Zoonoses

When to give lyme disease prophylaxis

Generally not recommended

Areas hihgly endemic for Lyme disease; Doxy 200 only if all critera met:

• Doxy not contraindicated

• Tick identified as I. scapularis

• Tick attached >36 hr based on engorgement or likely time of exposure

• Prophylaxis started with 72 hr

• Exposure in lyme disease area (WI included)

Lyme Disease Clinical Stages

Early localized
Early Disseminated
Late Disease
Post-treatment syndrome

Fill in this table

Stage/Condition	Manifestations	Treatment
Early Localized	Erythema migrans (EM)  *main	Doxycycline, Amoxicillin, Cefuroxime, Azithromycin (if allergy)
Early Disseminated	Facial palsy, meningitis, AV block	Doxycycline or Ceftriaxone (oral or IV based on severity)
Late Disease	Arthritis (esp. knee), chronic neuro symptoms	Doxycycline, Amoxicillin, or Cefuroxime for 28 days
Post-Treatment Syndrome	Fatigue, joint pain, neurocognitive symptoms	Symptom management only, no benefit from extended antibiotics

Recommend appropriate prevention and prophylaxis for tick‐borne infections

• Avoid areas likely to harbor ticks

• Protective clothing, insect repellent (DEET, permethrin, shower after outdoor activity)

• Frequent daily self-inspection to remove tick

  • Tick attached <24-72  hours very unlikely to transmit 

What are anti-malaria meds chosen based off of

After geography resistance patterns, anti-malaria medications are chosen based on drug interactions and patient characteristics.

List the anti-malaria meds

Atovaquone-Proguanil

Primaquine

Doxycycline

Tafenoquine

Mefloquine

Chloroquine

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Medication	Start Time Before Travel	Duration After Travel	Pros/Cons
Atovaquone-Proguanil	1-2 days	Daily during trip + 7 more days after	Well-tolerated, expensive
Primaquine	1-2 days	Daily during trip + 7 more days after	Best for P. vivax, G6PD test required
Doxycycline	1-2 days	Daily during trip + daily for 4 more weeks after	GI upset, sun sensitivity, pill burden (need good adherence)
Tafenoquine	3 days	1x week during trip + 1 more weekly dose after	Good for short trips, G6PD test needed
Mefloquine	1-2 weeks	1x week during trip + 4 more weekly doses after	Psych/CV contraindications
Chloroquine	1-2 weeks	1x week during trip + 4 more weekly doses after	Resistance common

Design a treatment plan for a 4-year-old who has anaplasmosis

Doxycycline 4.4 mg/kg 10-14 days