Tick Borne Illness Flashcards

1
Q

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.

A

Rocky Mountain Spotted Fever (RMSF)

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2
Q

Rocky Mountain Spotted Fever (RMSF)
Predisposing Factors:

A

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

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3
Q

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).

A

Rocky Mountain Spotted Fever (RMSF)

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4
Q

Rocky Mountain Spotted Fever (RMSF)
Incubation Period:

A

Typically 2–14 days

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5
Q

RMSF Lethality

A

typically, no.
if Untreated, YES!!

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6
Q

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

A

doxycycline

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7
Q

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.

A

RMSF

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

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8
Q

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.

A

5 days

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9
Q

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

A

True

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10
Q

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?

A

RMSF

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11
Q

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)

A

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

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12
Q

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

A

1) 12
2) 24

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13
Q

RMSF – Disposition

A

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

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14
Q

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

A

monitoring and laboratory studies

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15
Q

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

A

Lyme Disease

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16
Q

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.

A

Lyme Disease

17
Q

Lyme Disease
Incubation Period:

A

typically 3–30 days

18
Q

Lime disease
1. Reportable?
2. Lethal?

A
  1. Yes
  2. typically, no
19
Q

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

A

B.burgdorferi

20
Q

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

A

36 to 48

21
Q

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

A

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

22
Q

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

A

the groin, axilla, & scalp

23
Q

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.

A

Early Localized Stage

24
Q

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

A

Acute/Early Disseminated Stage

25
Q

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

A

Late Disseminated Stage

26
Q

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

A

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

27
Q

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

A

a) 14
b) 14
c) 28

28
Q

Lyme disease Prevention
-Medication post-exposure prophylaxis

A

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

29
Q

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.

A

doxycycline (200 mg)

30
Q

Prophylaxis can be started within __h of tick removal

A

72h

31
Q

(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.

A

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

32
Q

Rocky Mountain Spotted Fever (RMSF)
Organism Type:

A

Gram-negative, intracellular, coccobacillus bacterium