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ICM - Infectious Disease > Tick Bourne Diseases and Malaria > Flashcards

Tick Bourne Diseases and Malaria Flashcards

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1
Q

Ixodes tick. Disease and organism.

A

Borrelia burgdorferi

Lyme Disease

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2
Q

American dog tick. Disease and organism.

A

Rickettsia rickettsii

Rocky Mountain Spotted

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3
Q

Lone Star Tick. Disease and organism.

A

Ehrlichia chaffeensis

Human monocytotropic ehrlichiosis

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4
Q

Sole vector of borrelia burg. in the eastern US?

A

Blacklegged tick/Deer tick

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5
Q

Stage 1/3 of Lyme disease

A

Localized Rash (Erythema migrans)

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6
Q

Stage 2/3 of Lyme disease

A 
Disseminated
Multiple annular skin lesions
Meningitis
Cranial Neuritis
Carditis
Arthralgia
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7
Q

Stage 3/3 of Lyme disease

A 
Persistent...
Oligoarticular arthritis
Encephalopathy
Axonal Polyneuritis
Acrodermatitis
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8
Q

What is acrodermatitis

A

Skin changes of hands and feet

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9
Q

Rickettsia riskkettsii causes ______ by its trophism for _______

A

Rocky Mountain Spotted Fever

Vascular Endothelial Cells

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10
Q

Incubation period for Rocky Mountain Spotted Fever?

A

1 week

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11
Q

How does Rocky Mountain Spotted Fever vasculitis (the basic pathology) happen?

A 
Increased vascular permeability
Edema, hypovolemia
*Hyponatremia
*Thrombocytopenia
Rare DIC
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12
Q

Classic presentation of Rocky Mountain Spotted Fever

A

Fever+Rash+History of Tick Exposure
Headache
Malaise
Myalgia

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13
Q

Describe the rash in Rocky Mountain Spotted Fever

A

Fait macules –> petichiae –> purpura
Involvement of palms and soles
Non-blanching

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14
Q

Progression of Rocky Mountain Spotted Fever

A

Tick, Fever, Rash

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15
Q

SYmptoms of Rocky Mountain Spotted Fever?

A 
Hypovolemia, hypotension
Respiratory failure
Cardia arrythmia
CNS (confusion, lethargy, enceph)
Acute Tubular Necrosis
Shock
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16
Q

What are you looking for in Rocky Mountain Spotted Fever Lab Testing?

A

Thrombocytopenia (low platelets)
Hyponatremia (low sodium)
Azotemia (high BUN)

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17
Q

Important non CBC tests to run for Rocky Mountain Spotted Fever

A 
Skin Biopsy
Serologic testing (of IgM and G)
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18
Q

Three factors that tend to cause physicians to fail to treat Rocky Mountain Spotted Fever

A

Absence of a skin rash
Presentation within the first 3 days
Presentation between Aug 1 and April 30 (not commonly tick season)

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19
Q

Drug of choice for Rocky Mountain Spotted Fever treatment? If you’re pregnant?

A

Normal –> Doxycycline

Preggers –> Chloramphenicol

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20
Q

Way to identify a Lone Star Tick (Ehrlichiosis)

A

White spot on the back

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21
Q

Incubation period for Ehrlichiosis?

A

usually about 8 days

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22
Q

Symptoms of Ehrlichiosis

A

Fever
Headache
Myalgias

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23
Q

Lab findings in an Ehrlichiosis patient

A

Leukopenia
Thrombocytopenia
Elevated transaminases

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24
Q

Treatment for Ehrlichiosis?

