ID - Vector Borne Dz

Different presentations of Lymes

-Bulls Eye rash

-Cardiac with complete HB

-Bells Palsy

Lyme bacteria

Borrelia burgdorferi (gram negative spirochete)

Lyme tick

Ixodes scapularis

2 main reservoirs for lyme

Ioxes scapularis

White footed mouse

MC vector borne dz in the US

Lyme's Dz

Stages of Lyme

Early localized

-Rash

Early dissemimated

-MSK - large joints

-Heart block

-Bells palsy

Late disease

Dx of choice for Lyme's Dz

Serology = ELISA Av with reflex to Western Blot

Common to have false negatives in the Early stages

Treatment of Lyme's Dz

Doxy

Transmission unlikely if tick attachment is ______

Very likely if ______

< 24-48 hrs

> 72 hrs

General infection of Lyme's Dz occurs between _____ hrs of attatc,emt

36-48 hrs

____ are NOT recommended as first line for Lyme's Dz

Macrolides

Mild Lyme Carditis tx =

AV block tx =

Doxy, Amox, Cefuroxime

AV block = Ceftriaxone IV

Neuro lyme

-isolated facial nerve palsy tx

-menigitis sx tx

doxy

IV ceftriaxone

Joint mc affected in Lyme's Dz

Knee

Prophylaxis for lyme

Doxycycline 200mg 1 dose within 72 hours of bite (should be high risk bite)

Whats the difference between Lyme's Dz and a Tick Bite?

Lyme's Dz = rash happens days later

Tick bite = rash happens hours later

What should be avoided in pregnant pts with Lyme's Dz

Tetracyclines (Doxy)

Give Amox or Cefuroximine

A potential systemic shock like state following ABX

Jarisch-Herxheimer Reaction

Jarisch-Herxheimer Reaction involves what type of organism

Spirochetes (Lyme and Syphilis)

Treatment for Jarisch-Herxheimer Reaction

Supportive, CONTINUE ABX*

Gram negative obligate intracellular bacteria

R. Rickettsiae

RMSF has ___ for endothelial cells

tropism

Vectors for RMSF

Dog tick

Wood tick

Skin rash on the wrist and ankles, periorbital HA

RMSF

Why is RMSF cc of lawsuits

Deadly

Mis DX

Hx of tick bite often absnet

RMSF common in what time of yr

late spring and summer

Common sxs for RMSF

Periorbital HA

Tender LUQ

SKin rash on wrist and ankles

Lab findings in RMSF

Low plts

Low sodium

Aspetic meningitis on LP (lymphocytes)

If you suspect RMSF you should

treat patient right away don't wait for labs

Treatment of choice for RMSF

Doxy

Can children and preg get doxy in RMSF

Yes, short course is safe, they need it

______ is a reliable and important clue to dx RMSF

thrombocytopenia

Tick born infxn that lyses RBCs

Babesiosis

Species of Babesiosis we need to be concerned ab

Clade 1: B. microti

Babesiosis can be transmitted by

Deer tick - Ioxdes Scapularis (same as Lyme!)

White footed mouse

Babesiosis - must also think ab?

Lymes!

Labs of Babesiosis

RELATIVE BRADYCARDIA

FUO

Thrombocytopenia

Elevated LFTs/Jaundice

peripheral smear shows maltese cross

Babesiosis

Babesiosis on peripheral smear

Maltese cross

Treatment of Babesiosis

Atovaquone and Azithromycin

-OR-

Clindamycin and Quinine

Malaria smear

Ring form

Ehrlichiosis smear

WBCs

G- intracellular bacteria that destriys and infects WBCs

Ehrlichiosis

Ehrlichiosis Triad

WBC low

Plts low

Liver enzymes elevated

Smear revelas morula (cluster of intracellular coccobacilli) unside of PMN WBCs

Ehrlichiosis

Treat Ehrlichiosis

Doxy

3 main transmission from I. scapularis

Bebesia, Ehrlichiosis, Lyme

Ehrlichiosis - hallmark of dz?

Leukopenia

Bird hunting trip, feels like he got the flu, leukopenia, low plts, high LFTs

Ehrlichiosis

5yo with ataxia, parasthesias, weakness think ab

Tick paralysis

Ascending, flaccid paralysis due to reduced AcH and motor action potentials with absence of DTR

Tick paralysis

Tick paralysis - what type of paralysis

Ascending, flaccid paralysis

When can Tick paralysis be fatal?

If tick is not removed - due to respiratory paralysis

Tick paralysis can look like

Botulism, GB

What bacteria is associated with Q fever

Coxiella burnetii

Sheep, cats, goats (farm animals) think of

Q fever

HA & viral like PNA, no rash

Q fever

Q fever treatment

Doxy

If endocarditis add hydroxychlorquine

Tularemia bacteria

Francisella tularensis

Tularemia - vectors

Rodents, rabbits, hares

Hunter with big tender lymphadenopathy

Tularemia

6 related sxs to Tularemia

Glandular

Oculoglandular

Ulceroglandualr

Septic/typhoidial

PNA

Elevated CPK seen with

Tularemia

Tularemia treatment

Streptomycin

AMS + Mosq bite + Neuro sxs

West nile encephalitis

Parkinsonian like movements can be seen with

West nile encephaliits

Concerning Labs for West nile

Low WBCs

High LFTs

HIGH FERRATIN

IgM ab for West nile in CSF

HA + urinary issue + aspetic meninigits

St Louis encephalitid