40
Q

What form of Relapsing Fever is most commonly seen in the United States?

A

Tick-borne

41
Q

What is the main reservoir of Tick-borne Relapsing Fever?

A

Rodents

42
Q

Where at in the United States is Relapsing Fever most common?

A

Mountainous West

43
Q

A CBC of a patient with Relapsing Fever might show what?

A

Mild Anemia and Thrombocytopenia (common)
- usually normal CBC

44
Q

What blood smear tests are used to diagnose Relapsing Fever?

A

Wright-Geimsa Stain
Darkfield Microscopy

45
Q

If you suspect Relapsing Fever but don’t see any spirochete on a blood smear, what might you do next?

A

PCR

46
Q

What is a common sign of Relapsing Fever?

A

Hematuria

47
Q

Post-exposure prophylaxis treatment of Relapsing Fever in endemic areas.

A

Doxycycline (200mg) on the first day
+
Doxycycline (100mg) x4 days

48
Q

How do you treat Relapsing Fever without central nervous involvement?

A

Penicillin G (IV)
Ceftriaxone (IV)
- both followed by Tetracycline for 10 days

49
Q

What reaction is seen in about 50% of patients after starting antibiotics for Relapsing Fever?

A

Jarisch-Herxheimer Reaction

50
Q

What is the overall mortality rate of Relapsing Fever?

A

5%

51
Q

Illness caused by Rickettsia rickettsii

A

Rocky Mountain Spotted Fever

52
Q

How long must a tick remain attached to transmit Rocky Mountain Spotted Fever?

A

6 - 10 hours

53
Q

Rocky Mountain Spotted Fever spread via the lymph and blood vessels due to what?

A

Increased Vascular Permeability

54
Q

Rocky Mountain Spotted Fever is most commonly seen during what months?

A

April - September

55
Q

What is the mortality rate of Rocky Mountain Spotted Fever in treated patients?

A

10%

56
Q

Where are most cases of Rocky Mountain Spotted Fever found?

A

Midwest

57
Q

How soon do RMSF symptoms start after the tick bite?

A

2 - 14 days

58
Q

What are the signs and symptoms of Rocky Mountain Spotted Fever?

A

Abrupt onset of Fever
Headache
Rash that develops a few days later.

59
Q

How does a Rocky Mountain Spotted Fever Rash present?

A

blanching pink Macules that become Petechiae

60
Q

What is the classic triad of Rocky Mountain Spotted Fever?

A

History of Tick bite:
Fever
Headache
Rash

61
Q

How might Rocky Mountain Spotted Fever present in the early stages?

A

Flu-Like
- fever
- severe headache
- nausea
- vomiting
- myalgia
- malaise

62
Q

Where and when does the rash occur due to Rocky Mountain Spotted Fever?

A

Starts at Wrist and Ankles and Spreads Centrally
(2 - 3 days)
Palms and Soles are Characteristic

63
Q

What is the fatality rate of Rocky Mountain Spotted Fever if left untreated?

A

Up to 73%

64
Q

What can Rocky Mountain Spotted Fever cause in pregnant patients?

A

Spontaneous Abortion

65
Q

What may need to be done before a diagnosis of RMSF is confirmed?

A

Empiric Broad Spectrum Antibiotics

66
Q

How is Rocky Mountain Spotted Fever diagnosed?

A

Clinically
- skin biopsy or PCR to confirm

67
Q

What is the drug of choice for treating Rocky Mountain Spotted Fever?

A

Doxycycline (100mg)
2x a day for 5 - 7 days

68
Q

What drug is used to treat Rocky Mountain Spotted Fever in pregnant patients?

A

Chloramphenicol

69
Q

What is the usual cause of death in patients with Rocky Mountain Spotted Fever?

A

Pneumonitis with either:
- respiratory or cardiac failure

70
Q

Are prophylactic antibiotics recommended for Rocky Mountain Spotted Fever?

A

No

71
Q

Tick borne illness that infects monocytes or granulocytes

A

Ehrlichiosis

72
Q

Where is Ehrlichiosis most commonly found in the United States?

A

Missouri
Arkansas
Oklahoma

73
Q

What is the primary reservoir of Ehrlichiosis?

A

White Tail Deer
Mice

74
Q

What tick causes Ehrlichiosis?

A

Lone Start Tick

75
Q

What are the signs and symptoms of Ehrlichiosis?

A

Malaise
Rigors
Nausea
High Fever and Headache
- possible pleomorphic rash

76
Q

What are some rare but serious complications that can result from Ehrlichiosis?

A

Acute Respiratory Failure + ARDS
Meningoencephalitis
Acute Kidney Disease
Hemophagocytic Syndrome
Multi-organ failure

77
Q

How is Ehrlichiosis diagnosed?

A

Clinically
- PCR is sensitive in the first week
- Indirect Fluorescent Antibody from CDC

78
Q

What is the primary treatment of Ehrlichiosis?

A

Doxycycline (100mg)
2x a day for 10 - 14 days

79
Q

What is the alternative treatment for Ehrlichiosis in pregnant women?

A

Rifampin

80
Q

What might persist for weeks, despite the appropriate treatment of Ehrlichiosis?

A

Headache
Weakness
Malaise

81
Q

An acquired meat allergy from a tick. Results in a delayed form of anaphylaxis caused by red meat consumption.

A

Alpha-gal Syndrome

82
Q

What is different about Alpha-gal from other food allergies?

A

Alpha-gal is a carbohydrate
- most food allergies are to proteins

83
Q

Where is Alpha-gal syndrome most prevalent?

A

Midewest

84
Q

What antibody-mediated allergic reaction occurs in Alpha-gal syndrome?

A

IgE

85
Q

How is Alpha-gal diagnosed?

A

Serologic testing for Alpha-gal specific IgE

Clinical Medicine: Infectious Disease (Part 2) (8 decks)

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