Zoonotic Diseases

Lyme disease - Stage 1: Early Localized

• clinical manifestations

• treatment

• Erythema migrans (bulls-eye rash)

• flu-like symptoms

• treatment for bulls-eye rash

  • Doxycycline 100 mg BID x 10 days

  • Amoxicillin 500 mg TID x 14 days

  • Cefuroxime 500 mg PO BID x 14 days

• treatment in children (same as adults but based on wt)

  • Doxycycline 4.4 mg/kg in 2 divided doses for 10-14 days OR

    • Amox 50 mg/kg in 3 divided doses 14 doses OR

    • Cefuroxime 30 mg/kg in 2 divided doses 14 days

If unable to use beta-lactam or tetracycline, what is an alternative treatment for stage 1 lyme disease?

• Azithromycin 500 mg PO qd x 7-10 days

Lyme disease - Stage 2: Early Disseminated

• clinical manifestations

• treatment

• multuple erthem migrans

  • same treatments as stage 1

• neurologic

  • Facial Palsy: Doxycycline

    • Adults 100 mg BID for 14 days

    • Children: 4.4 mg/kg/day divided into 2 doses for 14-21 days

  • Lyme meningitis or radiculoneuritis

    • Adults 

      • Doxycycline

      • Ceftriaxone IV

    • Children

      • Doxycycline

      • Ceftriaxone IV

• Cardiovascular

  • mild-1st degree AV block

    • Doxycycline: 

      • adults 100 mg twice daily x14-21 days 

      • Children (any age) 4.4 mg/kg/day divided into 2 doses x 14-21 days

    • Amoxicillin or cefuroxime

  • Severe (symptomatic 1st degree or 2nd or 3rd degree AV block

    • Adults

      • Ceftriaxone 2 gm IV daily x 14-21 days (can switch to oral therapy)

    • Children

      • Ceftriaxone 50 -75 mg/kg IV daily x 14-21 days 

      Switch to oral therapy with resolution of symptoms and AV block

Lyme disease - Stage 2: Late disseminated (Chronic Lyme disease)

• clinical manifestations

• treatment

• neurologic

  • same treatment as stage 2

• Lyme arthritis (oral txt)

  • Adults

    • Doxycycline

    • Amoxicillin 

    • Cefuroxime

  • Children >/= 8 years old

    • Doxycycline

    • Amoxicillin cefuroxime

  • Children < 8 yo

    • Amoxicillin

    • cefuroxime

• Persistent Lyme arthritis txt

  • After first course of oral therapy with no or minimal response; repeat using an oral regimen

  • Adults

    • Ceftriaxone 2 gm daily x 14-28 days

  • Children

    • Ceftriaxone 50-75 mg daily x 14-28 days (max dose 2 gm)

    Refer to rheumatologist after one oral and one IV course of abx

Atovaquone-Proguanil

• anti-malaria medication based on patient characteristics and DDI

• txt course

  • Started 1-2 days BEFORE travel

  • given Daily when exposed to malaria and then for another 7 more days

• well tolerated

• $$$ compared to other options

Chloroquine

• anti-malaria medication based on patient characteristics and DDI

• txt course

  • Started 1-2 WEEKS BEFORE travel

  • given once a week and then another 4 more weeks

• patients may be using it for its other indications (so killing two birds, with one stone)

• *majority of the malaria in the world is NO LONGER susceptible to this drug

  • Resistance limits usefulness

Doxycycline

• anti-malaria medication based on patient characteristics and DDI

• txt course

  • Started 1-2 days before travel

  • Daily and then for another 4 weeks

• least expensive option

• Some patients may be using for another indication (but they can still use it for malaria prophylaxis)

• ADE: Sun sensitivity + GI upsets

Mefloquine

• anti-malaria medication based on patient characteristics and DDI

• txt course

  • started 1-2 weeks before travel

  • once a week and then for 4 more weeks

• resistance in some regions

• CI in some psychiatric conditions, seizure disorders, cardiac conduction abnormalities

Primaquine

• Anti-malaria medication based on patient characteristics and DDI

• txt course

  • Started 1-2 days before travel

  • Daily and then for 7 more days

• Most effective for P. Vivax

• Must test for G6PD deficiency

• GI intolerance

Tafenoquine

• Anti-malaria medication based on patient characteristics and DDI

• txt course

  • begins 3 days prior to travel

  • weekly during travel + 1 more week

• good for shorter trips and last minute travel

• must test for G6PD deficiency prior to use

S/sx of Anaplasmosis

S/sx occur 1-2 weeks after tick exposure

• Early illness: fever ,severe HA, muscle aches, NVD

• Late illness: renal or respiratory failure

Risk factors for severe anaplasmosis

• Delayed treatment

• Older age

• Immunocompromised

Treatment for anaplasmosis

• DOXYCYCLINE for everybody!!

• 100 mg BID daily for 10-14 days for adults and children

• Use of other abx beside this can increase the risk of severe illness and patient death!!