Tick Borne Illness

Question 1

Rocky Mountain Spotted Fever (RMSF)
Organism Type:

Answer 1

Gram-negative, intracellular, coccobacillus bacterium

Question 1

Prevalence of what Tick borne illness
Endemic in Central & South America. Occur throughout the United States, but are most commonly reported from North Carolina, Tennessee, Missouri, Arkansas, and Oklahoma.

Answer 1

Rocky Mountain Spotted Fever (RMSF)

Question 2

Rocky Mountain Spotted Fever (RMSF)
Predisposing Factors:

Answer 2

Hiking, camping, high tick population, spring, summer & fall months, not performing tick checks, lack of PPE/covering.

Question 3

What tick borne illness, Transmitted Via:
American dog tick - East of Rockies & Pacific Coast, Rocky Mountain wood tick - Rocky Mountain region, brown dog tick (worldwide).

Answer 3

Rocky Mountain Spotted Fever (RMSF)

Question 4

Rocky Mountain Spotted Fever (RMSF)
Incubation Period:

Answer 4

Typically 2–14 days

Question 5

RMSF Lethality

Answer 5

typically, no.
if Untreated, YES!!

Question 6

RMSF is a rapidly progressive disease and without early administration of _______ can be fatal within days.

Answer 6

doxycycline

Question 7

What issue / Tx
(1) Hx
-(a) Summer & fall month, Hiking, camping in North Carolina, Tennessee, Missouri, Arkansas, and Oklahoma.
-(b) Recent Tick Bite

(2) Early illness (days 1-4) Fever, HA, GI symptoms, myalgias, edema around eyes & back of hands, and rash.
-(a) Rash typically presents 2-4 days after fever onset
-(b) Begins as small flat pink macules on wrists, forearms and ankles that spreads to trunk
-(c) Can also involve palms of hands & soles of feet

(3) Late illness (day 5 or later)
-(a) infection of endothelial cells that line blood vessels, causing vasculitis and bleeding or clotting in the brain or other vital organs
-(b) Severe illness may cause permanent complications from:
–(1) Neurological deficits
–(2) Damage to internal organs (respiratory compromise, renal failure)
–(3) Vascular damage requiring amputation
-(c) The petechial rash of RMSF does not typically appear until
day 5-6 of illness.

Answer 7

RMSF

Doxycycline = Treatment of choice for all tickborne rickettsial
diseases. Doxycycline 100 mg PO BID for 5 – 7 days.

Question 8

RMSF – Treatment
Presumptive Tx with doxycycline is recommended in patients of all ages and is most effective when started within the first ____ days of illness.

Answer 8

5 days

Question 9

True/False
RMSF – Treatment
Use of antibiotics other than doxycycline associated with higher risk of death.

Answer 9

True

Question 10

Maintain clinical suspicion of what illness in cases of non-specific febrile illness & sepsis of unknown origin, particularly during spring/summer months when ticks are most active?

Answer 10

RMSF

Question 11

Tick Prevention
Gear Prep:
(a) Treat gear & clothing with products containing _________.
(b) Use EPA registered _______ repellents (DEET or picaridin both
commonly available).
(c) Wear ________________________ (light-colored clothing also helps to identify ticks)

Answer 11

a) 0.5% permethrin
b) insect
c) long pants, long sleeves, and long socks

Question 12

1) Perform tick checks at ___-hour intervals when training or operating in RMSF endemic areas.
2) Never let your personnel go > __hrs without a check

Answer 12

1) 12
2) 24

Question 13

RMSF – Disposition

Answer 13

(1) MedEvac patient to higher echelon of care.
(2) IDC should initiate treatment with doxycycline while patient is still on board.

Question 14

RMSF – Disposition
When caught & treated early, RMSF may never progress in severity, however, patient still requires MedEvac for what?

Answer 14

monitoring and laboratory studies

Question 15

What disease
Organism Type:
Spirochetes belonging to the Borrelia burgdorferi complex

Answer 15

Lyme Disease

Question 16

What tick borne illness
Prevalence:
Europe (central and eastern) Asia (western Russia, Mongolia, northeastern China, and into Japan). Northeastern and north-central United States.
Predisposing Factors:
Hiking, camping, high tick population, summer
& fall months, not performing tick checks, lack of PPE/covering.

