Tick-borne infections: Difference between revisions

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== Clinical Manifestations ==
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==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:
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** Flu-like illness that occurs not in flu season
 +
**Flu-like illness that occurs not in flu season
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** ± cytopenias, ± liver enzyme abnormalities
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**± cytopenias, ± liver enzyme abnormalities
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** Exposure history (outdoors activities, rats)
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**Exposure history (outdoors activities, rats)
   
−
== By Disease ==
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==By Disease==
   
  +
===Common Diseases===
 
{| class="wikitable"
  
{| class="wikitable"
 
!
  
!
−
! Lyme disease
 +
![[Lyme disease]]
−
! Babesiosis
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![[Babesiosis]]
−
! Anaplasmosis
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![[Anaplasmosis]]
−
! Ehrlichiosis
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![[Ehrlichiosis]]
−
! RMSF
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![[RMSF]]
 
|-
  
|-
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| Pathogen
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|Pathogen
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| ''[[B. burgdorferi]]''
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|''[[Borrelia burgdorferi|B. burgdorferi]]''
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| ''[[B. microti]]''
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|''[[Babesia microti|B. microti]]''
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| ''[[A. phagocytophilum]]''
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|''[[Anaplasma phagocytophilum|A. phagocytophilum]]''
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| ''[[E. chaffeensis]]''
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|''[[Ehrlichia chaffeensis|E. chaffeensis]]''
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| ''[[R. rickettsii]]''
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|''[[Rickettsia rickettsii|R. rickettsii]]''
 
|-
  
|-
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| Incubation
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|Incubation
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| 2-3 wk
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|2-3 wk
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| 1-4 wk
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|1-4 wk
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| 5-14 d
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|5-14 d
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| 5-14 d
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|5-14 d
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| 3-12 d
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|3-12 d
 
|-
  
|-
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| Tick
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|Tick
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| [[Black-legged tick]]
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|[[Black-legged tick]]
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| [[Black-legged tick]]
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|[[Black-legged tick]]
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| [[Black-legged tick]]
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|[[Black-legged tick]]
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| [[Black-legged tick]], [[Lonestar tick]]
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|[[Black-legged tick]], [[Lonestar tick]]
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| [[American dog tick]]
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|[[American dog tick]]
 
|-
  
|-
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| 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
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| Fever, HA
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|Fever, headache
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| Fever, HA, myalgias, n/v
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|Fever, headache, myalgias, nausea/vomiting
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| Fever, HA
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|Fever, headache
 
|-
  
|-
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| Cells
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|Cells
  +
|Disseminated
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| Disseminates
  
−
| Erythrocytes
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|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
 
|-
  
|-
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| Rash
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|Rash
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| Erythema migrans
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|[[Erythema migrans]]
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| Rare
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|Rare
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| Rare
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|Rare
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| Maculopapular (30%)
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|Maculopapular (30%)
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| Maculopapular; Eschar with ''R. parkeri''
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|Maculopapular; eschar with ''R. parkeri''
 
|-
  
|-
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| Labs
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|Labs
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| Uncommon
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|Uncommon
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| Hemolytic anemia, thrombocytopenia, liver enzymes
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|[[Hemolytic anemia]], [[thrombocytopenia]], liver enzymes
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| Leukopenia, liver enzymes, thrombocytopenia
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|[[Leukopenia]], liver enzymes, [[thrombocytopenia]]
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| Leukopenia ± lymphocytosis, liver enzymes, thrombocytopenia
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|[[Leukopenia]] ± [[lymphocytosis]], liver enzymes, [[thrombocytopenia]]
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| Thrombocytopenia, liver enzymes, hyponatremia
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|[[Thrombocytopenia]], liver enzymes, [[hyponatremia]]
 
|-
  
|-
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| Complications
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|Complications
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| Carditis, neuro sx, arthritis
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|[[Carditis]], neurological symptoms, [[arthritis]]
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| DIC, ARDS, CHF, AKI
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|[[DIC]], [[ARDS]], [[CHF]], [[AKI]]
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| Opportunistic infections, shock
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|Opportunistic infections, [[shock]]
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| Seizure, coma, CHF, pericardial effusion, shock
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|[[Seizure]], [[coma]], [[CHF]], [[pericardial effusion]], [[shock]]
−
| Coma/seizure (30%)
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|[[Coma]]/[[seizure]] (30%)
 
