Tick-borne infections: Difference between revisions
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− | == |
+ | ==Clinical Manifestations== |
− | * |
+ | *Many of the diseases should be suspected in patients with: |
− | ** |
+ | **Flu-like illness that occurs not in flu season |
− | ** |
+ | **± cytopenias, ± liver enzyme abnormalities |
− | ** |
+ | **Exposure history (outdoors activities, rats) |
− | == |
+ | ==By Disease== |
+ | ===Common Diseases=== |
||
{| class="wikitable" |
{| class="wikitable" |
||
! |
! |
||
− | ! |
+ | ![[Lyme disease]] |
− | ! |
+ | ![[Babesiosis]] |
− | ! |
+ | ![[Anaplasmosis]] |
− | ! |
+ | ![[Ehrlichiosis]] |
− | ! |
+ | ![[RMSF]] |
|- |
|- |
||
− | | |
+ | |Pathogen |
− | | |
+ | |''[[Borrelia burgdorferi|B. burgdorferi]]'' |
− | | |
+ | |''[[Babesia microti|B. microti]]'' |
− | | |
+ | |''[[Anaplasma phagocytophilum|A. phagocytophilum]]'' |
− | | |
+ | |''[[Ehrlichia chaffeensis|E. chaffeensis]]'' |
− | | |
+ | |''[[Rickettsia rickettsii|R. rickettsii]]'' |
|- |
|- |
||
− | | |
+ | |Incubation |
− | | |
+ | |2-3 wk |
− | | |
+ | |1-4 wk |
− | | |
+ | |5-14 d |
− | | |
+ | |5-14 d |
− | | |
+ | |3-12 d |
|- |
|- |
||
− | | |
+ | |Tick |
− | | |
+ | |[[Black-legged tick]] |
− | | |
+ | |[[Black-legged tick]] |
− | | |
+ | |[[Black-legged tick]] |
− | | |
+ | |[[Black-legged tick]], [[Lonestar tick]] |
− | | |
+ | |[[American dog tick]] |
|- |
|- |
||
− | | |
+ | |Symptoms |
− | | |
+ | |Fever |
− | | |
+ | |Fever, headache, nausea/vomiting, diarrhea |
− | | |
+ | |Fever, headache |
− | | |
+ | |Fever, headache, myalgias, nausea/vomiting |
− | | |
+ | |Fever, headache |
|- |
|- |
||
− | | |
+ | |Cells |
+ | |Disseminated |
||
− | | Disseminates |
||
− | | |
+ | |Erythrocytes |
− | | |
+ | |Granulocytes |
− | | |
+ | |Monocytes |
− | | |
+ | |Vascular endothelial |
|- |
|- |
||
− | | |
+ | |Rash |
− | | |
+ | |[[Erythema migrans]] |
− | | |
+ | |Rare |
− | | |
+ | |Rare |
− | | |
+ | |Maculopapular (30%) |
− | | |
+ | |Maculopapular; eschar with ''R. parkeri'' |
|- |
|- |
||
− | | |
+ | |Labs |
− | | |
+ | |Uncommon |
− | | |
+ | |[[Hemolytic anemia]], [[thrombocytopenia]], liver enzymes |
− | | |
+ | |[[Leukopenia]], liver enzymes, [[thrombocytopenia]] |
− | | |
+ | |[[Leukopenia]] ± [[lymphocytosis]], liver enzymes, [[thrombocytopenia]] |
− | | |
+ | |[[Thrombocytopenia]], liver enzymes, [[hyponatremia]] |
|- |
|- |
||
− | | |
+ | |Complications |
− | | |
+ | |[[Carditis]], neurological symptoms, [[arthritis]] |
− | | |
+ | |[[DIC]], [[ARDS]], [[CHF]], [[AKI]] |
− | | |
+ | |Opportunistic infections, [[shock]] |
− | | |
+ | |[[Seizure]], [[coma]], [[CHF]], [[pericardial effusion]], [[shock]] |
− | | |
+ | |[[Coma]]/[[seizure]] (30%) |
|- |
|- |
||
− | | |
+ | |Diagnosis |
− | | |
+ | |EM, serology |
− | | |
+ | |Microscopy |
− | | |
+ | |Serology, ±microscopy |
− | | |
+ | |Serology, ±microscopy |
− | | |
+ | |Serology, biopsy |
|- |
|- |
||
− | | |
+ | |Mortality |
− | | |
+ | |Rare |
− | | |
+ | |3-20% |
− | | |
+ | |7-10% |
− | | |
+ | |2-5% |
− | | |
+ | |8% |
|- |
|- |
||
− | | |
+ | |Treatment |
− | | |
+ | |[[Doxycycline]] |
− | | |
+ | |[[Azithromycin]], [[Atovaquone]] |
− | | |
+ | |[[Doxycycline]] |
− | | |
+ | |[[Doxycycline]] |
− | | |
+ | |[[Doxycycline]] |
|} |
|} |
||
− | == |
+ | ===Other Diseases=== |
+ | {| class="wikitable" |
||
+ | !Disease |
||
+ | !Vector |
||
+ | !Clinical Manifestations |
||
+ | |- |
||
+ | |[[African tick-bite fever]] |
||
+ | |[[Amblyomma]] |
||
+ | |fever with eschar in Africa |
||
+ | |- |
||
+ | |[[Mediterranean spotted fever]] |
||
+ | |[[Rhipicephalus sanguineus]] |
||
+ | |fever with eschar in the Mediterranean |
||
+ | |- |
||
+ | |[[Powassan virus]] |
||
+ | |[[Ixodes]] |
||
+ | |[[Encephalitis with lymphadenopathy|encephalitis]] in North America |
