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Clin Med I Exam I > Vector-Borne and Zoonotic Disease > Flashcards

Vector-Borne and Zoonotic Disease Flashcards

1
Q

Lyme Disease Epidemiology

A

-most common tick-borne illness in US and Europe
-Bimodal peak
→ 5-14 yrs
→ 45-55 yrs
-56% of cases occur in males
-Most likely to contract during June, July, or August

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2
Q

What is the name of the infection that causes lyme disease in US ?

What are the names of the ticks that commonly bite people in the eastern US/What disease do they relate

A

-Borrelia Burgdorferi

  • Black legged tick( I. Scapularis) → lyme
  • Lone star ticks (Amblyomma americanum)→ Anaplasmosis, Tularemia, Southern tick-associated rash illness
  • American Dog tick (Dermacentor variabilis)→ Rocky Mountain spotted fever, Tularemia
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3
Q

How long must ticks be attached to their host in order for B. Burgdorderi occurs ?

What are your chances of infection if it is a larva, nypmhal, adult female ?

A

36-48 hours

  • Larva-→ rarely infected
  • Nymphal→ 25% infected
  • Adult Female→ 50% infected
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4
Q

Clinical Manifestations of Early localized Lyme disease

A

-Erythema migrant (EM)-79% of pts
→ usually presents within 7-14 days after bite but can present up to 30 days after

-Fluid in knee with no history of knee injury

-Associated viral syndrome
→ fatigue
→ headache/neck stiffness
→ anorexia
→  muscle and joint pain 
→ regional lymphadenopathy
→ fever
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5
Q

Clinical Manifestations of Early Disseminated Lyme disease

A

Usually presents weeks to months after tick bite:
-*Neurologic Symptoms
→ Cranial nerve palsies (especially facial nerve)
→ Triad:
Cranial neuropathy, Meningitis, Radiculoneuropathy

-*Carditis
→ AV heart block
→ Peridcarditis

-*Ocular Manifestation
→ Conjunctivitis
→ Optic Neuropathy

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6
Q

Clinical Manifestations of Late Lyme disease

A

Occurs months to a few years after the onset of the infection

  • Arthritis (especially the knee)
  • Neurologic features (lyme encephalopathy-subtle cognitive disturbances, chronic headache)
  • Fibromyalgia
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7
Q

Post- Lyme Disease Syndrome

A

Often used to describe the non specific symptoms that may persist for month after treatment of Lyme disease

  • headache
  • fatigue
  • arthralgia
  • cognitive difficulties
  • Musculoskeletal pain
  • for the majority of these patients these symptoms improve gradually over 6-12 months
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8
Q

Lyme Disease Diagnostic Studies

A 
-CBC
→ Leukocytosis (usually not big enough infection to cause that much of a raise)
→ Leukopenia
→ Anemia
→ Thrombocytopenia
  • Elevated ESR (lets you know there is inflammation -non specific)
  • Elevated creatine phosphokinase (CPK)
  • Elevated AST and ALT
  • Spirochetemia on blood culture - not usually preformed

-ELISA→ most common initial serologic test
-Western Blot test → provides more information regarding which agent of B. Burgdorgeri are reacting to the serum antibody
→ Two tiered approach- serum sample is first sent for ELISA, if positive, the same sample is then sent for Western Blot

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9
Q

What is first line treatment for Lyme disease?

What is the duration of that treatment ?

A

-1st line: Doxycycline
-Alternatives:
→ Amoxicillin
→ Ceftriaxone IV
-Duration:
→ Early- 10-21 days
→ 14-28 days

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10
Q

Criteria for Lyme disease prophylaxis tx

A

all. must apply
- attached tick is ID as adult or nymph I. Scapularis and attached for >36 hours
- Prophylaxis can be started w/n 72 hours of time the tick was removed
- ecologic information indicated local rate of infection of ticks is ≥20%
- doxycycline is not C/I
* single dose of doxy to adults and children ≥ 8 yrs old

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11
Q

Babesiosis Clinical Presentation

A

■ Ranges from asymptomatic to progressively fatal ■

  • No rash
  • hemolytic anemia
  • Jaundice; dark urine
  • Flu like symptoms
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12
Q

Babesiosis is life threatening in what type of patients?

What complications can arise from this illness?

A

• Asplenic pts( b/c spleen helps filter RBC’s), weakened immune system, liver or kidney disease, elderly

○ Sepsis, hemolytic anemia, thrombocytopenia, DIC, multi organ failure, death

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13
Q

How do you diagnose and Tx Babesiosis ?

A

Diagnose:

  • CBC-hemolytic anemia labs
  • ★ Peripheral smear-look for Maltese cross of the tetrads and extra cellular mezozites
Tx:
Atovaquone +Azithromycin 
OR
Clindamycin + Quinine
-antipyretics
-vasopressors
-blood transfusion
-ventilation
-diaylisis

educate pt to not donate blood products

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14
Q

Babesiosis is transmitted by?

A
  • I. Scapulauris ticks in nymph stage
  • blood transfusion
  • northeast and upper midwest
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15
Q

Ehrlichiosis is described as ?