A

Doxycycline

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25
Vector for Malaria?
Anopheles freeborni mosquito
26
Causative agent of Malaria
Plasmodium species
27
Most severe disease for Malaria?
falciparum
28
Differential diagnosis for CN7 Palsy
Idiopathic (Bell's Palsy) HSV (Herpes Simplex Virus) -- No rash Herpes Zoster - Ramsay Hunt Syndrome (vesicles in the external auditory Lyme Disease
29
Symptoms of Chronic Lyme Disease
Pain syndrome (arthralgias) Chronic Fatigue Neurocognitive Symptoms
30
Treatment for Lyme Disease
Doxycycline
31
Diagnosis of Lyme Disease
Serologic Testing - IgM and IgG ELISA with Western Blot verification PCR of joint fluid
32
Tick prevention methods
``` Examine self after exposure Insecticides with DEET Tuck pants in socks Pre-treat clothes with permethrin insectisides Insect Shield ```
33
Differential diagnosis for fever, petechial rash on pales and soles, potential tick exposure
``` Meningococcal Disease Tick Bourne Disease -- RMSF Enteroviral disease secondary syph Rubella Drug eruption Kawasaki Coxsackie virus ```
34
Empiric therapy for meningococcal disease and RMSF
Ceftriaxone and Doxycycline
35
Lyme Disease Symptoms may be indistinguishable from
Chronic Fatigue Syndrome, Fibromyalgia
36
Difference between original presenting symptoms listed for Rocky Mountain and Ehrlichia?
Nausea with Rocky Mountain
37
Difference between CBC findings in Rocky Mountain and Ehrlichia?
RMSF -- hyponatremia, | Ehr -- Leukopenia
38
Similarities in CBC findings for RMSF and Ehrl.
Thrombocytopenia | Elevated Transaminase Levels
39
Incubation periods for RMSF and Ehrl.
RMSF -- 2-14 days | Ehrl. -- 5-14 days
40
What part of the tick do you check to identify when it is engorged?
Scutum
41
You should probably go back to the powerpoint and peek at the photos of the ticks again.
Seems like a reasonable thing to do?
42
The less commonly killing forms of malaria
P. vivax P. ovale P. mararae P. knowlesi
43
Talk through the Malaria life cycle | Bryan -- actually make yourself do this
1. Plasmodium sporozoites have trophism for hepatocytes 2. Asexual reproduction in hepatocytes 3. Release into bloodstream 4. Hijacking of RBC, Degradation of hemoglobin, Formation of Ring forms 5. Lyse RBC, release merozytes infect more RBC, or gametocytes to reinfect mosquitos (hemolytic anemia --> direct hyperbilirubinemia = Jaundice)
44
Additions to the life cycle for P vivax and P ovale
Can produce dormant hypnozoites in hepatocytes | Can reactivate in 3-12 months
45
Clinica features of malaria patient
FEVER Exposure to an endemic area Lack of prophylactic treatment Headache, Fatigue, Myalgias, Abdominal Pain
46
Seizures suggest which form of malaria?
P. falciparum infection
47
Paroxysmal chills, Fever, Rigors suggest what form of malaria?
P vivax or ovale | Caused by hepatic sequestration and re-release
48
Physical findings in a malaria patient
``` Fever Hepatomegaly Icterus (Jaundice) Palpable SPleen Rarely a rash, if so think of other diagnoses ```
49
What can happen with P falciparum in the vasculature
Sequestration and Agglutination
50
Severe abnormalities associated with P falciparum patients
Cerebral malaria (seizures, encephalopathy, coma) Hypoglycemia (poor prognostic sign, loss of hepatic gluconeogenesis) Metabolic Acidosis (Lactic acidemia from hypoperfusion) Noncardiogenic Pulmonary edema (ARDS) Renal Impairment (ATN) Hematologic Abnormalities (anemia) Liver Dysfunction (Cholestasis, Hepatitis)
51
Diagnostic testing for malaria
Light microscopy of Giemsa-stained blood smear Thick and Thin Blood Smears Rapid diagnostic tests w/ antigen detection
52
Reason you need Thick AND Thin blood smears
Thick -- Concentrated Parasites, Increased Sensitivity | Thin -- Pathologists can eval for ring forms and estimate parasite load
53
CBC findings in Malaria
Normocytic, normochromic anemia | Increased Acute phase reactants (ESR, CRP)
54
Treatment for Non-Falciparum Malaria
Chloroquine (if sensitive in that region)
55
Treatment for Falciparum Malaria
If def chloroquine sensitive, chloroquine | If unsure, Arteminsin-based combinations
56
Malaria prevention methods
Mosquito tents Insect repellants Preventative treatment in travelers
57
Which malaria drugs do you not give pregnant women?
Atovaquone-proguanil Doxy hydrate Primaquine
58
Which malaria drug has CNS side effects
Mefloquine
59
Three commonly used malaria drugs mentioned
Malarone Doxycycline Chloroquine
60
Important Malarone details?
Easy to tolerate, short lead up/follow up | Generic and Inexpensive
61
Important Doxy details?
``` Was inexpensive (apparently less so now) Have to take for 4 weeks after you're back ```
62
Important chloroquine details?
Generic, Inexpensive, Easy to tolerate

ICM - Infectious Disease (11 decks)

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