Tick borne illnesses Flashcards
List diseases carried by ticks
RMSF Lyme disease tick paralysis babesiosis relapsing tick borne fever colorado tic fever tularemia q fever
List 3 stages of lyme dz
- early localised
- early disseminated
- late disease
List Manifestations of acute disseminated Lyme disease.
-Neurologic (15% of untreated patients)
- Fluctuating menigoencephalitis
- Cranial neuropathy
o *7th CN (bilateral Bell’s palsies)
- Peripheral neuropathy
o Thoracic sensory radiculitis
o Brachial plexitis
o Mononeuritis
o Motor radiculitis
o Asymmetric sensorimotor distal > proximal (mononeuropathy multiplex)
- Radiculopathy (early)
- Headache
- Mild menigoencephalitis (lethargy, irritability, sleep disturbance, poor concentration, memory loss)
- Rare: chorea, tranverse myelitis, pseudotumour cerebri
Cardiac (4-10%)
- Myopericarditis
- AV blocks
- Tachyarrythmias
- Ventricular impairment
Arthritis
- Monoarticular
- Oligoartuicular
Opthalmic
- Conjunctivitis
- Keratitis
- Chorioditis
- Retinal detachment
- Optic neuritis
- Blindness
What is a differential for erythema migrans ?
o Erythema multiforme target lesions :this will involve palms and soles, and mucous membranes
o Erythema nodosum: more painful, predilection for extensor surfaces
o Erythema marginatum of acute rheumatic fever: occurs with arthritis and carditis
o Serum sickenss if atypical urticarial like erythema migrans
o Others:
Cellulitis, insect bites
List 5 criteria that must be met to provide post tick bite prophylaxis:
- Tick is Ixodes scapularis adult or nymph
- Tick has been attached for 36h or more (seen by degree of engorgement)
- Prophylaxis can be started within 72h of Tick removal
- Area where Lyme disease is endemic (>20% b. burgdoferi infection rate in ticks)
- Doxycycline is not contraindicated
What are the prophylactic agents for Lyme?
What is the treatment for Lyme
What is the treatment of early Lyme disease in pregnant/llactating women and children
Doxycyline 200mg PO x one dose (4mg/kg in kids >8yo)
- Doxyxycline 100mg PO BID x 3 weeks
Pregnant: - Amoxicillin 500mg PO TID (20 – 40mg/kg divided TID)
List treatments for cardiac early disseminated Lyme disease.
- Mild conduction disturbances (1st degree AV block, PR LT 0.3 seconds)
o Doxycycline or amoxicillin for 30 days - Higher degree AV block (PR GT 0.3) or ventricular impairment
Hospitalization for cardiac monitoring and IV Pen G or Ceftriaxone
How is the diagnosis of relapsing fever made?
- Demonstration of Borelia on thin and thick smears during febrile periods
- PCR testing
List a differential for relapsing fevers
tick borne relapsing fever malaria dengue yellow fever colorado tick fever typhus tularemia
What is the treatment of relapsing tick borne fever
doxy
How is tulariemia transmitted?
Via tic
direct contact with infected soil, water, animals, aerosol inhalation
List clinical signs of tularemia
ulceroglandular or glandular pulmonary (30% mortality) GI (fevers, chills wt loss, diarrhea ) oropharyngeal-pharyngitis oculoglandular: conjunctivitis + periauricular nodes
List clinical features of pulmonary Tularemia.
- Pneumonitis
- Lobar consolidation
- Abscess formation
How is the diagnosis of Tularemia made?
- Serology: antibody titers begin to rise 7-10 days, peak at 3-4 weeks
Rapid testing PCR
List symptoms and signs of Rocky Mountain Spotted Fever.
- Constitutional – fever, malaise
- Neurologic – headaches, ataxia, meningismus, cerebral vasculitis
- Cardiac: LV dysfunction, arrhythmias
- Pulmonary: pneumonitis
- MSK: severe myalgias
- Derm: any kind of rash but classic rash (starts as 1-5mm macules can progress to purpuric rash)
- Heme: DIC in fulminant cases
List cardiac manifestation of RMSF.
- LV dysfunction, myocarditis
- Cardiac enlargement of CXR
- ECG: low voltages, nonspecific ST-T changes
- 1st degree AV block
- PAT
Atrial fibrillation
Provide a list of conditions that look like RMSF:
- Meningococcemia
- Measles
- Mononucleosis
- TSS
- Enteroviral infections
TTP/HUS
Describe the rash of RMSF
Maculopapular Rash
Typically appears 2–5 days after the onset of fever
Small, flat, pink, non-itchy spots (macules) initially appear on the wrists, forearms, and ankles then spread to the trunk and sometimes palms and soles.
Rash may not develop until late in the disease process, after treatment should have already begun. Approximately 10% of RMSF patients never develop a rash at all.
Consider RMSF if other signs and symptoms support a diagnosis, even if a rash is not present.
Petechial Rash
Red to purple spots (petechiae) are usually not seen until day 6 or later after onset of symptoms.
Petechial rash is considered a sign of progression to severe disease. Every attempt should be made to begin treatment before petechiae develop.
List treatments for RMSF.
- Antibiotics: dyxycycline (treat children and do not delay)
- Supportive care
What cause Q fever.
List reservoirs of Q fever.
- Coxella burnettii
- Cattle, Sheep, goats,Ticks
List occupational risks for Q fever.
Inhalation of aerosolised particles or tick bite
- Slaughter house workers
- Farmers
- Other animal workers
What is the presentation of Q fever?
- Severe retrobulbar headache
- High fever >40C
- Shaking chills
- General malaise
- Myalgias
- Chest pain
- Respratory involvement
- Hepatic involvement
- Acute renal failure
Lymphocytic meningitis
What are treatments for Q fever?
- Doxycycline 200mg daily for 3 weeks
Chloramphenicol
How is the diagnosis of Babesiosis made?
Thick and thin smears – Intraerythrocytic forms