|-
  
|-
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| Diagnosis
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|Diagnosis
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| EM, serology
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|EM, serology
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| Microscopy
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|Microscopy
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| Serology, ±microscopy
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|Serology, ±microscopy
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| Serology, ±microscopy
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|Serology, ±microscopy
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| Serology, biopsy
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|Serology, biopsy
 
|-
  
|-
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| Mortality
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|Mortality
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| Rare
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|Rare
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| 3-20%
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|3-20%
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| 7-10%
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|7-10%
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| 2-5%
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|2-5%
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| 8%
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|8%
 
|-
  
|-
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| Treatment
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|Treatment
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| [[Doxycycline]]
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|[[Doxycycline]]
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| [[Azithromycin]], [[Atovaquone]]
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|[[Azithromycin]], [[Atovaquone]]
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| [[Doxycycline]]
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|[[Doxycycline]]
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| [[Doxycycline]]
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|[[Doxycycline]]
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| [[Doxycycline]]
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|[[Doxycycline]]
 
|}
  
|}
   
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== By Tick ==
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===Other Diseases===
  +
{| class="wikitable"
  +
!Disease
  +
!Vector
  +
!Clinical Manifestations
  +
|-
  +
|[[African tick-bite fever]]
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|[[Amblyomma]]
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|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]]
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|biphasic: flu-like illness followed by [[meningoencephalitis]]
  +
|-
  +
|[[Tick-borne relapsing fever]]
  +
|[[Ornithodorus]]
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|relapsing-remitting febrile illness (3 days on, 7 off)
  +
|-
  +
|[[Tick paralysis]]
  +
|[[Dermacentor]]
  +
|ascending paralysis with preserved sensation
  +
|-
  +
|[[Tularemia]]
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|multiple
  +
|severe flu-like illness ±ulcer ±lymphadenopathy
  +
|}
  +
  +
==By Tick==
   
 
{| class="wikitable"
  
{| class="wikitable"
−
! Tick
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!Tick
−
! Distribution
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!Distribution
−
! Transmits
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!Transmits
−
! Comments
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!Comments
 
|-
  
|-
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| American dog tick (''[[Dermacentor variabilis]]'')
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|American dog tick (''[[Dermacentor variabilis]]'')
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| 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.
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|Highest risk of bites in spring and summer. Sometimes called wood ticks.
 
|-
  
|-
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| Blacklegged (deer) 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]]
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|[[Lyme disease]], [[Anaplasma]], ''[[B. miyamotoi]]'', [[ehrlichiosis]], [[babesiosis]], and [[Powassan virus]]
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| 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.
 
|-
  
|-
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| Brown dog tick (''[[Rhipicephalus 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.
 
|-
  
|-
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| Gulf Coast tick (''[[Amblyomma maculatum]]'')
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|Gulf Coast tick (''[[Amblyomma maculatum]]'')
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| 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]]''
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|''[[Rickettsia parkeri]]''
 
|
  
|
 
|-
  
|-
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| 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.
 
|-
  
|-
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| Rocky Mountain wood tick (''[[Dermacentor andersoni]]'')
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|Rocky Mountain wood tick (''[[Dermacentor andersoni]]'')
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| 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
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| [[RMSF]], [[Colorado tick fever]], and [[tularemia]]
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|[[RMSF]], [[Colorado tick fever]], and [[tularemia]]
 
|
  
|
 
|-
  
|-
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| Western blacklegged tick (''[[Ixodes pacificus]]'')
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|Western blacklegged tick (''[[Ixodes pacificus]]'')
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| Pacific coast of the U.S., particularly northern California
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|Pacific coast of the U.S., particularly northern California
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| [[Anaplasmosis]] and [[Lyme disease]]
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|[[Anaplasmosis]] and [[Lyme disease]]
 
|-
  
|-
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| Soft tick (''[[Ornithodoros]]'' species)
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|Soft tick (''[[Ornithodoros]]'' species)
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|
+
|
−
| [[Tick-borne relapsing fever]] (non-Lyme ''[[Borrelia]]'' species)
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|[[Tick-borne relapsing fever]] (non-Lyme ''[[Borrelia]]'' species)
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| Short feeds at night, associated with rodents
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|Short feeds at night, associated with rodents
 
|}
  
|}
   
−
== Further Reading ==
 +
==Further Reading==
  +
−
* [https://tickencounter.org/tick_identification/tick_species TickEncounter tick identification], hosted by the University of Rhode Island
 +
*[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

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