Tick-borne infections: Difference between revisions

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== Clinical Presentation ==
 +
==Clinical Manifestations==
   
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* Many of the diseases should be suspected in patients with:
 +
*Many of the diseases should be suspected in patients with:
βˆ’
** Flu-like illness that occurs not in flu season
 +
**Flu-like illness that occurs not in flu season
βˆ’
** Β± cytopenias, Β± liver enzyme abnormalities
 +
**Β± cytopenias, Β± liver enzyme abnormalities
βˆ’
** Exposure history (outdoors activities, rats)
 +
**Exposure history (outdoors activities, rats)
   
βˆ’
== Diseases ==
 +
==By Disease==
   
  +
===Common Diseases===
 
{| class="wikitable"
  
{| class="wikitable"
 
!
  
!
βˆ’
! Lyme disease
 +
![[Lyme disease]]
βˆ’
! Babesiosis
 +
![[Babesiosis]]
βˆ’
! Anaplasmosis
 +
![[Anaplasmosis]]
βˆ’
! Ehrlichiosis
 +
![[Ehrlichiosis]]
βˆ’
! RMSF
 +
![[RMSF]]
 
|-
  
|-
βˆ’
| Pathogen
 +
|Pathogen
βˆ’
| ''[[B. burgdorferi]]''
 +
|''[[Borrelia burgdorferi|B. burgdorferi]]''
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| ''[[B. microti]]''
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|''[[Babesia microti|B. microti]]''
βˆ’
| ''[[A. phagocytophilum]]''
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|''[[Anaplasma phagocytophilum|A. phagocytophilum]]''
βˆ’
| ''[[E. chaffeensis]]''
 +
|''[[Ehrlichia chaffeensis|E. chaffeensis]]''
βˆ’
| ''[[R. rickettsii]]''
 +
|''[[Rickettsia rickettsii|R. rickettsii]]''
 
|-
  
|-
βˆ’
| Incubation
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|Incubation
βˆ’
| 2-3 wk
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|2-3 wk
βˆ’
| 1-4 wk
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|1-4 wk
βˆ’
| 5-14 d
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|5-14 d
βˆ’
| 5-14 d
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|5-14 d
βˆ’
| 3-12 d
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|3-12 d
 
|-
  
|-
βˆ’
| Tick
 +
|Tick
βˆ’
| Black-legged
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|[[Black-legged tick]]
βˆ’
| Black-legged
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|[[Black-legged tick]]
βˆ’
| Black-legged
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|[[Black-legged tick]]
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| Black-legged, Lonestar
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|[[Black-legged tick]], [[Lonestar tick]]
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| American dog
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|[[American dog tick]]
 
|-
  
|-
βˆ’
| Symptoms
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|Symptoms
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| Fever
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|Fever
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| Fever, HA, n/v/d
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|Fever, headache, nausea/vomiting, diarrhea
βˆ’
| Fever, HA
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|Fever, headache
βˆ’
| Fever, HA, myalgias, n/v
 +
|Fever, headache, myalgias, nausea/vomiting
βˆ’
| Fever, HA
 +
|Fever, headache
 
|-
  
|-
βˆ’
| Cells
 +
|Cells
  +
|Disseminated
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| Disseminates
  
βˆ’
| Erythrocytes
 +
|Erythrocytes
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| Granulocytes
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|Granulocytes
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| Monocytes
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|Monocytes
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| Vascular endothelial
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|Vascular endothelial
 
|-
  
|-
βˆ’
| Rash
 +
|Rash
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| Erythema migrans
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|[[Erythema migrans]]
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| Rare
 +
|Rare
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| Rare
 +
|Rare
βˆ’
| Maculopapular (30%)
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|Maculopapular (30%)
βˆ’
| Maculopapular; Eschar with ''R. parkeri''
 +
|Maculopapular; eschar with ''R. parkeri''
 