It is spread by?

A

• general name to describe disease caused by multiple parasites

It is spread by?
• spread through the bite of an infected adult or nymphal tick
○ Black legged tick( I. Scapularis) → lyme
○ Lone star ticks (Amblyomma americanum)→

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16
Q

Epidemiology of Ehrlichiosis

A
  • Missouri, Arkansas, NY and VA accounted for more than 50% of all cases
  • Men > women
  • 60-69 yrs
  • compromised immune system
17
Q

Ehrlichiosis Signs and Symptoms

A

■ symptoms begin 1-2 wks after bite
• malaise, rigors, high fever, and headache
• rash - infrequent! if present consider other tick borne co-infections

18
Q

Ehrlichiosis Diagnosis

A
  • PCR -identifies genes unique to Ehrlichiosis (most sensitive in the 1st week of illness
  • CBC-leukopenia, thrombocytopenia
  • CMP- abnormal LFT’s
  • Peripheral smear- you may see the bacteria in the leukocytes
19
Q

Ehrlichiosis Tx and Complications (if pts aren’t treated)

A

TX:
• Doxycycline
• Rifampin approved for pregnant females
-do not wait for confirmation if you have high suspicions
-lack of improvement after 48 hrs of tx suggest alternative dx

Complications:

  • confusion/seizures/coma
  • hemorrhage
  • heart failure
  • lung failure
  • kidney failure
  • septic shock
20
Q

Anaplasmosis Epidemiology and Etiology

A

Epidemiology:
-VT, M, RI, MI, MASS, NH, NY report 90% of cases

Etiology:

  • often misdiagnosed as Ehrlichiosis
  • caused by bacterium anaplasma phagocytophilum
  • I. scapularis ticks
21
Q

Anaplasmosis risk factors

A
  • spread from the bite of infected tick; rare cases blood transfusions
  • Males greater than 40
  • weakened immune system
  • time spent in contact with white tail deer and white-footed mouse
22
Q

Anaplasmosis signs and symptoms:

A 
■ Si/Symps typically begin 1-2 weeks after bite. Bites are usually painless and people don't remember being bitten
• early illness (1-5 days)
-fevers, chills, headache, myalgia, nausea vomiting, diarrhea, anorexia 
• late illness
-respiratory failure
-bleeding problems
-organ failure
-death (RARE <1%)
23
Q

Anaplasmosis Diagnosis

A
  • PCR -identifies genes unique to Ehrlichiosis (most sensitive in the 1st week of illness
  • CBC-leukopenia, thrombocytopenia ★
  • CMP- abnormal LFT’s
  • Peripheral smear- you may see the bacteria in the monocytes
24
Q

Anaplasmosis Tx and Management

A

TX:
• Doxycycline
• Rifampin approved for pregnant females

25
Q

Rocky Mountain Spotted fever is acquired via ?

This infection loves to infect what type of cells? This can lead to ?

A

-tick bites caused by rickettsia rickettsia infection
○ transmission after the tick has been attached for 6-10 hrs
○ incubation period 2-14 days after exposure

  • infection loves vascular endothelial cells → veins become permeable→ hypovolemia, hypotension
26
Q

RMSF is very prevalent in what areas ?

What age has an ↑ risk for fatality from this disease?

A

RMSF is very prevalent in what areas ?
• southeast and south central US

What age has an ↑ risk for fatality from this disease?
• fatality highest in very young ≤ 4 yrs and ≥ 60yrs

27
Q

What are the risk factors for Rocky Mountain spotted fever

A
  • higher incidence in age < 10 yrs and 40-60 yo
  • frequent exposure to dogs
  • reside near wooded area or high grass
  • American Indians appear to be at higher risk ★
28
Q

Rocky Mountain Spotted Fever si/sx’s?

A

★ blanching erythematous rash with macules (1-4 mm) that become petechial (small and scattered) over time -appears on the 3rd -5th day of illness
○ 88-90% of patients have rash → spotless RMSF may be severe and have fatal outcomes
○ rash initially involves wrist and angles → centrally to arms, legs and trunk
★ involves palms and soles
-★ Abdominal pain (children)
-★ fever (severe)
Other symptoms:
-facial flushing, conjuctival injection, and hard palate lesions may occur
-ARDS and necrotizing vasculitis are signs of concern
-★ pedal edema (esp children)
-focal neurologic deficits
-meningismus (can’t move neck and have fever)
-gangrene of the digits, ears scrotum

29
Q

RMSF diagnostic studies?

A
  • Normal WBC at presentation
    -As disease progresses
    ○ Thrombocytopenia
    ○ low fibrinogen and elvated fibrin split products
    ○ hyponatremia
    ○ elevated serum aminotransferases and bilirubin
    ○ azotemia
    prolonged put and pt
    -Chest x-ray -interstitial infiltrates on chest x-ray consistentent with early pulmonary edema
    -IFA assay for IgG R. Rickettsia antigen

Clin Med I Exam I (9 decks)

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