Wed - lymes and other tick borne infections

Question 1

What organism and vector causes:
Lymes disease?
RMSF?
Babesiosis?
Tularemia?

Answer 1

Borrelia burgdoferi (hard to culture, spirochaete) - deer tick (ixodes scapularis or ixodes pacificus in the US)

Rickettsia rickettsii - wood tick (Dermacentor variabilis)

Babesia microti in US (hemato-parasite) - deer tick (ixodes scapularis)

Franciscella tularenis - Rabbits >deer >other rodents (ticks on them)

Question 2

Name of rash seen in 60-80% of lymes disease patients?

Answer 2

Erythema migrans (EM)

Question 3

Symptoms of early disseminated lymes disease

Answer 3

Multiple EM lesions, migratory arthritis, facial nerve palsy, , radicular pain, potential AV block (pacemaker not needed)

Question 4

Chronic lymes disease symptoms

Answer 4

Chronic arthritis, neurological impairments

Question 5

What do you look for in a western blot of borrelia burgdoferi?

Answer 5

2 or more bands of IgM

5 or more bands of IgG

Question 6

What are some problems associated with serological (serum) tests for lymes disease?

Answer 6

You can get a false pos for IgM
IgM and IgG antibodies may persist for years after initial infection
early treatment may blunt the antibody response.

Question 7

What can you give someone with lymes diesease? what is the best?

Answer 7

Doxycycline - also for rickettsii
amoxycillin
cefuroxime

Question 8

What is meant by the saying: R. rickettsii is transmitted trans-stadially?

Answer 8

it means that the bacteria transfer it from one generation to the next.

Question 9

Clinical manifestation of RMSF

Answer 9

incubation ~7days
abrupt onset of flu like symptoms
centripetal rash observed by day 4
pruprua (bleeding in dermal-epidermal junction) may develope

Question 10

What can you give someone for RMSF

Answer 10

doxycycline
tetracycline
chloramphenicol - cheap, 3rd world.

Question 11

Most common transfusion-related infection in the US?

Answer 11

Babesiosis (ixodes scapularis or wood tick)

Question 12

What do you give someone with babesiosis?

Answer 12

Quinine PLUS Clindamycin

Question 13

Diagnosis of babesiosis in the lab?

Answer 13

May see bilirubin (babesia are hemato-parasites)

Gimsa stain will show bacteria in RBC

Question 14

Tularemia - clinical manifestation and treatment

Answer 14

Abrupt onset of fever and chills.
bite ulcerates and forms black eschar with non healing ulcer.

streptomycin, gentamicin, doxycycline

Question 15

Morulae is what? seen in what infection?

Answer 15

Cluster of bacteria (Ehrlichia and Anaplasma)

Question 16

What is the only illness we talked about that you DONT give doxycycline to?

Answer 16

Babesiosis