||
+ | |- |
||
+ | |[[Rickettsioses]], not otherwise specified |
||
+ | |multiple |
||
+ | |fever ±rash ±ulcer |
||
+ | |- |
||
+ | |[[Rocky Mountain spotted fever]] |
||
+ | |multiple |
||
+ | |fever with cetripetal rash in North America |
||
+ | |- |
||
+ | |[[Southern tick-associated rash illness]] |
||
+ | |[[Amblyomma americanum]] |
||
+ | |[[erythema migrans]] in the southern US |
||
+ | |- |
||
+ | |[[Tick-borne encephalitis]] |
||
+ | |[[Ixodes]] |
||
+ | |biphasic: flu-like illness followed by [[meningoencephalitis]] |
||
+ | |- |
||
+ | |[[Tick-borne relapsing fever]] |
||
+ | |[[Ornithodorus]] |
||
+ | |relapsing-remitting febrile illness (3 days on, 7 off) |
||
+ | |- |
||
+ | |[[Tick paralysis]] |
||
+ | |[[Dermacentor]] |
||
+ | |ascending paralysis with preserved sensation |
||
+ | |- |
||
+ | |[[Tularemia]] |
||
+ | |multiple |
||
+ | |severe flu-like illness ±ulcer ±lymphadenopathy |
||
+ | |} |
||
+ | |||
+ | ==By Tick== |
||
{| class="wikitable" |
{| class="wikitable" |
||
− | ! |
+ | !Tick |
− | ! |
+ | !Distribution |
− | ! |
+ | !Transmits |
− | ! |
+ | !Comments |
|- |
|- |
||
− | | |
+ | |American dog tick (''[[Dermacentor variabilis]]'') |
− | | |
+ | |East of the Rockies, and in limited areas in the Pacific coast |
− | | |
+ | |[[Tularemia]] and [[RMSF]] |
− | | |
+ | |Highest risk of bites in spring and summer. Sometimes called wood ticks. |
|- |
|- |
||
− | | |
+ | |Blacklegged (deer) tick (''[[Ixodes scapularis]]'') |
− | | |
+ | |Across the eastern US and in Ontario |
− | | |
+ | |[[Lyme disease]], [[Anaplasma]], ''[[B. miyamotoi]]'', [[ehrlichiosis]], [[babesiosis]], and [[Powassan virus]] |
− | | |
+ | |Highest risk in spring through fall, but can be found any time it's above freezing. |
|- |
|- |
||
− | | |
+ | |Brown dog tick (''[[Rhipicephalus sanguineus]]'') |
− | | |
+ | |Worldwide |
− | | |
+ | |[[RMSF]] (uncommon) |
− | | |
+ | |Dogs are the primary host but it can also bite humans. |
|- |
|- |
||
− | | |
+ | |Gulf Coast tick (''[[Amblyomma maculatum]]'') |
− | | |
+ | |Coastal areas along the Guld of Mexico and southern Atlantic |
− | | |
+ | |''[[Rickettsia parkeri]]'' |
| |
| |
||
|- |
|- |
||
− | | |
+ | |Lone Star tick (''[[Amblyomma americanum]]'') |
− | | |
+ | |Southeastern and eastern United States |
− | | |
+ | |[[Ehrlichiosis]], [[Heartland virus]], [[tularemia]], [[STARI]] |
− | | |
+ | |Very aggressive tick. Irritation at site does not indicate infection. |
|- |
|- |
||
− | | |
+ | |Rocky Mountain wood tick (''[[Dermacentor andersoni]]'') |
− | | |
+ | |Rocky Mountains and southwestern Canada from elevations of 4,000 to 10,500 feet |
− | | |
+ | |[[RMSF]], [[Colorado tick fever]], and [[tularemia]] |
| |
| |
||
|- |
|- |
||
− | | |
+ | |Western blacklegged tick (''[[Ixodes pacificus]]'') |
− | | |
+ | |Pacific coast of the U.S., particularly northern California |
− | | |
+ | |[[Anaplasmosis]] and [[Lyme disease]] |
+ | |- |
||
+ | |Soft tick (''[[Ornithodoros]]'' species) |
||
| |
| |
||
+ | |[[Tick-borne relapsing fever]] (non-Lyme ''[[Borrelia]]'' species) |
||
+ | |Short feeds at night, associated with rodents |
||
|} |
|} |
||
+ | ==Further Reading== |
||
+ | |||
+ | *[https://tickencounter.org/tick_identification/tick_species TickEncounter tick identification], hosted by the University of Rhode Island |
||
[[Category:Vector-borne infections]] |
[[Category:Vector-borne infections]] |
Latest revision as of 22:31, 16 September 2022
Clinical Manifestations
- Many of the diseases should be suspected in patients with:
- Flu-like illness that occurs not in flu season
- ± cytopenias, ± liver enzyme abnormalities
- Exposure history (outdoors activities, rats)
By Disease
Common Diseases
Lyme disease | Babesiosis | Anaplasmosis | Ehrlichiosis | RMSF | |
