Tick-Borne Disease

Suspect tick-borne disease when a patient presents with a flu-like illness +/- a rash in a geographical location consistent with known tick-borne disease. Classically, patients will also present with transaminitis and thrombocytopenia.

Diagnosis can be confirmed with serology, but often, the diagnosis can be made clinically and empiric treatment may need to be initiated before serology has time to return.

Lyme Disease

  • Borrelia Burgdorferi
  • Tick: Ixodes scapularis
  • Geography: Northeastern United States
  • Symptoms
    • Stage I: Erythema migrans, nonspecific flu-like symptoms
    • Stage II: Multiple annular-shaped plaques, AV node block, radiculopathy, Bell’s palsy (may be bilateral), meningoencephalitis
    • Stage III: Weakness, encephalopathy, memory impairment, somnolence, arthritis (Chronic monoarticular arthritis with large effusion; stiffness but minimal pain)
  • Diagnosis: Clinical, serology, lumbar puncture
  • Treatment (1)
    • Stage I: PO Doxycycline or Amoxicillin
    • Lyme carditis: PO Doxycycline if mild, IV Ceftriaxone if severe
    • Neuroborreliosis: PO Doxycycline or IV Ceftriaxone (if more serious, like encephalitis)
    • Lyme arthritis: PO Doxycycline, can use IV Ceftriaxone if PO therapy fails
    • Unilateral or bilateral facial nerve palsy in isolation: PO Doxycycline

Rocky Mountain Spotted Fever

  • Rickettsia rickettsii
  • Tick: Dermacentor sp.
  • Geography: Southeast, south central United States
  • Symptoms: Fever, headache, rash (blanching maculopapular rash spreads from ankles/wrists to trunk)
  • Diagnosis: Serology
  • Treatment: Doxycycline, can use chloramphenicol if doxycycline is contraindicated (i.e. pregnancy) (2)

Human Monocytic Ehrlichiosis

  • Ehrchlichia chaffeensis
  • Tick: Amblyomma americanum, Ixodes scapularis
  • Geography: Southeast, south-central, mid-atlantic United States
  • Symptoms: Flu-like illness, leukopenia
  • Diagnosis:
    • Serology (2-4 weeks after illness)
    • PCR or buffy coat morulae (inracytoplasmic inclusions) to diagnose in acute phase (3)
  • Treatment: Doxycycline

Human Granulocytic Anaplasmosis

  • Anaplasma phagocytophilum
  • Tick: Ixodes scapularis
  • Geography: Northeast United States
  • Symptoms: Flu-like illness
  • Diagnosis: Serology
  • Treatment: Doxycycline

Babesiosis

  • Babesia microti
  • Tick: Ixodes scapularis
  • Geography: Northeast United States
  • Symptoms: Non-specific flu-like symptoms
  • Diagnosis: Serology, intracellular “maltese cross” on peripheral smear
  • Treatment: Atovaquone + azithromycin OR clindamycin + quinine (if severely ill) (4)

Epidemic Typhus

  • Rickettsia prowazekii
  • Louse, NOT actually from a tick
  • Geography: Africa, South America, Asia
  • Symptoms: Fever, headache, malaise, rash (maculopapular, spreads from trunk to ankles/wrists)
  • Diagnosis: Serology
  • Treatment: Doxycycline, can use chloramphenicol if doxycycline is contraindicated (i.e. pregnancy) (5)

References:

  1. Treatment for erythema migrans. (2020, November 03). Retrieved March 17, 2021, from https://www.cdc.gov/lyme/treatment/index.html
  2. Edwin J. Masters, M. (2003, April 14). Rocky Mountain spotted fever. Retrieved March 17, 2021, from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215364
  3. Ehrlichiosis / anaplasmosis. (n.d.). Retrieved March 17, 2021, from https://www.pathologyoutlines.com/topic/bonemarrowHGL.html
  4. CDC – Babesiosis – resources for health professionals. (2019, October 30). Retrieved March 17, 2021, from https://www.cdc.gov/parasites/babesiosis/health_professionals/index.html
  5. Akram, S. (2021, January 31). Rickettsia prowazekii. Retrieved March 17, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK448173/

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