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Elaina: Infectious Disease > ticks and bugs and stuffs > Flashcards

ticks and bugs and stuffs Flashcards

1
Q

pathogen, vector, and host of lyme disease?

A

pathogen: borrelia burgdorferi (gram negative spirochete)
vector: ixodes scapularis (blacklegged deer ticks)
host: white tailed deer

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2
Q

during which life cycle phase do ticks typically bite and infect humans with lyme?

A

nymphal stage!

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3
Q

how long must a ticks bloodmeal be in order to infect a human? what must occur?

A

24-48 hours to get the bacterium from the gut to the mouth, there must be OSPa to OSPc conversion because A is not infectious but C is!

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4
Q

what does a tick secrete when it bites us?

A

an anesthetic and anticoagulant

hinders pain and clotting so we can’t detect it when it happens!

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5
Q

what is the first stage of a lyme disease infection?

A

erythema migrans (80 percent); bullseye rash that shows up 7-10 days post bite and is sometimes associated with viral-like syndrome (headaches, fever, malaise)

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6
Q

what is the second stage of a lyme infection?

A

early disseminated (1-2 weeks)

  • arthralgias
  • multiple erythema migrans
  • CN 7 palsy, radiculoneuritis, neuropathy
  • AV BLOCK!
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7
Q

what does late disease (over 6 months) of lymes disease consist of?

A

persistent arthritis (usually knee), neurological issues (peripheral axonal neuropathy, mild encephalopathy, encephalomyelitis)

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8
Q

how do we diagnose lyme disease?

A

often clinically
ELISA followed by western blot if ELISA positive

PCR can be done in research labs

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9
Q

treatment of lyme disease?

A

doxycycline in adults; amoxicillin DOC in children 9 years and younger

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10
Q

when would we consider treating lyme with IV ceftriaxone?

A

complete heart block, CNS diseases

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11
Q

what is post-lyme syndrome?

A

prior LD with stabilization post RX; persistence of fatigue, MSK pain, cognitive complaints past 6 months

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12
Q

what are the four conditions in which prophylaxis with doxycycline is indicated for lyme?

A

1) tick has been identified as engorged deer tick attached over 36 hours
2) exposure occurred in an area where there is a high rate of infected ticks
3) prophylaxis can be started within 72 hours
4) doxy treatment is not contraindicated

**even if prophylaxis used, monitor symptoms for 30 days

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13
Q

do we continue to treat people with post-lyme syndrome with ABX?

A

NO!

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14
Q

pathogen and vector for rocky mountain spotted fever?

A

pathogen: rickettsia rickettsi (spirochete bacteria)
vector: dermacentor (hard or dog) ticks

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15
Q

which of our tick disease is potentially fatal but easily curable? how do we treat it?

A

rocky mountain spotted fever, treat with doxycycline (even in children)

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16
Q

what type of acquisition accounts for the majority of rocky mountain spotted fever cases?

A

peridomestic acquisition

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17
Q

who is most likely to acquire RMSF?

A

MALE CHILDREN

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18
Q

early symptoms vs. late symptoms of RMSF?

A

early: high fever, headache, myalgia, GI symptoms
late: RASH, photophobia, confusion, ataxia, seizures, JAUNDICE, thrombocytopenia, hyponatremia

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19
Q

how does the rash of RMSF present?

A

red maculopapular rash FIRST on wrists/ankles/forearms that spreads centrally to the trunk

petechiae after day 6

face usually spared!

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20
Q

long term sequelae of RMSF?

A

CNS deficits, amputations

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21
Q

why is diagnosis of RMSF difficult?

A

85% of patients lack diagnostic titers in first week of illness

need to test acute and convalescent samples (2-4 weeks apart) via indirect immunofluorescence; a four-fold rise in titers is confirmatory

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22
Q

pathogen, vector, and reservoir for anaplasmosis?

A

pathogen: BACTERIAL infection (caused by rickettsial agent anaplasma phagocytophilum)
vector: ixodes scapularis (black legged tick)
reservoir: HGA: deer & white footed mouse

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23
Q

what is the pathogenesis of anaplasmosis?

A

infects WBC and granulocytes over 24-48 hours

you will see granulocytes on peripheral blood smear

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24
Q

where is ehrlichiosis most common? what tick is responsible for infecting humans?

A

south!

lonestar tick

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25
Q

what is STARI? how does it present?

A

southern tick associated rash illness

cause is unknown; transmitted by lonestar tick

get similar rash as lyme but NO arthritic, neurologic, or chronic symptoms

26
Q

what disease is considered our “summer flu”? how does it present?

A

anaplasmosis

fever, chills, severe headache, malaise, myalgia, arthralgia

some cough, GI upset, stiff neck

27
Q

what laboratory findings are associated with anaplasmosis?

