Tick Borne and Viral

Rocky Mountain Spotted Fever Organism

Rickettsia rickettsii

Which ticks have the pathogen for RMSF?

American Dog tick, Brown Dog tick, Rocky Mountain Wood tick

Early Symptoms of RMSF

• abrupt high fever and GI symptoms

• Edema around eyes and back of hand

Late Symptoms of RMSF

• altered mental state

• Respiratory issues

• Necrosis

• Multiorgan Failure

RMSF Rash

• Begins 2-5 days after onset

• Starts on extremities then to trunk, small flat and nonitchy spots

• Late Rash- petechial rash, red and purple spots

Diagnose RMSF

Clinical Eval, Antibody titer, PCR, Tissue Biopsy

Treat RMSF

Doxycycline

Lyme Disease Organism

Borrelia burgdorferi (spirochete)

Which ticks have the pathogen for Lyme Disease?

Deer Tick

Symptoms of Lyme

• Erythema migrans (Bulls-eye rash)

• Flu-like symptoms

• Swollen lymph nodes

• Later: Moving arthritis

Early Severe Symptoms of Lyme

• Bells Palsy

• Bilateral cranial nerve palsies

• Carditis

How long can Late Lyme disease occur after onset?

Months to a few years

Diagnose Lyme

EM rash or two-step antibody testing

Treat Lyme

Doxycycline

What organism causes ehrlichiosis?

E. chaffeensis, Gram negative bacteria

Which tick does this pathogen live in?

Lone star tick and deer tick

Symptoms of Ehrlichiosis

• Flu-like symptoms

• GI

• Altered mental status

• Rash

Diagnose Ehrlichiosis

Leukopenia, thrombocytopenia, elevated liver enzymes

Treat Ehrlichiosis

Doxycycline

What organism causes babesiosis?

Babesia microti (protozoa parasite)

Which tick transmit pathogen for babesiosis?

Deer tick

Symptoms of Babesiosis

• Flu-like symptoms

• GI symptoms

• Dark urine

• Maltese cross

What type of cell does Babesia microti attack?

Red blood cells

Diagnose babesiosis

Microscope exam, PCR

Treat Babesiosis

antiparasitic and an antibiotic

What type of cell does ehrlichiosis attack?

White blood cells

What type of cells does Lyme disease attack?

extracellular infection involving connective tissue eventually leading to organs

What type of cells does RMSF attack?

intracellular infection of vascular endothelial cells (blood vessels)

Epstein-Barr Virus Attacks:

B lymphocytes and oropharyngeal epithelial cells

Epstein-Barr Virus Symptoms

Low grade fever, exudative pharyngitis, severe fatigue, posterior cervical node enlargement, splenomegaly

Cytomegalovirus Attacks:

Monocytes and macrophages, epithelial and endothelial cells

Cytomegalovirus Symptoms

Heterophile-negative mononucleosis, no phayngitis and lymphadenopathy

Herpes Simplex Virus 1 Attacks:

mucosal epithelial cells; latency in sensory neurons of trigeminal neurons

Herpes Simplex Virus 1 Symptoms

Burning, tingling sensation before vesicles appear; small clusters that crust near mouth

Herpes Simplex Virus 2 Attacks:

genital epithelial cells; latency in sensory neurons of sacral ganglia

Herpes Simplex Virus 2 Symptoms

• Burning, tingling sensation before small clusters of vesicles appear on external genitalia, can turn into ulcers

• Causes dysuria, cervicitis, urinary retention (Women), urethritis (men)

Varicella Zoster Virus Attacks:

• respiratory epithelial cells, T cells, and skin epithelial cells

• Latency in sensory neurons

Varicella Zoster Virus Symptoms

• “dew drops on a rose petal”

• vesicles in multiple stages of healing

• starts at face/scalp and trunk → extremities

Herpes Zoster Virus Attacks:

sensory neurons of dorsal-root or cranial-nerve ganglia; then spreads to epithelial cells

Herpes Zoster Virus Symptoms

Unilateral painful dermatomal vesicles

Varicella Vaccine Name

Varivax, Varilrix

Shingles Vaccine Name

Shingrix

Roseola Infantum (Sixth Disease) Attacks:

CD4+ T lymphocytes

Roseola Infantum Symptoms

• Very high fevers for days then rash appears

• Rose-colored rash

• Trunk → extremities

Rubeola (Measles) Attacks:

respiratory epithelial cells, lymphocytes, macrophages, and dendritic cells

Rubeola (paramyxoviridae) Symptoms

• High fever that increases for a week

• 3 C’s: cough, coryza, conjunctivitis

• Koplik spots = table salt on muscus membranes

• Brick red, blotchy rash

• starts face → down to extremities including palms and soles

Rubella (Togavirus) Attack:

respiratory epithelial cells intitially; then moves to lymphoid tissue and fetal tissues during pregnancy

Rubella Symptoms

• Posterior cervical and postauricular swollen nodes, joint pain

• Mild rash for 3 days

• starts at head → extremities

Congenital Rubella Syndrome

deaf, catracts, congenital heart diseases, blueberry muffin rash

Erythema Infectiosum (parvovirus) Attacks:

red blood cells in bone marrow

Erythema Infectiosum (parvovirus) Symptoms

• Slapped-cheek look

• Lacy rash on trunk and limbs

• Flu-like symptoms

• Joint pain in adults

Mumps (paramyxoviridae) Attacks:

respiratory epithelial cells then parotid glandular cells

Mumps Symptoms

• enlarged parotid salivary glands

• Inflammation of testicles and epididimis

Influenza Attacks:

ciliated respiratory epithelial cells

Influenza Symptoms

• Fast onset of fever

• Headache and swollen lymph nodes

• Congestion and non-productive cough

• Use Tamiflu for pts w/ comorbidities

COVID-19 Attacks:

Type 2 alveolar pneumocytes and repiratory epithelial cells expressing ACE2, vascular endothelial cells

COVID-19 Symptoms

• flu-like symptoms

• Cough with or without dyspnea

• GI symptoms

• Loss of taste and smell

Long COVID Symptoms

• chronic fatigue, anxiety, pain

• cough, SOB, pneumonia

• neuropathy, brain fog

• Multisystem inflammatory syndrome

Treatment for COVID

Paxlovid for outpatient high risk pts

Remdesivir for hospitalized

Human Immunodefiniency Virus Attacks:

CD+ 4 T-helper lymphocytes

HIV Symptoms

• Starts with flu-like symptoms

• Asymptomatic

• CD4+ T cells being killed so immune system cannot fight off most infections

Human Papillomavirus Attacks:

basal cells of epithelium of skin or muscus membranes

HPV Cutaneous Infections

• common warts

• flat warts

• plantar warts

• filiform warts

HPV Mucosal Infections

• Papillomatosis → voice change

• Condylomata acuminata: painless skin-colored bumps with cauliflower appearance

• Genital cancer

Rabies Attacks:

skeletal muscle cells initially, followed by PNS and CNS neurons

Rabies Symptoms

• flu-like symptoms

• nausea, vomiting, photophobia

• Hydrophobia and pharyngeal spasms

Polio Attacks:

anterior horn motor neurons of spinal cord and motor nuclei in brainstem

Polio Symptoms

• Flu-like symptoms

• Back, neck, limb pain and stiffness

• Muscle weakness

• Loss of reflexes

• Severe muscle weakness

• Asymmetric loose and floppy limbs w/ sensory intact

Anaplasmosis