JC CM Infectious Disease

how long must the tick be attached before bacterium is transmitted?

36-48 hours

maltese cross = ?

babesiosis

(RBC inclusion body)

POOR SENSITIVTY THO

Most lethal tick borne disease (mortality highest under 10)?

RMSF (Rickettsia rickettsiae)

70% mortality if untreated

RMSF (Rickettsia rickettsiae) transmission + reservoir

wood tick (Dermacentor andersoni), mites, fleas

reservoir: rodents/dogs

RMSF (Rickettsia rickettsiae - rocky mountain spotted fever)) presentation - initial s/sx

rash starts as small/blanching/pink macules on extremities → maculopapules

rash spreads centripetally to trunk + abdomen + PALMS AND SOLES, BUT spares face, can → petechia

fever, HA, N/V, myalgia, malaise, chills, arthralgia

rapidly progressing small vasculitis = ?

RMSF (Rickettsia rickettsiae)

RMSF (Rickettsia rickettsiae) sx in children

prominent abd pain

altered mental status

conjunctival infx

RMSF (Rickettsia rickettsiae) late complications

myocarditis, HSM, jaundice, cerebral edema (CNS involv)

pulmonary hemorrhage + edema

acute respiratory distress syndrome

acute renal failure

RMSF (Rickettsia rickettsiae) labs (do not need to memorize)

thrombocytopenia,

hyponatremia,

elevated transaminases,

hyperbilirubinemia

what is the universal treatment for RMSF?* and #2?

doxcycline

(including kids + pregnant pts)

#2. Chloramphenicol (risk of aplastic anemia)

Ehrlichiosis (E. ewingii, E. muris) E. chaffeensis =

HME (human monocytic ehrilichiosis)

Ehrlichiosis (E. ewingii, E. muris) E. chaffeensis sx, children, and late manifestations

sx occur 5-14 days after exposure

rash: maculopapular, petechial, or diffuse erythema

fever, chills, HA, myalgia, GI sx

children: abd pain, altered mental status, conj. infx

late manifestations (untreated): meningocephalitis, resp or organ failure

labs for Ehrlichiosis (E. ewingii, E. muris) E. chaffeensis (do not need to memorize) and anaplasmosis

thrombocytopenia,

leukopenia

modest elevations of liver transaminase levels suggest HME + HGA

PCR

morulae on blood smear

Ifa

blood tests help detect HGA + HME infx

morulae definition

inclusion bodies of bacteria in monocytes

tx of ehrlichiosis and anaplasmosis

rifampin*

doxy

ehrlichiosis vectors

lone star tick

deer tick

american dog tick

anaplasmosis species and vector

anaplasma phagocytophilium

deer tick (same as lyme, think co-infx)

anaplasmosis = ?

HGA

anaplasmosis vs. ehrlichiosis rash*

anaplasmosis has milder/absent rash

Which tick-borne illness probably needs no treatment?*

Colorado Tick Fever

What do you do with a recovered tick?

Currently no recommended role for testing ticks for infection

presence of pathogen in tick doesn’t mean the person was exposed

How do you prevent tick bites?

1. Protective clothing

2. Tick repellents

• N,N-diethyl-m-toluamide (DEET) – safe after the 1st trimester of pregnancy + children older than 2 months

• Picardin

• IR3535 – the most effective agent against I. scapularis

• Permethrin can be sprayed on clothing to also repel ticks

3. Long-sleeved shirts tucked into pants + pants tucked into socks

Deer Tick / Black-legged (Ixodes scapularis + pacificus) can cause what diseases?*

1. Lyme Disease

2. Babesiosis

3. Tickborne Relapsing Fever (B. miyamotoi)

4. Ehrlichia (E. ewingii)

5. Anaplasmosis

6. Powassan Virus

7. Rocky Mountain Spotted Fever

8. Tularemia

Rocky Mountain Wood Tick (Dermacenter andersoni) causes what diseases?*

1. Rocky Mountain Spotted Fever

2. Tularemia

3. Colorado Tick Fever (think co-inf w/ RMSF)

American Dog Tick (Dermacentor variabilis) causes what diseases?

1. Tularemia

2. Ehrlichia (E. chaffeensis)

3. Rocky Mountain Spotted Fever

Lone Star Tick (Amblyomma americanum) can cause what diseases?

