TICK BORNE ILLNESS

Question 1

Organism Type:

Answer 1

Gram-negative, intracellular, coccobacillus bacterium

Question 2

Scientific name:

Answer 2

R. rickettsia

Question 3

Subtypes:

Answer 3

None

Question 4

Common Name(s):

Answer 4

‘Spotted Fever,’ ‘black measles’

Question 5

Prevalence:

Answer 5

Europe (central and eastern) Asia (western Russia,
Mongolia, northeastern China, and into Japan). Northeastern and
north-central United States.

Question 6

Predisposing Factors:

Answer 6

hiking, camping, high tick population, summer
& fall months, not performing tick checks, lack of PPE/covering
(7) Transmitted Via: American dog tick - east of Rockies & Pacific
Coast, Rocky Mountain wood tick - Rocky Mountain region, brown
dog tick (worldwide)

Question 7

Vector

Answer 7

Yes

Question 8

Incubation Period:

Answer 8

typically 2–14 days

Question 9

Vaccine

Answer 9

No

Question 10

Reportable

Answer 10

Yes

Question 11

Lethal

Answer 11

typically, no. Untreated, YES!

Question 12

Peak transmission occurs in

Answer 12

May – August, although reported

year-round.

Question 13

RMSF is a rapidly progressive disease and without early

administration of____ can be fatal within days.

Answer 13

doxycycline

Question 14

(a) Fever, HA, GI symptoms, myalgias and rash.
1) Rash typically presents 3-5 days after fever onset
2) Begins as small flat pink macules on wrists, forearms
and ankles that spreads to trunk
3) Can also involve palms of hands & soles of feet

Answer 14

Early illness (days 1-4)

Question 15

R. rickettsii infects endothelial cells that line blood vessels, causing
vasculitis and bleeding or clotting in the brain or other vital organs.

Answer 15

late Disease

Question 16

Severe RMSF may cause permanent complications from

Answer 16

(a) Neurological deficits
(b) Damage to internal organs
(c) Vascular damage requiring amputation

( Late Disease )

Question 17

(3) Patients without vascular damage in the initial stages of disease
typically experience a full recovery.
(4) There is no evidence that R. rickettsii causes persistent or chronic
disease.

Answer 17

late Disease

Question 18

A classic RMSF involves a rash that appears 2-4 days after

the onset of fever as small, flat, pink, macules on

Answer 18

(1) the wrists,
forearms, and ankles and spreads to include the trunk and
sometimes the palms of hands and soles of feet
(2) Rash can be highly variable and people who fail to develop a
rash, or develop an atypical rash, are at increased risk of
being misdiagnosed.

Question 19

(a) The petechial rash of RMSF does not typically appear until
day ___

Answer 19

5-6 of illness.
1) NOTE: Petechiae are a sign of severe disease.
(b) Every attempt should be made to treat before petechiae
develop.

Question 20

Differentials

Answer 20

(1) Measles
(2) Hepatitis
(3) Leptospirosis
(4) Meningococcemia
(5) Infectious mononucleosis
(6) Maladie

Question 21

Maladies that can produce lesions on the hands & feet:

Answer 21

(a) Syphilis
(b) HFMD
(c) Dyshidrosis Treatment

Question 22

Diagnosis

Answer 22

TRAINEE GUIDE B-300-0019C
FOR TRAINING USE ONLY 27
(1) Early consideration of rickettsial disease in the DDX & empiric
treatment with doxycycline is crucial to prevent severe illness and
death.
(2) RMSF is difficult to DX due to non-specific signs & symptoms in
early illness.
(3) Crucial History findings to R/I or R/O RMSF:
(a) Recent tick bite. NOTE: Tick bites are often painless, and
many patients do not remember being bitten.
(b) While no recollection of a tick-bite lessens can potentially
lessen the suspicion for RMSF, it does not rule it out.
(c) Exposure to areas where ticks are common (wooded or
brushy areas with high grasses and leaf litter).
(d) Domestic & International travel history to areas where RMSF
is endemic.
(4) Maintain clinical suspicion of RMSF in cases of non-specific febrile
illness & sepsis of unknown origin, particularly during spring/summer
months when ticks are most active.
(5) Laboratory confirmation is helpful for disease surveillance and but
should not be relied upon to make a treatment decision.

Question 23

Treatment

Answer 23

Doxycycline = treatment of choice for all tickborne rickettsial
diseases.

Question 24

After Doxycycline TX, fever generally subsides within ___

hours,

Answer 24

24–48

Question 25

where to expect ticks

Answer 25

b) Where: wooded and brushy areas with high grass and leaf
litter
(c) When: Spring/summer/fall

Question 26

Treat gear & clothing with products containing

Answer 26

0.5%

permethrin.

Question 27

Use EPA registered insect repellents

Answer 27

DEET or picaridin both

commonly available

Question 28

Wear long pants, long sleeves, and long socks

Answer 28

(light-colored

clothing also helps to identify ticks)

Question 29

Perform tick checks at ____ intervals when training or
operating in RMSF endemic areas. Never let your personnel
go > ___ without a check.

Answer 29

12-hour

24hrs

Question 30

Disposition

Answer 30

MedEvac patient to higher echelon of care.

Question 31

IDC should initiate treatment with ___while patient is still on
board.

Answer 31

doxycycline