|-
  
|-
βˆ’
| Labs
 +
|Labs
βˆ’
| Uncommon
 +
|Uncommon
βˆ’
| Hemolytic anemia, thrombocytopenia, liver enzymes
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|[[Hemolytic anemia]], [[thrombocytopenia]], liver enzymes
βˆ’
| Leukopenia, liver enzymes, thrombocytopenia
 +
|[[Leukopenia]], liver enzymes, [[thrombocytopenia]]
βˆ’
| Leukopenia Β± lymphocytosis, liver enzymes, thrombocytopenia
 +
|[[Leukopenia]] Β± [[lymphocytosis]], liver enzymes, [[thrombocytopenia]]
βˆ’
| Thrombocytopenia, liver enzymes, hyponatremia
 +
|[[Thrombocytopenia]], liver enzymes, [[hyponatremia]]
 
|-
  
|-
βˆ’
| Complications
 +
|Complications
βˆ’
| Carditis, neuro sx, arthritis
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|[[Carditis]], neurological symptoms, [[arthritis]]
βˆ’
| DIC, ARDS, CHF, AKI
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|[[DIC]], [[ARDS]], [[CHF]], [[AKI]]
βˆ’
| Opportunistic infections, shock
 +
|Opportunistic infections, [[shock]]
βˆ’
| Seizure, coma, CHF, pericardial effusion, shock
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|[[Seizure]], [[coma]], [[CHF]], [[pericardial effusion]], [[shock]]
βˆ’
| Coma/seizure (30%)
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|[[Coma]]/[[seizure]] (30%)
 
|-
  
|-
βˆ’
| Diagnosis
 +
|Diagnosis
βˆ’
| EM, serology
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|EM, serology
βˆ’
| Microscopy
 +
|Microscopy
βˆ’
| Serology, Β±microscopy
 +
|Serology, Β±microscopy
βˆ’
| Serology, Β±microscopy
 +
|Serology, Β±microscopy
βˆ’
| Serology, biopsy
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|Serology, biopsy
 
|-
  
|-
βˆ’
| Mortality
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|Mortality
βˆ’
| Rare
 +
|Rare
βˆ’
| 3-20%
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|3-20%
βˆ’
| 7-10%
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|7-10%
βˆ’
| 2-5%
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|2-5%
βˆ’
| 8%
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|8%
 
|-
  
|-
βˆ’
| Treatment
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|Treatment
βˆ’
| Doxycycline
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|[[Doxycycline]]
βˆ’
| Azithromycin, Atovaquone
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|[[Azithromycin]], [[Atovaquone]]
βˆ’
| Doxycycline
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|[[Doxycycline]]
βˆ’
| Doxycycline
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|[[Doxycycline]]
βˆ’
| Doxycycline
 +
|[[Doxycycline]]
 
|}
  
|}
   
βˆ’
== Ticks ==
 +
===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 Β±rash Β±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 Β±ulcer Β±lymphadenopathy
  +
|}
  +
  +
==By Tick==
   
 
{| class="wikitable"
  
{| class="wikitable"
βˆ’
! Tick
 +
!Tick
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! Distribution
 +
!Distribution
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! Transmits
 +
!Transmits
βˆ’
! Comments
 +
!Comments
 
|-
  
|-
βˆ’
| American dog tick (''Dermacentor variabilis'')
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|American dog tick (''[[Dermacentor variabilis]]'')
βˆ’
| East of the Rockies, and in limited areas in the Pacific coast
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|East of the Rockies, and in limited areas in the Pacific coast
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| Tularemia and RMSF
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|[[Tularemia]] and [[RMSF]]
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| Highest risk of bites in spring and summer. Sometimes called wood ticks.
 +
|Highest risk of bites in spring and summer. Sometimes called wood ticks.
 
|-
  
|-
βˆ’
| Blacklegged tick (''Ixodes scapularis'')
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|Blacklegged (deer) tick (''[[Ixodes scapularis]]'')
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| Across the eastern US and in Ontario
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|Across the eastern US and in Ontario
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| Lyme disease, Anaplasma, ''B. miyamotoi'', ehrlichiosis, babesiosis, and Powassan virus
 +
|[[Lyme disease]], [[Anaplasma]], ''[[B. miyamotoi]]'', [[ehrlichiosis]], [[babesiosis]], and [[Powassan virus]]
βˆ’
| Highest risk in spring through fall, but can be found any time it's above freezing.
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|Highest risk in spring through fall, but can be found any time it's above freezing.
 