1. Anaphylactic mammalian meat allergy (alpha gal)

2. Tularemia

3. Southern tick-associated rash illness

4. Ehrlichia (E. chaffeensis)

Brown Dog Tick (Rhipcephalus sanguineus) can cause what diseases?

1. Ehrlichia (E. muri)

2. Rickettsial Pox

3. Rocky Mountain Spotted Fever (in Arizona)

Ornithodoros Ticks causes what?

Tickborne Relapsing Fever (B. hermsii, parkerii, turicatae)

lice transmits what disease?

• epidemic typhus

• trench fever

fleas transmits what disease?*

1. Murine (Endemic Typhus)

2. Rocky Mountain Spotted Fever

chiggers (mite larvae) can cause what disease

scrub typhus

mites can cause what disease

rocky mountain spotted fever

rickettsial pox

T/F: doxy can be used in children and pregnant pts

T - the restrictions have been lifted for RMSF, ehrlichiosis, and anaplasmosis

tick bites can sometimes cause what kind of paralysis?

toxin-mediated flaccid ascending paralysis

(looks similar to GBS, polio, botulism - removing tick = sx go away)

Babesiosis (Babesia microti) is caused by a?

parasite

Babesiosis (Babesia microti) sx

lysis of erythrocytes (think hemolytic anemia AKA schistocytes)

Gradual onset fatigue, malaise, fever, chills, sweats, HA, weakness, myalgia

Arthralgia, anorexia, nausea, dry cough, emotional lability, dark urine

PE: splenomegaly, hepatomegaly, jaundice

Babesiosis (Babesia microti) tx*

atovaquone

azithromycin

Babesiosis (Babesia microti) complications

acute respiratory failure

DIC

renal/splenic failure

Babesiosis (Babesia microti) sx looks like what disease

malaria

Tularemia (Francisella tularensis) = ?

rabbit fever

Tularemia (Francisella tularensis) transmission 2n1s*

rabbits

Tularemia (Francisella tularensis) sx*

ulcero-glandular disease

PAINFUL lymphadenopathy, cutaneous central eschar at tick site

oropharyngeal, pneumonia, typhoidal tularemia (it can infect these parts)

Tickborne Relapsing Fever (B. hermsii, B. parkerii, B. turicatae (non-bergdorferi)) - transmission

rodent-infested cabin (they live in rodent burrows)

Tickborne Relapsing Fever (B. hermsii, B. parkerii, B. turicatae (non-bergdorferi)) - sx

high fever (3 days + ends w rigors), tachycardia, HTN

→ profuse sweating + defervescence

sx disappear for 7 days then repeat

Tickborne Relapsing Fever (B. hermsii, B. parkerii, B. turicatae (non-bergdorferi)) - uncommon complication

mengitis

ARDS

iritis/uveitis

myocarditis

bacterial “ticks” pathology

tularemia

tickborne relapsing fever

parasitic ticks” pathology

babesiosis

viral tick pathology

colorado tick fever

powassan virus

colorado tick fever sx

conjunctival injection,

photophobia,

retro-orbital pain,

severe myalgia, HA, pharyngitis

biphasic fever = “saddle back pattern”

saddle back pattern 2n1s

colorado tick fever

colorado tick fever tx

no specific tx - dz self imited

colorado tick fever complications

encephalitis

myocarditis

pneumonitis

hepatitis

DIC

tx for tularemia - mild vs. severe

mild: doxy

severe: aminoglycosides (streptomycin and gentamycin)

Powassan Virus can cause _

encephalitis

what disease is often co-infx w/ lyme?

babesiosis

babesiosis species, vector?

babesia microti

deer tick

which disease is transmitted through blood transfusions?

Colorado Tick Fever

babesiosis

tularemia is transmitted by what ticks?

-Lone Star Tick

-Rocky Mtn Wood Tick

-American Dog Tick

Non-burgdorferi species for tickborne relapsing fever (ornithodoros ticks)

Borrelia hermsii

B. parkerii

B. turnicatae

which type of ticks spread tickborne relapsing fever?

ornithodoros ticks

ixodes

diseases that cause conjunctival injection

anaplasmia

colorado tick fever

lyme disease - species + vector

species: Borrelia burgdorferi

vector: deer tick

colorado tick fever’s vector

rocky mountain wood tick

powassan virus vector

ixodes

rocky mountain spotted fever is caused by? (list)

rocky mountain wood tick

mites + fleas

american and brown dog tick

which tick disease often co-infx with RMSF?

