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Tick-borne Illnesses Lecture Flashcards

1
Q

Borrelia burdorferi ss

A

Lyme disease

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2
Q

Babesia microti

A

Human babesiosis

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3
Q

Anaplasma phagocytophila

A

Human granulocytic anaplasmosis

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4
Q
  • Multisystem inflammatory disease
  • Causes by spirochetes: Borrelia burgdorferi – identified in 1981
  • Spread by Ixodes ticks
A

Lyme disease

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5
Q

Transmission: Bite of an infected nymph in the spring

Preferred host: White-tailed deer

A

Lyme disease

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6
Q

Egg
Six-legged larvae
Eight-legged nymph
Adult

A

Life cycle of hard ticks

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7
Q

Adults peak in spring and fall – preferred host is white-tailed deer. Mating occurs.
Nymphs peak May-July – aggressive - frequently bite humans
Larvae peak August-September (from eggs on the ground)

A

Life cycle of Ixodes scapularis

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8
Q

To transmit lyme dz bacterium, ticks must feed for at least…..

A

24 hours

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9
Q

_____ secrete an anesthesia and anticoagulant when biting

A

Ticks

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10
Q

Blacklegged (or deer) ticks (Ixodes scapularis can transmit several tick-borne diseases including:

A

anaplasmosis
babesiosis
Lyme disease

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11
Q

Which type of ticks most commonly bite humans, adult or nymphal?

A

Nymphal

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12
Q

Agent – Anaplasma phagocytophilum
Originally confused with Ehrlichiosis
Tick – Ixodes scapularis
Animal reservoir (deer and white footed mouse)

A

Human Anaplasmosis (aka Human Granulocytic Anaplasmosis)

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13
Q
  • Bacterial infection: Caused by the rickettsial agent Anaplasma phagocytophilum
  • Infects white blood cells: Granulocytes
  • Unknown transmission time from tick: Suspected to be between 24 and 48 hours
A

Human Anaplasmosis

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14
Q

Bacterial diseases
Ehrlichia chaffeensis
Ehrlichia ewingii
Anaplasma phagocytophilum

A

Ehrlichiosis

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15
Q 
Cause is unknown
Rash appearance similar to Lyme disease
Has not been linked to arthritic, neurologic, or chronic symptoms
Transmitted by lone star tick
Most cases found in southeastern US
A

Southern Tick Associated Rash Illness (STARI)

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16
Q

Incubation period – 1 to 2 weeks
Fever, chills, severe headache – common
Malaise, Myalgia, Arthralgia – also common
Cough, GI upset, stiff neck – less common

“summer-flu”

A

Anaplasmosis

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17
Q

Mild anemia
Thrombocytopenia
Leukopenia with a left shift
Mild elevation of LFT’s

A

Anaplasmosis

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18
Q

Anaplasmosis diagnosis is made via…

A

PCR assay for DNA

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19
Q

Four-fold rise in IgG antibody by IFA
Immunochemistry staining of organism
Isolation in cell culture

A

Diagnosis of Anaplasmosis

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20
Q

Anaplasmosis tx for adults…

A

Doxycycline

if Doxy resistant, consider Rifampin

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21
Q

Anaplasmosis tx for kids..

A

start with Doxy, may follow up with Beta-lactam

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22
Q

Parasitic infection:

Caused by protozoa of the Babesia genus (Babesia microti and others)

A

Babesiosis

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23
Q

Infects RBCs

Unknown transmission time from tick

A

Babesiosis

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24
Q 
Tick-borne illness
Protozoa of family Babesiidae
Animals: rodents and small mammals
**enters RBCs and causes hemolysis 
Vector= Ixodid tick
A

