Ticks and More Ticks

Question 1

Scrub typhus

Answer 1

orienta tsutugamushi

Question 2

louse born relapsing fever

Answer 2

borrelia recurrentis

Question 3

TIck borne relapsing fever

Answer 3

borellia hermsii, borellia turicatae

Question 4

boutonneuse fever?

Answer 4

also known as mediterranean fever, rickettissia conorii

Question 5

louse-borne endemic typhus

Answer 5

rickettisa prowazekii

Question 6

endemic (murine) typhus?

Answer 6

rickettsia typhi

Question 7

tick borne diseases general principles?

Answer 7

flu-like illness with empiric treatment, prognosis worse on extremes of age (<10/>60), with doxycycline is preferred therapy for most.

Question 8

lab tip offs for tick borne illnesses?

Answer 8

thrombocytopenia, elevated LFTs, WBC abnormality

Question 9

what are the 4 basic life stages of ticks?

Answer 9

egg–>larva–>mymph–> adult

Question 10

what are the two major types of human disease vectors?

Answer 10

mosquitos is 1, ticks is 2

Question 11

what are the two major groups of rickettsial species

Answer 11

spotted fever group (rickettsia), Typhus group (epidemic - rickettsia prowazekii (body louse), murine/endemic - rickettisa typhus (rat flea))

Question 12

RMSF rash description?

Answer 12

Early: Rash absent/maculopaular on extremeties moving towards petechial

Question 13

What labs do you see with RMSF?

Answer 13

Leukocytosis, thrombocytoepnia, transaminitis

Question 14

How is RMSF diagnosed?

Answer 14

Skin biopsy immunochemistry (DFA) is 70% sensitive. Seroconversion occurs 7-10 days after onset of symptoms. IFA gold standard but can x react. IgG/IgM can persist long after recovery

Question 15

Rickettsia Parkeri transmission/unique symptoms?

Answer 15

Lone star or gulf coast ticks transmission vector. See headache, mylagia with faint salmon colored rash with single or multiple eschars

Question 16

Clinical characteristics of Ricketssia Africae infection?

Answer 16

Fever, neck muscle myalgia, vesicular rash, lymphadenopathy. But, multiple eschars and inoculation eschars are unique

Question 17

Returning traveler with fever. common causes?

Answer 17

Malaria, typhoid, and R.Africae

Question 18

clinical characteristics of rickettsial pox?

Answer 18

Organism: R.Akari, Reservoir: house mouse, vector: house mites, Clinical: Single eschar, 20-40 papulovesicular rash. Dx with PCR swab eschar/vesicle. tx with doxycycline

Question 19

ddx of vesicular rash?

Answer 19

HSV, VZV, Pox viruses, ricketsialpox, african tick bite fever, queensland tick typhus

Question 20

Scrub typhus organism and vector?

Answer 20

Orientia tsutsugamushi is organism, vector is trombiculid mite (chiggers)

Question 21

Geography of scrub typhus?

Answer 21

Triangle from Japan to eastern australia to southern russia

Question 22

Clinical presentation of scrub typhus? TX?

Answer 22

Eschar, painful/draining lymph nodes, rash, delirium that may progress to MODS. treat with doxycyclinex 7 days/azithromycin

Question 23

flying squirrels association?

Answer 23

Epidemic typhus or R.Prowazekii

Question 24

vector/population of R.Prowazekii?

Answer 24

Louse(body/head), with crowded conditions

Question 25

vector/population of R.typhi?

Answer 25

Flea (rat, cat) worldwide/texas, US southern california

Question 26

what is the difference in vectors between HME and HGA?

Answer 26

HME vector is lone star tick (E.Chaffeensis) and HGA is ixodes scapularis (anaplasma phagocytophilum).

Question 27

Clinical characteristics btw HME and HGA?

Answer 27

HME has possible rash (maculopapular/petechial) and HGA has worse LFTs (both have LFT, leukoepnia, thrombocytopenia)

Question 28

vector for babesia microti?

Answer 28

reservoir is white footed mouse, tick transmission via ixodes scapularis

Question 29

Special pearl for babesia microti?

Answer 29

most common cause of blood transfusion related infection in the US?

Question 30

Treatment for severe babesiosis ?

Answer 30

Quinine 650mg TID + clindamycin 1200mg PO BID for 7-10 days. May require blood transfusion especially for B.Divergens, some B.Microti

Question 31

treatment for mild-moderate babesiosis?

Answer 31

azithromycin + Atovaquone

Question 32

Erythema migrans rash outside endemic area?

Answer 32

STARI (midcentral/southcentral US)

Question 33

Morula blood smear and tick?

Answer 33

if PMN - anaplasma, if monocyte - Ehrlichia

Question 34

Blood smear with morula with spirochete?

Answer 34

Relapsing fever of borrelia or B.Miyamotoi

Question 35

Tick with erythrocyte inclusion?

Answer 35

Babesia