|-
  
|-
βˆ’
| Brown dog tick (''Thipicephalus sanguineus'')
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|Brown dog tick (''[[Rhipicephalus sanguineus]]'')
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| Worldwide
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|Worldwide
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| RMSF
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|[[RMSF]] (uncommon)
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| Dogs are the primary host but it can also bite humans.
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|Dogs are the primary host but it can also bite humans.
 
|-
  
|-
βˆ’
| Gulf Coast tick (''Amblyomma maculatum'')
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|Gulf Coast tick (''[[Amblyomma maculatum]]'')
βˆ’
| Coastal areas along the Guld of Mexico and southern Atlantic
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|Coastal areas along the Guld of Mexico and southern Atlantic
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| ''Rickettsia parkeri''
 +
|''[[Rickettsia parkeri]]''
 
|
  
|
 
|-
  
|-
βˆ’
| Lone Star tick (''Amblyomma americanum'')
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|Lone Star tick (''[[Amblyomma americanum]]'')
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| Southeastern and eastern United States
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|Southeastern and eastern United States
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| Ehrlichiosis, Heartland virus, tularemia, STARI
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|[[Ehrlichiosis]], [[Heartland virus]], [[tularemia]], [[STARI]]
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| Very aggressive tick. Irritation at site does not indicate infection.
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|Very aggressive tick. Irritation at site does not indicate infection.
 
|-
  
|-
βˆ’
| Rocky Mountain wood tick (''Dermacentor andersoni'')
 +
|Rocky Mountain wood tick (''[[Dermacentor andersoni]]'')
βˆ’
| Rocky Mountains and southwestern Canada from elevations of 4,000 to 10,500 feet
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|Rocky Mountains and southwestern Canada from elevations of 4,000 to 10,500 feet
βˆ’
| RMSF, Colorado tick fever, and tularemia
 +
|[[RMSF]], [[Colorado tick fever]], and [[tularemia]]
 
|
  
|
 
|-
  
|-
βˆ’
| Western blacklegged tick (''Ixodes pacificus'')
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|Western blacklegged tick (''[[Ixodes pacificus]]'')
βˆ’
| Pacific coast of the U.S., particularly northern California
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|Pacific coast of the U.S., particularly northern California
βˆ’
| Anaplasmosis and Lyme disease
 +
|[[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==
βˆ’
=== Blacklegged tick (''Ixodes scapularis'') ===
  
βˆ’  
βˆ’
* Where found: Widely distributed across the eastern United States.
  
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* Transmits: ''Borrelia burgdorferi'' and ''B. mayonii'' (which cause Lyme disease), ''Anaplasma phagocytophilum'' (anaplasmosis), ''B. miyamotoi'' disease (a form of relapsing fever), ''Ehrlichia muris eauclairensis'' (ehrlichiosis), ''Babesia microti'' (babesiosis), and Powassan virus (Powassan virus disease).
  
βˆ’
** Coinfections in 5-10%
  
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* Comments: The greatest risk of being bitten exists in the spring, summer, and fall. However, adults may be out searching for a host any time winter temperatures are above freezing. Stages most likely to bite humans are nymphs and adult females.
  
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[[File:https://www.cdc.gov/ticks/images/geo/blacklegged_tick.jpg|Blacklegged tick (blacklegged_tick.jpg)]]
  
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[[File:lgmap-blacklegged_tick.jpg|Approximate distribution of the Blacklegged tick in the United States of America. The map shows that the blacklegged tick is widely distributed across the entire eastern half of the United States]]
  
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=== Brown dog tick (''Rhipicephalus sanguineus'') ===
  
βˆ’  
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* Where found: Worldwide.
  
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* Transmits: Rocky Mountain spotted fever (in the southwestern U.S. and along the U.S.-Mexico border).
  
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* Comments: Dogs are the primary host for the brown dog tick in each of its life stages, but the tick may also bite humans or other mammals.
  
