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Infectious Disease > Tick-borne Illnesses Lecture > Flashcards

Tick-borne Illnesses Lecture Flashcards

1
Q

Borrelia burdorferi ss

A

Lyme disease

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2
Q

Babesia microti

A

Human babesiosis

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3
Q

Anaplasma phagocytophila

A

Human granulocytic anaplasmosis

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4
Q
  • Multisystem inflammatory disease
  • Causes by spirochetes: Borrelia burgdorferi – identified in 1981
  • Spread by Ixodes ticks
A

Lyme disease

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5
Q

Transmission: Bite of an infected nymph in the spring

Preferred host: White-tailed deer

A

Lyme disease

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6
Q

Egg
Six-legged larvae
Eight-legged nymph
Adult

A

Life cycle of hard ticks

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7
Q

Adults peak in spring and fall – preferred host is white-tailed deer. Mating occurs.
Nymphs peak May-July – aggressive - frequently bite humans
Larvae peak August-September (from eggs on the ground)

A

Life cycle of Ixodes scapularis

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8
Q

To transmit lyme dz bacterium, ticks must feed for at least…..

A

24 hours

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9
Q

_____ secrete an anesthesia and anticoagulant when biting

A

Ticks

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10
Q

Blacklegged (or deer) ticks (Ixodes scapularis can transmit several tick-borne diseases including:

A

anaplasmosis
babesiosis
Lyme disease

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11
Q

Which type of ticks most commonly bite humans, adult or nymphal?

A

Nymphal

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12
Q

Agent – Anaplasma phagocytophilum
Originally confused with Ehrlichiosis
Tick – Ixodes scapularis
Animal reservoir (deer and white footed mouse)

A

Human Anaplasmosis (aka Human Granulocytic Anaplasmosis)

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13
Q
  • Bacterial infection: Caused by the rickettsial agent Anaplasma phagocytophilum
  • Infects white blood cells: Granulocytes
  • Unknown transmission time from tick: Suspected to be between 24 and 48 hours
A

Human Anaplasmosis

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14
Q

Bacterial diseases
Ehrlichia chaffeensis
Ehrlichia ewingii
Anaplasma phagocytophilum

A

Ehrlichiosis

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15
Q 
Cause is unknown
Rash appearance similar to Lyme disease
Has not been linked to arthritic, neurologic, or chronic symptoms
Transmitted by lone star tick
Most cases found in southeastern US
A

Southern Tick Associated Rash Illness (STARI)

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16
Q

Incubation period – 1 to 2 weeks
Fever, chills, severe headache – common
Malaise, Myalgia, Arthralgia – also common
Cough, GI upset, stiff neck – less common

“summer-flu”

A

Anaplasmosis

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17
Q

Mild anemia
Thrombocytopenia
Leukopenia with a left shift
Mild elevation of LFT’s

A

Anaplasmosis

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18
Q

Anaplasmosis diagnosis is made via…

A

PCR assay for DNA

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19
Q

Four-fold rise in IgG antibody by IFA
Immunochemistry staining of organism
Isolation in cell culture

A

Diagnosis of Anaplasmosis

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20
Q

Anaplasmosis tx for adults…

A

Doxycycline

if Doxy resistant, consider Rifampin

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21
Q

Anaplasmosis tx for kids..

A

start with Doxy, may follow up with Beta-lactam

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22
Q

Parasitic infection:

Caused by protozoa of the Babesia genus (Babesia microti and others)

A

Babesiosis

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23
Q

Infects RBCs

Unknown transmission time from tick

A

Babesiosis

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24
Q 
Tick-borne illness
Protozoa of family Babesiidae
Animals: rodents and small mammals
**enters RBCs and causes hemolysis 
Vector= Ixodid tick
A

Babesiosis

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25
Q

Incubation period.. 1-3 weeks following tick bite. 6-9 weeks following blood transfusion

A

Babesiosis

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26
Q

Fever, chills, sweats
Myalgias, arthralgia, fever
N/V

Exam shows: splenomegaly, hepatomegaly, jaundice

A

Babesiosis

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27
Q

High-level parasitemia (> 10 percent)
Significant hemolysis ( plus DIC)
Renal, hepatic, pulmonary compromise

Risk factors:
Age over 50 years
Asplenia,Malignancy,HIV,Immunosuppressives

A

Severe Babesiosis

28
Q

Asymptomatic Disease—Common
1 May not need treatment
2 Can be monitored – clear 4-6 weeks
3 If no underlying disease- watch

A

Babesiosis

29
Q

Laboratory: Anemia-thrombocytopenia-increased conjugated bilirubin

Confirmation: Blood smear- Intra-erythrocytic parasites

PCR **

Serology: Indirect immunofluorescent antibody test

A

Dx of Babesiosis

30
Q

Clindamycin/Quinine or Atovaquone/Azithromycin

A

First line tx for Babesiosis

31
Q

For severe Babesiosis, tx includes antibiotics plus…

A

exchange transfusion (until parasitemia is under 5%)

32
Q 
Erythema migrans (Bull’s eye) rash
Muscle and joint pain
Fatigue
Chills, fever, and headache
Swollen lymph nodes
A

Early Lyme dz symptoms

33
Q

Symptoms: Arthralgias (oligoarticular and migratory)
Headache (often occipital)
Paresthesias (face/arm/leg)
No GI or respiratory symptoms

A

Lyme dz

34
Q

Early localized: Erythema migrants rash (80-90%) and associated symptoms

A

Lyme disease

35
Q

Early disseminated: Multiple EM rashes, associated symptoms (weeks to months)
-Lyme carditis (fluctuating AV Block)
- Neurologic SX: Cranial neuritis (7th nerve palsy—can be bilateral)
Lymphocytic meningitis
Radiculoneuritis

A

Lyme disease

36
Q

Lyme dz dissemination is greater than _____

A

6 months

37
Q
  • Arthritis (migratory polyarthritis or monoarthritis)

- Neurologic (peripheral axonal neuropathy, mild encephalopathy, encephalomyelitis)

A

Lyme disease dissemination (greater than 6 mo)

38
Q

What is used to confirm the diagnosis of lyme disease?