---|---|---|---|---|---|
Pathogen | B. burgdorferi | B. microti | A. phagocytophilum | E. chaffeensis | R. rickettsii |
Incubation | 2-3 wk | 1-4 wk | 5-14 d | 5-14 d | 3-12 d |
Tick | Black-legged tick | Black-legged tick | Black-legged tick | Black-legged tick, Lonestar tick | American dog tick |
Symptoms | Fever | Fever, headache, nausea/vomiting, diarrhea | Fever, headache | Fever, headache, myalgias, nausea/vomiting | Fever, headache |
Cells | Disseminated | Erythrocytes | Granulocytes | Monocytes | Vascular endothelial |
Rash | Erythema migrans | Rare | Rare | Maculopapular (30%) | Maculopapular; eschar with R. parkeri |
Labs | Uncommon | Hemolytic anemia, thrombocytopenia, liver enzymes | Leukopenia, liver enzymes, thrombocytopenia | Leukopenia ± lymphocytosis, liver enzymes, thrombocytopenia | Thrombocytopenia, liver enzymes, hyponatremia |
Complications | Carditis, neurological symptoms, arthritis | DIC, ARDS, CHF, AKI | Opportunistic infections, shock | Seizure, coma, CHF, pericardial effusion, shock | Coma/seizure (30%) |
Diagnosis | EM, serology | Microscopy | Serology, ±microscopy | Serology, ±microscopy | Serology, biopsy |
Mortality | Rare | 3-20% | 7-10% | 2-5% | 8% |
Treatment | Doxycycline | Azithromycin, Atovaquone | Doxycycline | Doxycycline | Doxycycline |
Other Diseases
Disease | Vector | Clinical Manifestations |
---|---|---|
African tick-bite fever | Amblyomma | fever with eschar in Africa |
Mediterranean spotted fever | Rhipicephalus sanguineus | fever with eschar in the Mediterranean |
Powassan virus | Ixodes | encephalitis in North America |
Rickettsioses, not otherwise specified | multiple | fever ±rash ±ulcer |
Rocky Mountain spotted fever | multiple | fever with cetripetal rash in North America |
Southern tick-associated rash illness | Amblyomma americanum | erythema migrans in the southern US |
Tick-borne encephalitis | Ixodes | biphasic: flu-like illness followed by meningoencephalitis |
Tick-borne relapsing fever | Ornithodorus | relapsing-remitting febrile illness (3 days on, 7 off) |
Tick paralysis | Dermacentor | ascending paralysis with preserved sensation |
Tularemia | multiple | severe flu-like illness ±ulcer ±lymphadenopathy |
By Tick
Tick | Distribution | Transmits | Comments |
---|---|---|---|
American dog tick (Dermacentor variabilis) | East of the Rockies, and in limited areas in the Pacific coast | Tularemia and RMSF | Highest risk of bites in spring and summer. Sometimes called wood ticks. |
Blacklegged (deer) tick (Ixodes scapularis) | Across the eastern US and in Ontario | Lyme disease, Anaplasma, B. miyamotoi, ehrlichiosis, babesiosis, and Powassan virus | Highest risk in spring through fall, but can be found any time it's above freezing. |
Brown dog tick (Rhipicephalus sanguineus) | Worldwide | RMSF (uncommon) | Dogs are the primary host but it can also bite humans. |
Gulf Coast tick (Amblyomma maculatum) | Coastal areas along the Guld of Mexico and southern Atlantic | Rickettsia parkeri | |
Lone Star tick (Amblyomma americanum) | Southeastern and eastern United States | Ehrlichiosis, Heartland virus, tularemia, STARI | Very aggressive tick. Irritation at site does not indicate infection. |
Rocky Mountain wood tick (Dermacentor andersoni) | Rocky Mountains and southwestern Canada from elevations of 4,000 to 10,500 feet | RMSF, Colorado tick fever, and tularemia | |
Western blacklegged tick (Ixodes pacificus) | Pacific coast of the U.S., particularly northern California | Anaplasmosis and Lyme disease | |
Soft tick (Ornithodoros species) | Tick-borne relapsing fever (non-Lyme Borrelia species) | Short feeds at night, associated with rodents |
Further Reading
- TickEncounter tick identification, hosted by the University of Rhode Island