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[[File:https://www.cdc.gov/ticks/images/geo/brown_dog_tick.jpg|Brown dog tick (brown_dog_tick.jpg)]]
  
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[[File:lgmap-brown_dog_tick.jpg|Map of the United States showing approximate distribution of the Brown dog tick. The entire United States is affected. ]]
  
βˆ’  
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=== Gulf Coast tick (''Amblyomma maculatum'') ===
  
βˆ’  
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* Where found: Coastal areas of the U.S. along the Atlantic coast and the Gulf of Mexico.
  
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* Transmits: ''Rickettsia parkeri'' rickettsiosis, a form of spotted fever.
  
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* Comments: Larvae and nymphs feed on birds and small rodents, while adult ticks feed on deer and other wildlife. Adult ticks have been associated with transmission of R. parkeri to humans.
  
βˆ’  
βˆ’
[[File:https://www.cdc.gov/ticks/images/geo/gulf_coast_tick.jpg|Image for Gulf Coast tick (gulf_coast_tick.jpg)]]
  
βˆ’  
βˆ’
[[File:lgmap-gulf_coast_tick.jpg|Map of the United States showing the approximate distribution of the Gulf coast tick. Distribution area is the southeastern part of the country.]]
  
βˆ’  
βˆ’
=== Lone star tick (''Amblyomma americanum'') ===
  
βˆ’  
βˆ’
* Where found: Widely distributed in the southeastern and eastern United States.
  
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* Transmits: ''Ehrlichia chaffeensis'' and ''Ehrlichia ewingii'' (which cause human ehrlichiosis), Heartland virus, tularemia, and STARI.
  
βˆ’
* Comments: A very aggressive tick that bites humans. The adult female is distinguished by a white dot or β€œlone star” on her back. Lone star tick saliva can be irritating; redness and discomfort at a bite site does not necessarily indicate an infection. The nymph and adult females most frequently bite humans and transmit disease.
  
βˆ’  
βˆ’
[[File:lone_star_tick.jpg|Lone star tick (lone_star_tick.jpg)]]
  
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βˆ’
[[File:lgmap-lone_star_tick.jpg|Map of the United States showing the approximate distribution of the Lone Star tick. The area affected is the eatern half of the country.]]
  
βˆ’  
βˆ’
=== Rocky Mountain wood tick (''Dermacentor andersoni'') ===
  
βˆ’  
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* Where found: Rocky Mountain states and southwestern Canada from elevations of 4,000 to 10,500 feet.
  
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* Transmits: Rocky Mountain spotted fever, Colorado tick fever, and tularemia.
  
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* Comments: Adult ticks feed primarily on large mammals. Larvae and nymphs feed on small rodents. Adult ticks are primarily associated with pathogen transmission to humans.
  
βˆ’  
βˆ’
[[File:rocky_mountain_wood_tick.jpg|Rocky Mountain wood tick (rocky_mountain_wood_tick.jpg)]]
  
βˆ’  
βˆ’
[[File:lgmap-rocky_mountain_wood_tick.jpg|Map of the United States showing the approximate distribution of the Rocky mountain wood tick. The area effected is the Northwestern part of the country.]]
  
βˆ’  
βˆ’
=== Western blacklegged tick (''Ixodes pacificus'') ===
  
βˆ’  
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* Where found: Along the Pacific coast of the U.S., particularly northern California.
  
βˆ’
* Transmits: Anaplasmosis and Lyme disease.
  
βˆ’
* Comments: Nymphs often feed on lizards, as well as other small animals. As a result, rates of infection are usually low (~1%) in adults. Stages most likely to bite humans are nymphs and adult females.
  
βˆ’  
βˆ’
[[File:western_blacklegged_tick.jpg|Western blacklegged tick (western_blacklegged_tick.jpg)]]
  
   
  +
*[https://tickencounter.org/tick_identification/tick_species TickEncounter tick identification], hosted by the University of Rhode Island
βˆ’
[[File:lgmap-western_blacklegged_tick.jpg|Map of the United States showing the approximate distribution of the Western blacklegged tick. The area affected is the western coast.]]
  
   
 
[[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
    • Β± cytopenias, Β± 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 Β± 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, Β±microscopy Serology, Β±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 Β±rash Β±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 Β±ulcer Β±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

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