A

Serologic tests

39
Q

Two-test step – Elisa followed by Western Blot:
If ELISA positive-test Western blot

If ELISA negative-no Western blot
Same sample tested by each test

A

Used in dx of lyme disease

40
Q

Antibiotics in early disease may prevent seroconversion

A

Lyme dz

41
Q

If less than 4 weeks illness - IgM and IgG tested
If more than 4 weeks illness - IgG tested

(can also test synovial fluid or CSF)

A

Lyme disease

42
Q

Treat lyme dz with..

A

Doxycycline

43
Q

Caused by the bacteria Rickettsia ricketsiae
Carried by Dermacenter (hard or dog) ticks
Untreated, the mortality is very high

A

Rocky mountain spotted fever

44
Q

Rickettsia ricketsiae

A

Rocky mountain spotted fever

45
Q

The disease is usually characterized by a fine skin rash, high fever, headaches and muscle pain
Doxycycline and chloramphenicol are very effective in treating the disease
Is less common on Nantucket than previously, probably because the dog ticks are less common

A

Rocky mountain spotted fever

46
Q

Over 90% of cases occur during April-September

Peridomestic acquisition may account for majority of cases

Age-specific incidence highest in children, disease more frequent in males

Case clusters occur in hyperendemic foci

A

Rocky mountain spotted fever

47
Q

Early: high fever, severe headache, myalgia, and gastrointestinal symptoms
Late: rash, photophobia, confusion, ataxia, seizures, cough, dyspnea, arrhythmias, jaundice, severe abdominal pain
Thrombocytopenia, hyponatremia
Long term sequelae: CNS deficits, amputations

A

Rocky mountain spotted fever

48
Q

Rash not apparent until 2-5 days after onset of fever
Begins as 1 to 5 mm macules, typically on ankles, wrists, and forearms, spreads centripetally to trunk
Petechial rash occurs on or after day 6
Rash may be asymmetric, localized, or absent

A

rocky mountain spotted fever

49
Q

85% of patients lack diagnostic titers in the first week of illness
As many as 50% of patients lack a diagnostic titer 7-9 days after onset of illness
Need to test acute and convalescent samples (2-4 weeks apart)
Indirect immunofluorescence assay (IFA)- four fold rise in titers confirmatory

A

RMSF

50
Q

Rocky mountain spotted fever DOC

A

Tetracyclines

51
Q

Less common tickborne dz
Bacterial: Francisella tularensis
Transmitted by American dog tick, lone star tick, and Rocky Mountain wood tick
Other transmission routes include deer fly bites, inhalation, ingestion, skin contact with infected animals
Cases found in every state except Hawaii

A

Tularemia

52
Q

Francisella tularensis

Gram negative non-motile non-sporulating cocco-bacillus

A

Tularemia

53
Q

-Infects small mammals:
ground squirrels, rabbits, hares, voles, muskrats, water rats and other rodents
-Arthropod vectors: ticks, biting flies, mosquitoes
Uncommon zoonosis
125 cases/year in USA
farmers, hunters, walkers, forest workers
**kills less than 50 people a year worldwide

A

Tularemia

54
Q

**Highly infectious: inhalation of 10 bacteria can cause disease
-Avenues:
ingestion (water and food)
inhalation
direct contact
arthropod intermediates
animal bites

No person to person spread

A

Tularemia

55
Q

Ulceroglandular (

A

Tularemia

56
Q

Dx made thru…
-Culture (high risk to lab!)

  • Non culture (ELISA, micro agglutination, Western blot, flow cytometry, indirect immunofluorescence)
  • also PCR!
A

Tularemia

57
Q

Streptomycin
Gentamicin

Recommended for….

A

Tularemia

58
Q

A group of acute infections caused by arthropod born spirochetes of the genus Borrelia.

*Characterized by recurrent cycles of febrile episodes, separated by asymptomatic intervals of apparent recovery.

A

Relapsing fevers

59
Q

Louse-Borne Relapsing Fever (Borrelia recurrentis)

Trench Fever (Bartonella quintana)

Epidemic typhus (Rickettsia prowazekii)

A

Body lice diseases

60
Q

Which types of lice spread dz (head, body, pubic)?

A

only body! (can spread bacterial disease)

61
Q

A single organism, Borrelia recurrentis, is the cause of louse borne….

A

relapsing fever

62
Q

In ____ Borreli duttoni, and Borrelia croicuidare are the predominant species.

A

Africa

63
Q

______ are slender actively motile spirochetes.

and measure10-20µ long and 0.2-0.5µ wide, with 4-10 loose coils.

A

Borrelia

64
Q

Portal of entry, infected lice crushed into abraded skin.
Incubation period, 5-10 days.
High level spirochetemia.
Patients’ producing neutralizing antibodies, clearing of the circulating strain Borrelia in 3-5 days

A

Relapsing fever

65
Q

Aims of Management:
Clinical cure
Prevention of relapse
Prevention/treatment of complications

Antibiotic treatment:
 Penicillin
Tetracycline
Chloramphenicol
Erythromycin
A

Borrelia relapsing fever

Infectious Disease (9 decks)

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