Colorado Tick Fever

tickborne relapsing fever is caused by?

non-bergdorferi borrelia species

tickborne relapsing fever tx

doxy

erythromycin

pt has HTN, you suspect what tick disease?

tickborne relapsing fever

Borrelia burgdorferi is what shape*

spirochete

transmission of Borrelia burgdorferi is? what stage?

deer tick in NYMPH stage

lyme disease stage 1 (early localized) 1-30 days sx

general: Flu-like symptoms, fever, HA, fatigue, malaise, lymphadenopathy

lymph: regional lymphadenopathy

MSK: myalgia, athralgia

skin: erythema migrains, expanding/warm central clearing (bull’s eye)

lyme disease stage 2 (early disseminated), days-weeks sx

general: malaise, fatigue, HA, fever, weakness

CV: pericarditis, arrhythmia

lymph: general lymphadenopathy

MSK: migratory muscle/bone or joint pain, inflammatory arthritis, arthralgia, myalgia

neuro: bell’s palsy, meningitis, neuritis, vertigo

skin: secondary annular lesions

typical co-infx of lyme disease*

#1: babesiosis (Babesia microti)

ehrlichia

Anaplasmosis

Tickborne Relapsing Fever (Borrelia miyamotoi)

Mycoplasma

RMSF

bartonella (cat scratch fever)

brucella

prophylaxis for lyme disease

doxy within 72 h of tick removal if tick has been attached for >/36 hours

CI in allergy, pregnancy

lyme disease stage 1 tx

doxy x 21 days

if preg or child: amoxicillin or cefuroxime x 21 days

lyme disease stage 1 sx overview

fever, arthralgia, rash

stage 2 lyme disease overview

peripheral neuro disease or arthritis

lyme disease stage 2 tx

amoxicillin or cefuroxime x 28 days

lyme disease stage 3 tx

parenteral ceftriaxone 21-28 days

penicillin G

lyme disease stage 3 sx overview

w/ cardiac, recurrent arthritis, or CNS dz

rickettsiae genus characteristics

• obligate intracellular parasite

• gram neg pleomorphic bacteria

borrelia burgorferi mainly attacks?

joints

borrelia afzelii mainly attacks?

skin

borrelia garinii mainly attacks?

neuro - accounts for most cases of lymphocytic meningio-radiculitis and encephalitis

the interval stage in lyme disease between stage 1 and 2 can be up to _ months

9

What are the usual signs and symptoms of lyme disease (with particular regard to RMSF)?

sudden fever, chills, HA, malaise + myalgia

early: N/V, anorexia

children w RMSF/ehrlichiosis: abd pain, alt mental status, conjunctival infx

rare sx: severe abd pain + meningoencephalitis

rash is common w/ spotted fevers (less common w/ ehr + anaplas)

lyme disease stage 3 (late disseminated) weeks to months sx

AV block, myocarditis

long attacks of inflammatory arthritis'/chronic

encephalitis

polyneuropathy

lymphocytoma

lyme arthritis responds to _ but will NOT respond to abx

NSAIDs

typhus group diseases

endemic (classic typhus)

murine (endemic) typhus

scrub typhus

epidemic (classic) typhus rickettsia agent, insect vector, reservoir

R. prowazekii

Louse

Humans + flying squirrels

murine (endemic) typhus rickettsia agent, insect vector, reservoir*

R. typhi

Flea

Rodents

scrub typhus rickettsia agent, insect vector, reservoir

Orientia tsutsugamushi

Chigger (mite larvae)

Rodents

rocky mountain spotted fever - rickettsia agent, insect vector, reservoir

R. rickettsii

Wood Tick (D. andersoni)

Rodents + dogs

rickettsial pox - rickettsia agent, insect vector, reservoir

R. akari

-Brown Dog Tick

-Mite

-House Mice (reservoir)

indian tick typhus - rickettsia agent, insect vector, reservoir

R. conorii

Tick

Rodents + dogs

Q fever - rickettsia agent, insect vector, reservoir*

Coxiella burnetii

NONE !!!!

Sheep, cattle, goats

trench fever - rickettsia agent, insect vector, reservoir

Bartonella quintana

Louse

Humans

3 groupings of rickettsial diseases

typhus group

spotted fever group

pseudo rickettsial diseases

spotted fever group for rickettsial diseases

rocky mtn spotted fever

rickettsial pox

indian tick typhus