Tick Borne Illness Flashcards
Who should receive antibiotic prophylaxis for Lyme Disease
Prophylaxis with Doxycycline is indicated:
If it is identified as adult/nymphal deer tick, Has been attached for > 36 hours and Prophylaxis is started within 72 hours of removal
Tick bite shouldve been in an endemic area and patient should not be pregnant or less than 8 years of age
What is the presentation of Acute Localized Lyme Disease
How is it diagnosed and what is the treatment
Acute localized Lyme will present within 30 days of exposure with: Erythema Migrans, fever, fatigue, headache, arthralgia and myalgia
Begin Doxycycline for 10-21 days, amoxicillin or cefuroxime for 14-21 days WITHOUT serologic confirmation of Borrelia Burgdorferi
What is the presentation of Acute Disseminated Lyme Disease
How is it diagnosed and what is the treatment
Presents weeks to months after exposure, Multiple Erythema Migrans, Heart Conduction Block, Cranial Neuropathy, Radiculoneuropathy, Lymphocytic Meningitis, Acute attacks of monoarticular or oligoarticular arthritis
Treat if ELISA is positive, Obtain Western Blot if ELISA is indeterminate
Manage late carditis or neurologic disease with IV PCN or IV Ceftriaxone for 28 days
Manage Arthritis and Facial Nerve Palsy with Doxycycline
Do not treat post lyme disease syndrome ( fatigue/ arthralgia/myalgia/ memory disturbance with abx)
Do not rely on serologic test results to decide on the adequacy of treatment
What is the presentation of Late Lyme Disease
How do you diagnose
What is the treatment
Months to years after exposure: attacks of monoarticular or oligoarticular arthritis and or chronic monoarthritis or oligoarthritis
Peripheral Neuropathy or
Encephalomyelitis
Treat if ELISA is positive, Obtain Western Blot if ELISA is indeterminate
Manage late carditis or neurologic disease with IV PCN or IV Ceftriaxone for 28 days
Manage Arthritis and Facial Nerve Palsy with Doxycycline
Do not treat post lyme disease syndrome ( fatigue/ arthralgia/myalgia/ memory disturbance with abx)
Do not rely on serologic test results to decide on the adequacy of treatment
How is Babesiosis transmitted
this is a tick borne illness ( black legged deer tick..ixodes tick)
same as Lyme
What is the illness script if Babesiosis
How do mild cases and severe cases differ?
Who is severe illness more likely in
Malaria like ill ness ( High fevers) endemic to North East Coast of US
Mild Cases : fevers, myalgia, headache, fatigue
Severe cases: Severe Hemolytic Anemia, Jaundice, Kidney Failure and Death
Severe cases are more common in elderly patients, immunocompromised, functional or anatomic asplenia
How do you diagnose Babesiosis
hint- tetrad
A Wright or Giemsa stained peripheral blood smear will show INTRA erythrocytic parasites in the ring or more rarely Tetrad formation in the shape of a maltese cross
Consider PCR for Babesia DNA in cases of low parasitemia
Dont be tricked! Babesia trophozoites appear as ring forms inside erythrocytes and may be confused with malaria unless a thorough travel history is obtained
How is asymptomatic Babesiosis treated
When Babesia infection is detected in a asymptomatic patient, monitoring for resolution of parasitemia without treatment is recommended for 3 months.
if they have persistent parasitemia, give atovaquone plus azithromycin
How is mild to moderate Babesia treated?
How is severe Babesia treated?
Mild to mod - Azithro plus atovaquone
Severe- Clindamycin plus a quinine
How is Ehrlichia chaffeenis ( Human Monocytic Ehrichiosis) transmitted, where is it endemic and which other tick borne illness is the presentation very similar to?
The lone start tick which is most prevalent in south central and southeastern US.
Very similar to Anaplasmosis ( Human Granulocytic Anaplasmosis)
How is Anaplasma Phagocytophilum ( Human Granulocytic Anaplasmosis) transmitted, where is it endemic and which other tick borne illness is the presentation very similar to?
Transmitted by ixodes tick ( same as Lyme)
Very similar to Ehrlichia
How do both Ehrlichiosis and Anaplasmosis present?
Fever/ headache/ myalgia
Multiorgan Failure ( AKI/ ARDS/ Meningioencephalitis)
Fever of Unknown Origin ( can persist for months)
Elevated LFTs with normal alk phos and bili
LEUKOPENIA and THROMBOCYTOPENIA
Presence of MORULAE ( clumps of organisms in the cytoplasm of the appropriate leukocyte)
Dont be tricked! HGA is transmitted by same vector as Lyme and Babesiosis so double or triple infection is possible.
What is the treatment for Ehrlichiosis and Anaplasmosis
IV or oral doxycycline
How is Rocky Mountain Spotted Fever transmitted and where is it the most common
Tick borne illness which is endemic to South Eastern and South Central States
How does Rocky Mountain Fever present
Febrile illness in the spring/ summer months plus non specific sx like Nausea/ Myalgia/ Dyspnea/ Cough and headache. Also look for a macular rash starting on the ankles and and wrists ( Affecting palms and soles) spreads centripetally and becomes petechial
