Ticks and mosquitos

Question 1

Prophylaxis for malaria

Answer 1

Mefloquine, or atovaquone-proguanil, or doxycycline

Due to high level of chloroquine-resistant malaria

Question 2

Treatment of malaria

Answer 2

Chloroquine but resistance is increasing
Add primaquine for P Vivax and P Ovale
For severe infections, can use IV quinidine

Question 3

Tick bite
Flu-like symptoms
Anemia, thrombocytopenia, elevated bile/LDH/LFTs

Answer 3

Babesiosis (tick-borne protozoal illness transmitted via Ixodes scapularis - same ticks that transmit Lyme)

Multiplies in RBCs —> hemolysis sx (jaundice, dark urine, scleral icterus)

Question 4

Maltese cross in blood smears

Answer 4

Babesiosis

Intraerythrocytic rings

Question 5

Treatment of babesiosis

Answer 5

Atovaquine + azithromycin

Or quinine + clindamycin if severe

Question 6

Tick bite
Headache/fever/chills/AMS/myalgia
No rash!!!!!
Leukopenia, thrombocytopenia, elevated liver enzymes

Answer 6

Ehrlichiosis (amblyomma americanum transmitted by tick)

Note: ehrlichiosis -> leukopenia; babesiosis -> leukocytosis

TREAT WITH EMPIRIC DOXYCYCLINE

Question 7

Atrioventricular block

Answer 7

Lyme carditis

Question 8

What drug to use for Lyme disease in <8yo and pregnant/lactating women?

Answer 8

Amoxicillin

Question 9

What to do if find tick?

Answer 9

Remove w tweezers asap
Do not need prophylaxis for Lyme if tick attached for <36hr (because B burgdorferi needs longer feeding before migration of salivary glands)