Babesiosis

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25
Incubation period.. 1-3 weeks following tick bite. 6-9 weeks following blood transfusion
Babesiosis
26
Fever, chills, sweats Myalgias, arthralgia, fever N/V Exam shows: splenomegaly, hepatomegaly, jaundice
Babesiosis
27
High-level parasitemia (> 10 percent) Significant hemolysis ( plus DIC) Renal, hepatic, pulmonary compromise Risk factors: Age over 50 years Asplenia,Malignancy,HIV,Immunosuppressives
Severe Babesiosis
28
Asymptomatic Disease—Common 1 May not need treatment 2 Can be monitored – clear 4-6 weeks 3 If no underlying disease- watch
Babesiosis
29
Laboratory: Anemia-thrombocytopenia-increased conjugated bilirubin Confirmation: Blood smear- Intra-erythrocytic parasites PCR ** Serology: Indirect immunofluorescent antibody test
Dx of Babesiosis
30
Clindamycin/Quinine or Atovaquone/Azithromycin
First line tx for Babesiosis
31
For severe Babesiosis, tx includes antibiotics plus...
exchange transfusion (until parasitemia is under 5%)
32
``` Erythema migrans (Bull’s eye) rash Muscle and joint pain Fatigue Chills, fever, and headache Swollen lymph nodes ```
Early Lyme dz symptoms
33
Symptoms: Arthralgias (oligoarticular and migratory) Headache (often occipital) Paresthesias (face/arm/leg) No GI or respiratory symptoms
Lyme dz
34
Early localized: Erythema migrants rash (80-90%) and associated symptoms
Lyme disease
35
Early disseminated: Multiple EM rashes, associated symptoms (weeks to months) -Lyme carditis (fluctuating AV Block) - Neurologic SX: Cranial neuritis (7th nerve palsy—can be bilateral) Lymphocytic meningitis Radiculoneuritis
Lyme disease
36
Lyme dz dissemination is greater than _____
6 months
37
- Arthritis (migratory polyarthritis or monoarthritis) | - Neurologic (peripheral axonal neuropathy, mild encephalopathy, encephalomyelitis)
Lyme disease dissemination (greater than 6 mo)
38
What is used to confirm the diagnosis of lyme disease?
Serologic tests
39
Two-test step – Elisa followed by Western Blot: If ELISA positive-test Western blot If ELISA negative-no Western blot Same sample tested by each test
Used in dx of lyme disease
40
Antibiotics in early disease may prevent seroconversion
Lyme dz
41
If less than 4 weeks illness - IgM and IgG tested If more than 4 weeks illness - IgG tested (can also test synovial fluid or CSF)
Lyme disease
42
Treat lyme dz with..
Doxycycline
43
Caused by the bacteria Rickettsia ricketsiae Carried by Dermacenter (hard or dog) ticks Untreated, the mortality is very high
Rocky mountain spotted fever
44
Rickettsia ricketsiae
Rocky mountain spotted fever
45
The disease is usually characterized by a fine skin rash, high fever, headaches and muscle pain Doxycycline and chloramphenicol are very effective in treating the disease Is less common on Nantucket than previously, probably because the dog ticks are less common
Rocky mountain spotted fever
46
Over 90% of cases occur during April-September Peridomestic acquisition may account for majority of cases Age-specific incidence highest in children, disease more frequent in males Case clusters occur in hyperendemic foci
Rocky mountain spotted fever
47
Early: high fever, severe headache, myalgia, and gastrointestinal symptoms Late: rash, photophobia, confusion, ataxia, seizures, cough, dyspnea, arrhythmias, jaundice, severe abdominal pain Thrombocytopenia, hyponatremia Long term sequelae: CNS deficits, amputations
Rocky mountain spotted fever
48
Rash not apparent until 2-5 days after onset of fever Begins as 1 to 5 mm macules, typically on ankles, wrists, and forearms, spreads centripetally to trunk Petechial rash occurs on or after day 6 Rash may be asymmetric, localized, or absent
rocky mountain spotted fever
49
85% of patients lack diagnostic titers in the first week of illness As many as 50% of patients lack a diagnostic titer 7-9 days after onset of illness Need to test acute and convalescent samples (2-4 weeks apart) Indirect immunofluorescence assay (IFA)- four fold rise in titers confirmatory
RMSF
50
Rocky mountain spotted fever DOC
Tetracyclines
51
Less common tickborne dz Bacterial: Francisella tularensis Transmitted by American dog tick, lone star tick, and Rocky Mountain wood tick Other transmission routes include deer fly bites, inhalation, ingestion, skin contact with infected animals Cases found in every state except Hawaii
Tularemia
52
Francisella tularensis Gram negative non-motile non-sporulating cocco-bacillus
Tularemia
53
-Infects small mammals: ground squirrels, rabbits, hares, voles, muskrats, water rats and other rodents -Arthropod vectors: ticks, biting flies, mosquitoes Uncommon zoonosis 125 cases/year in USA farmers, hunters, walkers, forest workers **kills less than 50 people a year worldwide
Tularemia
54
**Highly infectious: inhalation of 10 bacteria can cause disease -Avenues: ingestion (water and food) inhalation direct contact arthropod intermediates animal bites **No person to person spread**
Tularemia
55
Ulceroglandular (
Tularemia
56
Dx made thru... -Culture (high risk to lab!) - Non culture (ELISA, micro agglutination, Western blot, flow cytometry, indirect immunofluorescence) * also PCR!
Tularemia
57
Streptomycin Gentamicin Recommended for....
Tularemia
58
A group of acute infections caused by arthropod born spirochetes of the genus Borrelia. *Characterized by recurrent cycles of febrile episodes, separated by asymptomatic intervals of apparent recovery.
Relapsing fevers
59
Louse-Borne Relapsing Fever (Borrelia recurrentis) Trench Fever (Bartonella quintana) Epidemic typhus (Rickettsia prowazekii)
Body lice diseases
60
Which types of lice spread dz (head, body, pubic)?
only body! (can spread bacterial disease)
61
A single organism, Borrelia recurrentis, is the cause of louse borne....
relapsing fever
62
In ____ Borreli duttoni, and Borrelia croicuidare are the predominant species.
Africa
63
______ are slender actively motile spirochetes. | and measure10-20µ long and 0.2-0.5µ wide, with 4-10 loose coils.
Borrelia
64
Portal of entry, infected lice crushed into abraded skin. Incubation period, 5-10 days. High level spirochetemia. Patients’ producing neutralizing antibodies, clearing of the circulating strain Borrelia in 3-5 days
Relapsing fever
65
Aims of Management: Clinical cure Prevention of relapse Prevention/treatment of complications ``` Antibiotic treatment: Penicillin Tetracycline Chloramphenicol Erythromycin ```
Borrelia relapsing fever

Infectious Disease (9 decks)

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