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Tick borne illnesses Flashcards

1
Q

List diseases carried by ticks

A 
RMSF
Lyme disease
tick paralysis
babesiosis
relapsing tick borne fever
colorado tic fever
tularemia
q fever
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2
Q

List 3 stages of lyme dz

A
  1. early localised
  2. early disseminated
  3. late disease
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3
Q

List Manifestations of acute disseminated Lyme disease.

A

-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

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4
Q

What is a differential for erythema migrans ?

A

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

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5
Q

List 5 criteria that must be met to provide post tick bite prophylaxis:

A
  1. Tick is Ixodes scapularis adult or nymph
  2. Tick has been attached for 36h or more (seen by degree of engorgement)
  3. Prophylaxis can be started within 72h of Tick removal
  4. Area where Lyme disease is endemic (>20% b. burgdoferi infection rate in ticks)
  5. Doxycycline is not contraindicated
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6
Q

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

A

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)

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7
Q

List treatments for cardiac early disseminated Lyme disease.

A
  • 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
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8
Q

How is the diagnosis of relapsing fever made?

A
  • Demonstration of Borelia on thin and thick smears during febrile periods
  • PCR testing
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9
Q

List a differential for relapsing fevers

A 
tick borne relapsing fever
malaria
dengue
yellow fever
colorado tick fever
typhus
tularemia
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10
Q

What is the treatment of relapsing tick borne fever

A

doxy

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11
Q

How is tulariemia transmitted?

A

Via tic

direct contact with infected soil, water, animals, aerosol inhalation

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12
Q

List clinical signs of tularemia

A 
ulceroglandular or glandular 
pulmonary (30% mortality)
GI (fevers, chills wt loss, diarrhea )
oropharyngeal-pharyngitis
oculoglandular: conjunctivitis + periauricular nodes
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13
Q

List clinical features of pulmonary Tularemia.

A
  • Pneumonitis
  • Lobar consolidation
  • Abscess formation
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14
Q

How is the diagnosis of Tularemia made?

A
  • Serology: antibody titers begin to rise 7-10 days, peak at 3-4 weeks
    Rapid testing PCR
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15
Q

List symptoms and signs of Rocky Mountain Spotted Fever.

A
  • 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
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16
Q

List cardiac manifestation of RMSF.

A
  • LV dysfunction, myocarditis
  • Cardiac enlargement of CXR
  • ECG: low voltages, nonspecific ST-T changes
  • 1st degree AV block
  • PAT
    Atrial fibrillation
17
Q

Provide a list of conditions that look like RMSF:

A
  • Meningococcemia
  • Measles
  • Mononucleosis
  • TSS
  • Enteroviral infections
    TTP/HUS
18
Q

Describe the rash of RMSF

A

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.

19
Q

List treatments for RMSF.

A
  • Antibiotics: dyxycycline (treat children and do not delay)

- Supportive care

20
Q

What cause Q fever.

List reservoirs of Q fever.

A
  • Coxella burnettii

- Cattle, Sheep, goats,Ticks

21
Q

List occupational risks for Q fever.

A

Inhalation of aerosolised particles or tick bite

  • Slaughter house workers
  • Farmers
  • Other animal workers
22
Q

What is the presentation of Q fever?

A
  • Severe retrobulbar headache
  • High fever >40C
  • Shaking chills
  • General malaise
  • Myalgias
  • Chest pain
  • Respratory involvement
  • Hepatic involvement
  • Acute renal failure
    Lymphocytic meningitis
23
Q

What are treatments for Q fever?

A
  • Doxycycline 200mg daily for 3 weeks

Chloramphenicol

24
Q

How is the diagnosis of Babesiosis made?

A

Thick and thin smears – Intraerythrocytic forms

25
Q

What is the treatment of severe babesiosis or for persons who have had splenectomies?

A
  • Quinine 650mg PO Q6H, and

Clindamycin 600mg IV q6h

26
Q

What is the clinical presentation of Colorado Tick Fever?

A

lu-like illness
o Fever chills, Headache, Myalgias, Lethargy, Anorexia, Nausea, Vomiting, Abdominal pain
o Maculopapular rash in upt o 12%, but not prominent feature like RMSF

27
Q

What is the natural history of Colorado tick fever?

A

Spontaneous recovery

28
Q

What is the clinical presentation of Tick paralysis?

A
  • Ascending paralysis
  • Absence of deep tendon reflexes
  • Ataxia
  • Bulbar involvement
  • Respiratory paralysis
  • Death
  • +/- fixed, dilated pupils, nystagmus (can distinguish from Guillan-Barre
29
Q

What is the treatment of tick paralysis?

A

Removal of tick

30
Q

Provide a list of conditions that can cause ascending flaccid paralysis:

A
  • GBS
  • Eaton-Lambert syndrome
  • Myasthenia gravis
  • Poliomyelitis
  • Botulism
    Diptheritic polyneuropathy

ID (11 decks)

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