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ICM - Infectious Disease > Tick Borne diseases and Malaria > Flashcards

Tick Borne diseases and Malaria Flashcards

1
Q

Three major diseases from Ticks

A

Lyme disease, Rocky mountain, spotted fever, Human monocytotropic ehrlichiosis

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2
Q

Lyme disease organism and vector

A

Borrelia Burgdorferi; Ixodes tick(Deer tick or Blacklegged ticks)

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3
Q

RMSF organism and vector

A

Rickettsia rickettsii; American dog tick

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4
Q

Ehrlichiosis organism and vector

A

Ehrlichia chaffeensis; Lone star tick

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5
Q

Description of Borrelia burgdorferi

A

Spirochete

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6
Q

Reported cases of lyme disease

A

Endemic to parts of the Northeast and Upper Midwest

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7
Q

Stage 1 of Lyme disease

A
  • localized(incubation 3-32 days)

- rash(Erythema migrans)

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8
Q

Stage 2 of Lyme disease

A
  • disseminated
  • multiple annular skin lesions
  • meningitis(headache, fever, stiff neck)
  • cranial neuritis(CN 7)
  • carditis(AV block)
  • arthralgia
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9
Q

Stage 3 of Lyme disease

A
  • persistent
  • oligoarticular arthritis(knee joints)
  • encephalopathy(mood, memory, sleep disturbance)
  • axonal polyneuropathy(tingling feet, weakness)
  • acrodermatitis
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10
Q

Description of an erythema migrans

A

central clearing and a necrotic center

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11
Q

Vesicular erythema migrans

A

-vesicles may appear near the center of erythema migrants lesions

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12
Q

Physical findings of Cranial nerve 7 palsy

A
  • inability to raise the left eyebrow or generate wrinkles on the left side of the forehead
  • difficulty closing the left eye and inability to raise the left corner of mouth
  • demonstrates drooping at the left corner of mouth, loss of the left nasolabial fold, and inability to complete close the left eye
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13
Q

Differential diagnosis of CN 7 palsy

A
  • idiopathic(Bell’s Palsy)
  • HSV(herpes simplex virus); usually no rash
  • herpes zoster(ramsay hunt syndrome); vesicles in the external auditory canal
  • lyme disease
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14
Q

Post lyme syndrome

A
  • “Chronic lyme disease”
  • pain syndrome(arthralgias), chronic fatigue, neurocognitive symptoms
  • symptoms occur for years after eradication of infection
  • symptoms may be indistinguishable from chronic fatigue or fibromyalgia
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15
Q

Serologic testing of lyme disease

A
  • IgM and IgG
  • often retrospective diagnosis using paired sera
  • acute and convalescent, draw at presentation and 2-4wks later
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16
Q

ELISA and Western blot verification

A

-similar to older HIV testing methods

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17
Q

PCR

A
  • arthrocentesis of joint fluid done in patient with arthritis
  • low sensitivity in CSF
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18
Q

Treatment of Lyme disease

A

Doxycycline

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19
Q

Prevention of Lyme disease

A
  • no human vaccine available

- examine self, use insecticides with DEET, tuck pants into socks, permethrin insecticides, insect shieldEpid clothing

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20
Q

Description of Rickettsia rickettsii

A

-small, obligate intracellular gram - bacilli

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21
Q

Tropism of Rickettsia rickettsii

A

vascular endothelial cells

22
Q

Epidemiology of Rickettsia rickettsii

A

Generally widespread, concentrated in mid america

23
Q

Incubation period of Rickettsia rickettsii

A

-1 week

24
Q

Pathophysiology of Rickettsia rickettsii

A
  • increased vascular permeability
  • edema, hypovolemia
  • hyponatremia following compensatory ADH release
  • thrombocytopenia
  • DIC rare
25
Q

Clinical presentation of Rickettsia rickettsii

A

Classic triad = Fever, rash, history of tick exposure

-fever, headache, malaise, myalgia

26
Q

Rash of RMSF

A
  • begins as faint merciless
  • progresses to vasculitis rash
  • petechiae
  • palms and soles potential
27
Q

