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ICM - Infectious Disease > Tick Bourne Diseases and Malaria > Flashcards

Tick Bourne Diseases and Malaria Flashcards

1
Q

Ixodes tick. Disease and organism.

A

Borrelia burgdorferi

Lyme Disease

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2
Q

American dog tick. Disease and organism.

A

Rickettsia rickettsii

Rocky Mountain Spotted

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3
Q

Lone Star Tick. Disease and organism.

A

Ehrlichia chaffeensis

Human monocytotropic ehrlichiosis

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4
Q

Sole vector of borrelia burg. in the eastern US?

A

Blacklegged tick/Deer tick

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5
Q

Stage 1/3 of Lyme disease

A

Localized Rash (Erythema migrans)

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6
Q

Stage 2/3 of Lyme disease

A 
Disseminated
Multiple annular skin lesions
Meningitis
Cranial Neuritis
Carditis
Arthralgia
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7
Q

Stage 3/3 of Lyme disease

A 
Persistent...
Oligoarticular arthritis
Encephalopathy
Axonal Polyneuritis
Acrodermatitis
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8
Q

What is acrodermatitis

A

Skin changes of hands and feet

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9
Q

Rickettsia riskkettsii causes ______ by its trophism for _______

A

Rocky Mountain Spotted Fever

Vascular Endothelial Cells

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10
Q

Incubation period for Rocky Mountain Spotted Fever?

A

1 week

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11
Q

How does Rocky Mountain Spotted Fever vasculitis (the basic pathology) happen?

A 
Increased vascular permeability
Edema, hypovolemia
*Hyponatremia
*Thrombocytopenia
Rare DIC
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12
Q

Classic presentation of Rocky Mountain Spotted Fever

A

Fever+Rash+History of Tick Exposure
Headache
Malaise
Myalgia

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13
Q

Describe the rash in Rocky Mountain Spotted Fever

A

Fait macules –> petichiae –> purpura
Involvement of palms and soles
Non-blanching

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14
Q

Progression of Rocky Mountain Spotted Fever

A

Tick, Fever, Rash

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15
Q

SYmptoms of Rocky Mountain Spotted Fever?

A 
Hypovolemia, hypotension
Respiratory failure
Cardia arrythmia
CNS (confusion, lethargy, enceph)
Acute Tubular Necrosis
Shock
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16
Q

What are you looking for in Rocky Mountain Spotted Fever Lab Testing?

A

Thrombocytopenia (low platelets)
Hyponatremia (low sodium)
Azotemia (high BUN)

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17
Q

Important non CBC tests to run for Rocky Mountain Spotted Fever

A 
Skin Biopsy
Serologic testing (of IgM and G)
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18
Q

Three factors that tend to cause physicians to fail to treat Rocky Mountain Spotted Fever

A

Absence of a skin rash
Presentation within the first 3 days
Presentation between Aug 1 and April 30 (not commonly tick season)

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19
Q

Drug of choice for Rocky Mountain Spotted Fever treatment? If you’re pregnant?

A

Normal –> Doxycycline

Preggers –> Chloramphenicol

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20
Q

Way to identify a Lone Star Tick (Ehrlichiosis)

A

White spot on the back

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21
Q

Incubation period for Ehrlichiosis?

A

usually about 8 days

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22
Q

Symptoms of Ehrlichiosis

A

Fever
Headache
Myalgias

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23
Q

Lab findings in an Ehrlichiosis patient

A

Leukopenia
Thrombocytopenia
Elevated transaminases

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24
Q

Treatment for Ehrlichiosis?

A

Doxycycline

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25
Q

Vector for Malaria?

A

Anopheles freeborni mosquito

26
Q

Causative agent of Malaria

A

Plasmodium species

27
Q

Most severe disease for Malaria?

A

falciparum

28
Q

Differential diagnosis for CN7 Palsy

A

Idiopathic (Bell’s Palsy)
HSV (Herpes Simplex Virus) – No rash
Herpes Zoster - Ramsay Hunt Syndrome (vesicles in the external auditory
Lyme Disease

29
Q

Symptoms of Chronic Lyme Disease

A

Pain syndrome (arthralgias)
Chronic Fatigue
Neurocognitive Symptoms

30
Q

Treatment for Lyme Disease

A

Doxycycline

31
Q

Diagnosis of Lyme Disease

A

Serologic Testing - IgM and IgG
ELISA with Western Blot verification
PCR of joint fluid

32
Q

Tick prevention methods

A 
Examine self after exposure
Insecticides with DEET
Tuck pants in socks
Pre-treat clothes with permethrin insectisides
Insect Shield
33
Q

Differential diagnosis for fever, petechial rash on pales and soles, potential tick exposure

A 
Meningococcal Disease
Tick Bourne Disease -- RMSF
Enteroviral disease
secondary syph
Rubella
Drug eruption
Kawasaki
Coxsackie virus
34
Q

Empiric therapy for meningococcal disease and RMSF

A

Ceftriaxone and Doxycycline

35
Q

Lyme Disease Symptoms may be indistinguishable from

A

Chronic Fatigue Syndrome, Fibromyalgia

36
Q

Difference between original presenting symptoms listed for Rocky Mountain and Ehrlichia?