A

mild anemia
thrombocytopenia
leukopenia with a left shift
mild elevation of LFT

28
Q

how do we diagnose anaplasmosis?

A

PCR assay for DNA

four-fold rise in IgG antibody by IFA

immunochemistry staining of organism

29
Q

treatment of anaplasmosis?

A

doxycycline

30
Q

which of our tick infections is a parasitic infection?

A

babesiosis! caused by protozoa of the babesia genus

31
Q

pathogen, vector, and reservoir for babesiosis?

A

pathogen: babesia microti
vector: ixodid tick
reservoir: ANIMALS! rodents and small animals

32
Q

where does babesiosis primarily infect?

A

the red blood cells! causes hemolysis

considered the “american malaria”

33
Q

where in the US is babesiosis most common?

A

northeast!

34
Q

incubation period for babesiosis?

A

following tick bite: 1-3 weeks

following blood transfusion: 6-9 weeks

35
Q

symptoms of babesiosis? what will PE look like?

A

fever, chills, myalgia, arthralgia, fatigue, NV

PE: splenomegaly, hepatomegaly, JAUNDICE

36
Q

what are some risk factors of developing severe disease with babesiosis?

A 
over 50
asplenia
malignancy
HIV
immunosuppressives
37
Q

is asymptomatic disease common in babesiosis? why is this nervewracking?

A

YES. this is how it is transmitted via infusion!

38
Q

how does severe babesiosis present?

A

high-level parasitemia (over 10 percent)

significant hemolysis (plus DIC)

renal, hepatic, pulmonary compromise

39
Q

how will labs look for someone with babesiosis?

A

anemia, thrombocytopenia, increased conjugated bilirubin

40
Q

how do we diagnose babesiosis?

A

blood smear (intra-erythrocytic parasites)

PCR

serology for antibody testing

41
Q

first line treatment for babesiosis?

A

clindamycin/quinine

OR

atovaquone/azithromycin

42
Q

which tickborne disease is uncommon but has been found in every state besides hawaii?

A

tularemia

125 cases/year

43
Q

what type of tickborne disease is tularemia?

A

bacterial disease (francisella tularensis)

gram-negative, non-motile, non-sporulating coccibacillus

44
Q

how is tularemia transmitted?

A

via the american dog tick, lone star tick, and rocky mountain wood tick, deer fly bites, inhalation, ingestion, or skin contact with infected animals

45
Q

what species does tularemia infect? who are the vectors?

A

small mammals (squirrels, rabbits, muskrats, etc.)

arthropod vectors (ticks, biting flies, mosquitoes)

46
Q

which of our tickborne diseases kills less than 50 people a year worldwide?

A

tularemia

47
Q

why is tularemia so concerning in terms of transmission?

A

it is HIGHLY infectious (inhalation of 10 bacteria can cause disease)

48
Q

can tularemia be spread person to person?

A

NO!

just by arthropod intermediates or animal bites

49
Q

what are the types of disease forms that tularemia can cause?

A

ulceroglandular (less than 5 percent mortality)

oculoglandular

typhoidal syndrome (30-60 percent mortality)

oropharyngeal

gastrointestinal

pneumonia

50
Q

what is the gold standard for diagnosing tularemia?

A

PCR!

know there is a high risk to lab personnel with culture

51
Q

treatment of tularemia?

A

streptomycin, gentamycin

ciprofloxacin

mortality=0 with treatment

52
Q

what is the name for the group of acute infections caused by the athropod born spirochetes of the genus borrelia?

A

relapsing fevers

53
Q

what are relapsing fevers characterized by?

A

infection by borrelia genus

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

54
Q

borrelia recurrentis causes what type of relapsing fever?

A

louse-borne relapsing fever!

case fatality is 10%

spread when uninfected human crushes infected louse and it enters abraded skin

invades bloodstream

55
Q

bartonella quintana causes what type of relapsing fever?

A

trench fever! less serious (flu-like symptoms), rarely fatal

characteristic five-day fever

56
Q

rickettsia prowazekii is responsible for causing what type of relapsing fever?

A

epidemic typhus!

significant contributor to worldwide mortality prior to ABX

57
Q

which of our relapsing fevers is considered a category B bioterrorism agent?

A

epidemic typhus! caused by rickettsia prowazekii

58
Q

which type of lice is the only lice that can transmit disease?

A

body lice!! pediculosis humanus

59
Q

what is the pathogenesis of relapsing fever?

A

1) lice is crushed
2) incubation period 5-10 days
3) patient produces neutralizing antibodies (clear circulating strain in 3-5 days)
4) new antigenic variants appear (3-5 relapses may occur)

60
Q

treatment of relapsing fever?

A

penicillins

tetracyclines

Elaina: Infectious Disease (3 decks)

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