Tick Borne Illness Flashcards
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.
Rocky Mountain Spotted Fever (RMSF)
Rocky Mountain Spotted Fever (RMSF)
Predisposing Factors:
Hiking, camping, high tick population, spring, summer & fall months, not performing tick checks, lack of PPE/covering.
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).
Rocky Mountain Spotted Fever (RMSF)
Rocky Mountain Spotted Fever (RMSF)
Incubation Period:
Typically 2–14 days
RMSF Lethality
typically, no.
if Untreated, YES!!
RMSF is a rapidly progressive disease and without early administration of _______ can be fatal within days.
doxycycline
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.
RMSF
Doxycycline = Treatment of choice for all tickborne rickettsial
diseases. Doxycycline 100 mg PO BID for 5 – 7 days.
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.
5 days
True/False
RMSF – Treatment
Use of antibiotics other than doxycycline associated with higher risk of death.
True
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?
RMSF
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) 0.5% permethrin
b) insect
c) long pants, long sleeves, and long socks
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
1) 12
2) 24
RMSF – Disposition
(1) MedEvac patient to higher echelon of care.
(2) IDC should initiate treatment with doxycycline while patient is still on board.
RMSF – Disposition
When caught & treated early, RMSF may never progress in severity, however, patient still requires MedEvac for what?
monitoring and laboratory studies
What disease
Organism Type:
Spirochetes belonging to the Borrelia burgdorferi complex
Lyme Disease
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.
Lyme Disease
Lyme Disease
Incubation Period:
typically 3–30 days
Lime disease
1. Reportable?
2. Lethal?
- Yes
- typically, no
________ the causative bacteria in Lyme disease, is transmitted to a host (most often a mammal) via ticks when taking a blood meal.
B.burgdorferi
The tick must be attached for _____ hours or more before b.burgdorferi can be transmitted to the host and cause lime disease.
36 to 48
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) Blacklegged ticks (Ixodes scapularis)
b) Western Blacklegged tick
Ticks attach to any part of the host but often prefer what parts?
the groin, axilla, & scalp
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.
Early Localized Stage
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
Acute/Early Disseminated Stage
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
Late Disseminated Stage
In the early localized stage lime disease, diagnosis can be made clinically without serologic testing based on what?
Characteristic EM rash in a person who has lived or recently been in an endemic Lyme disease area
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) 14
b) 14
c) 28
Lyme disease Prevention
-Medication post-exposure prophylaxis
Doxycycline 200mg PO 1 dose
-If patient meets CDC guidelines
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.
doxycycline (200 mg)
Prophylaxis can be started within __h of tick removal
72h
(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.
1) IDC
2) ABx
(a) Post-treatment Lyme Disease Syndrome
Rocky Mountain Spotted Fever (RMSF)
Organism Type:
Gram-negative, intracellular, coccobacillus bacterium