A

Nausea with Rocky Mountain

37
Q

Difference between CBC findings in Rocky Mountain and Ehrlichia?

A

RMSF – hyponatremia,

Ehr – Leukopenia

38
Q

Similarities in CBC findings for RMSF and Ehrl.

A

Thrombocytopenia

Elevated Transaminase Levels

39
Q

Incubation periods for RMSF and Ehrl.

A

RMSF – 2-14 days

Ehrl. – 5-14 days

40
Q

What part of the tick do you check to identify when it is engorged?

41
Q

You should probably go back to the powerpoint and peek at the photos of the ticks again.

A

Seems like a reasonable thing to do?

42
Q

The less commonly killing forms of malaria

A

P. vivax
P. ovale
P. mararae
P. knowlesi

43
Q

Talk through the Malaria life cycle

Bryan – actually make yourself do this

A
  1. Plasmodium sporozoites have trophism for hepatocytes
  2. Asexual reproduction in hepatocytes
  3. Release into bloodstream
  4. Hijacking of RBC, Degradation of hemoglobin, Formation of Ring forms
  5. Lyse RBC, release merozytes infect more RBC, or gametocytes to reinfect mosquitos (hemolytic anemia –> direct hyperbilirubinemia = Jaundice)
44
Q

Additions to the life cycle for P vivax and P ovale

A

Can produce dormant hypnozoites in hepatocytes

Can reactivate in 3-12 months

45
Q

Clinica features of malaria patient

A

FEVER
Exposure to an endemic area
Lack of prophylactic treatment
Headache, Fatigue, Myalgias, Abdominal Pain

46
Q

Seizures suggest which form of malaria?

A

P. falciparum infection

47
Q

Paroxysmal chills, Fever, Rigors suggest what form of malaria?

A

P vivax or ovale

Caused by hepatic sequestration and re-release

48
Q

Physical findings in a malaria patient

A 
Fever
Hepatomegaly
Icterus (Jaundice)
Palpable SPleen
Rarely a rash, if so think of other diagnoses
49
Q

What can happen with P falciparum in the vasculature

A

Sequestration and Agglutination

50
Q

Severe abnormalities associated with P falciparum patients

A

Cerebral malaria (seizures, encephalopathy, coma)
Hypoglycemia (poor prognostic sign, loss of hepatic gluconeogenesis)
Metabolic Acidosis (Lactic acidemia from hypoperfusion)
Noncardiogenic Pulmonary edema (ARDS)
Renal Impairment (ATN)
Hematologic Abnormalities (anemia)
Liver Dysfunction (Cholestasis, Hepatitis)

51
Q

Diagnostic testing for malaria

A

Light microscopy of Giemsa-stained blood smear
Thick and Thin Blood Smears
Rapid diagnostic tests w/ antigen detection

52
Q

Reason you need Thick AND Thin blood smears

A

Thick – Concentrated Parasites, Increased Sensitivity

Thin – Pathologists can eval for ring forms and estimate parasite load

53
Q

CBC findings in Malaria

A

Normocytic, normochromic anemia

Increased Acute phase reactants (ESR, CRP)

54
Q

Treatment for Non-Falciparum Malaria

A

Chloroquine (if sensitive in that region)

55
Q

Treatment for Falciparum Malaria

A

If def chloroquine sensitive, chloroquine

If unsure, Arteminsin-based combinations

56
Q

Malaria prevention methods

A

Mosquito tents
Insect repellants
Preventative treatment in travelers

57
Q

Which malaria drugs do you not give pregnant women?

A

Atovaquone-proguanil
Doxy hydrate
Primaquine

58
Q

Which malaria drug has CNS side effects

A

Mefloquine

59
Q

Three commonly used malaria drugs mentioned

A

Malarone
Doxycycline
Chloroquine

60
Q

Important Malarone details?

A

Easy to tolerate, short lead up/follow up

Generic and Inexpensive

61
Q

Important Doxy details?

A 
Was inexpensive (apparently less so now)
Have to take for 4 weeks after you're back
62
Q

Important chloroquine details?

A

Generic, Inexpensive, Easy to tolerate

ICM - Infectious Disease (11 decks)

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