Answer 16

Lyme Disease

Question 17

Lyme Disease
Incubation Period:

Answer 17

typically 3–30 days

Question 18

Lime disease
1. Reportable?
2. Lethal?

Answer 18

1. Yes
2. typically, no

Question 19

________ the causative bacteria in Lyme disease, is transmitted to a host (most often a mammal) via ticks when taking a blood meal.

Answer 19

B.burgdorferi

Question 20

The tick must be attached for _____ hours or more before b.burgdorferi can be transmitted to the host and cause lime disease.

Answer 20

36 to 48

Question 21

Vectors Lime disease:
(a) __________ spreads the disease in the northeastern, mid-Atlantic, and north-central United States.
(b) _________ spreads the disease on the Pacific Coast
(c) Most transmission & infection occurs in summer months
(May – August) when ticks & mammals are active

Answer 21

a) Blacklegged ticks (Ixodes scapularis)
b) Western Blacklegged tick

Question 22

Ticks attach to any part of the host but often prefer what parts?

Answer 22

the groin, axilla, & scalp

Question 23

What stage of Lime disease
(1) Flu-like symptoms—Malaise, headache, fever, myalgia, arthralgia,
Lymphadenopathy.
(2) Erythema migrans (EM)—Red ring-like or homogenous expanding
rash; Classic rash, not present in all cases.
-(a) EM appears about 1 week after the initial infection.
-(b) Begins as a slightly raised red lesion at the site of the tick bite
-(c) After several days the rash expands out from the central
lesion sometimes appearing as a “bulls-eye/target” lesion, but
more often as a muddled circular rash.

Answer 23

Early Localized Stage

Question 24

What stage of lime disease
(1) Constitutional:
-(a) Multiple secondary annular rashes
-(b) Flu-like symptoms
-(c) Lymphadenopathy
(2) Cardiac Manifestations
-(a) Conduction abnormalities, e.g., atrioventricular node block
-(b) Myocarditis, pericarditis
(3) Neurologic Manifestations
-(a) Bell’s palsy or other cranial neuropathy
-(b) Meningitis
-(c) Encephalitis

Answer 24

Acute/Early Disseminated Stage

Question 25

What stage of lime disease
(1) Same symptoms as Acute Disseminated Stage, with:
(2) Rheumatologic Manifestations
-(a) Transient, migratory arthritis and effusion in one or multiple
joints
-(b) Migratory pain in tendons, bursae, muscle, and bones

Answer 25

Late Disseminated Stage

Question 26

In the early localized stage lime disease, diagnosis can be made clinically without serologic testing based on what?

Answer 26

Characteristic EM rash in a person who has lived or recently been in an endemic Lyme disease area

Question 27

Treatment:
(a) Early Lyme (Erythema migrans)
-1) Doxycycline 100mg PO BID x __ days
(b) Early disseminated (Bell’s Palsy)
-1) Doxycycline 100mg PO BID x ____ days
(c) Late disseminated (Arthritis)
-1) Doxycycline 100mg PO BID x ___ days

Answer 27

a) 14
b) 14
c) 28

Question 28

Lyme disease Prevention
-Medication post-exposure prophylaxis

Answer 28

Doxycycline 200mg PO 1 dose
-If patient meets CDC guidelines

Question 29

In areas highly endemic for Lyme disease, a single prophylactic dose of ____________ may be used to reduce the risk of acquiring Lyme disease after the bite of a high-risk tick bite.

Answer 29

doxycycline (200 mg)

Question 30

Prophylaxis can be started within __h of tick removal

Answer 30

72h

Question 31

(1) Clinical suspicion of Lyme disease will necessitate Med Advice and treatment at the ____ level.
(2) Vast majority of patients treated with appropriate ______ in early stages of infection recover rapidly & completely without complications or sequalae.
(3) However, a small percentage of cases, lingering fatigue, myalgia, and arthritis can persist for months to years.
-(a) Known as “___________________” (PTLDS), although it is often called “chronic Lyme disease.

Answer 31

1) IDC
2) ABx
(a) Post-treatment Lyme Disease Syndrome