Progressive disease of RMSF

A
  • hypovolemia, hypotension, fluid third spacing
  • respiratory failure
  • cardiac dysrhythmia
  • CNS symptoms(confusion, lethargy, encephalopathy)
  • ATN(acute tubular necrosis)
  • shock
  • elevated transaminase(acute hepatitis/liver failure)
28
Q

Definition of thrombocytopenia

A

low platelets

29
Q

Definition of hyponatremia

A

low sodium

30
Q

Definition of azotemia

A

-increased BUN, potentially increased creatinine if ATN develops

31
Q

Testing for R. rickettsii

A
  • no completely reliable test in early stages of disease
  • skin biopsy of lesion with direct immunofluorescence staining(obtain before or within 12hrs of antibiotic therapy)
  • serologic testing of IgM and IgG(first set of sera after 5days of illness, second set 14-21days after symptoms onset)
32
Q

Limited differential diagnosis of patient with fever, petechial rash on palms and soles, potential tick exposure

A
  • meningococcal disease
  • Tick borne disease, RMSF
  • enteroviral disease
  • secondary syphilis
  • rubella
  • drug eruption
  • kawasaki disease
  • coxsackie virus(hand foot and mouth disease)
33
Q

Treatment of RMSF

A

Ceftriaxone and Doxycycline therapy for both meningococcal disease and RMSF

34
Q

Treatment of RMSF

A
  • doxycycline for adults and children
  • not for pregnant women
  • dental staining in children
35
Q

RMSF and chloramphenicol

A

-pregnant women

36
Q

Description of Ehrlichia chaffeensis

A

obligate intracellular organism

37
Q

Incubation period of ehrlichiosis

A

~ 8 days

38
Q

Symptoms of Ehrlichiosis

A

fever, headache, mylagias

39
Q

Lab findings of ehrlichiosis

A

leukopenia, thrombocytopenia, elevated transaminases

40
Q

Treatment of ehrlichiosis

A

Doxycycline

41
Q

Area for Malaria

A

-tropical climates

42
Q

Organism and vector of Malaria

A

Plasmodium species; Anopheles mosquito

43
Q

Interesting fact about Pathological Hb disorder

A

Hemoglobinopathy map echoes malaria map

44
Q

Review chart of malaria species

A

Go to notes

45
Q

Plasmodium life cycle

A
  1. Sporozoites have trophism for hepatocytes
  2. asexual reproduction in hepatocytes
  3. release into bloodstream
  4. hijacking of RBC and degradation of hemoglobin, formation of ring forms
  5. lyse RBC and release merozoites to invade more RBC, or gametocytes to reinfect mosquitos(hemolytic anemia => direct hyperbilirubinemia = jaundice)
  6. Pvivax and Povale can produce dormant hypnozoites in hepatocytes, can reactivate in 3-12months
46
Q

Clinical features of patient presentation

A

headache, fatigue, myalgias, abdominal pain, fever, seizures(Pfalciparum), paroxysmal chills(Pvivax, ovale)

47
Q

Clinical presentation malaria

A

fever, mild hepatomegaly, mild icterus(jaundice), palpable spleen, rash is unusual

48
Q

Complications of P falciparum

A
  • sequestration and agglutination in vasculature, including CNS
  • cerebral malaria(seizures, encephalopathy, coma)
  • hypoglycemia
  • metabolic acidosis(hypoperfusion and lactic acidemia)
  • noncardiogenic pulmonary edema(ARDS)
  • renal impairment(ATN)
  • hematologic abnormalities(anemia)
  • liver dysfunction(cholestasis, acute hepatitis)
49
Q

Diagnostic testing for malaria

A
  • light microscopy of giemsa -stained blood smear
  • thick and thin blood smears, pathologist evaluation for ring forms and estimation of parasite load
  • thick blood smears concentrate parasites, increases diagnostic sensitivity
  • rapid diagnostic test, antigen detection
50
Q

Lab findings

A
  • normocytic normochromic anemia

- increased acute phase reactants(ESR and CRP)

51
Q

Treatment of malaria

A
  • non falciparum and chloroquine sensitive = chloroquine
  • p falciparum and chloroquine sensitive = chloroquine
  • chloroquine insensitive = Arteminsin-based combinations
52
Q

Preventive drugs

A
  • malarone
  • doxycycline
  • chloroquine
  • mefloquine - CNS side effects

ICM - Infectious Disease (4 decks)

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