1/20
TICKBORNE INFECTIONS (TBI)
It’s summer (= tick bites 🐞) and we have new faculty, fellows, residents, interns, & students coming from different places.
@grepmeded
This tweetorial is an overview of TBI mainly in the US.
▪️Climate change is expanding the seasonal/geographic distribution of TBI.
▪️Lack of tick bite in H/P should not dissuade you from considering TBI. In fact, only ¼ with Lyme remember a tick bite.
▪️No perfect test.
▪️Early Abx is important.
#idcoretopics
Geography matters!
An effective way of learning about TBI is learning it according to its geography.
@MohitHarshMD @TxID_Edu @rabihmgeha @DxRxEdu @Anirban63395569 @k_vaishnani @VarunPhadke2 @NNolanMD @Jncherabie @LeMiguelChavez @LParraRod @CGhaznavi
#idcoretopics
💡Mainly in the Midwest, these are the main culprits 👇.
“REST in the Heart and Bourbon of the Midwest” 😊
▪️RMSF
▪️Ehrlichia
▪️STARI
▪️Tularemia
▪️Heartland virus
▪️Bourbon virus
#idcoretopics
![](https://pbs.twimg.com/media/EcvDUJxXYAQqWf9.jpg)
![](https://pbs.twimg.com/media/EcvDUJ1X0AIQcqH.jpg)
1️⃣ Ehrlichia
▪️Fever + ⬇️ plt/low WBC + ⬆️ AST, ALT 👉 very common ▪️Prompt initiation of doxy when suspected (don’t wait for test result)
▪️Dx: blood PCR (only 87% Sn, a negative test does not rule out)
WuidQ tweetorial here: bit.ly/3egPcrz
#idcoretopics
2️⃣ RMSF
▪️Most lethal TBI
▪️Petechial/purpuric rash (may involve palms/soles) seen in 90% of cases⚡️ however, only 50% will have it at presentation
▪️Severe sepsis and meningitis (much like meningococcemia)
▪️No classic lab findings unlike Ehrlichia
3️⃣ STARI (Southern tick-associated rash illness)
▪️Causes erythema migrans-like rash, much like Lyme 👇
#idcoretopics
![](https://pbs.twimg.com/media/EcvDVDYXgAEapCw.jpg)
5️⃣ & 6️⃣ Heartland and Bourbon virus👇
▪️Newly emerged TBI
▪️Consider in patients that present like Ehrlichia but does not respond to doxy
WuidQ tweetorial: bit.ly/3fn5kcd
#idcoretopics
![](https://pbs.twimg.com/media/EcvDV3LWoAAPexR.jpg)
💡Mainly in the Northeast, upper Midwest
“LABBP” 👇
▪️Lyme
▪️Anaplasma
▪️Babesiosis
▪️Borrelia miyamotoi
▪️Powassan virus
⚡️All are transmmitted by Ixodes scapularis
#idcoretopics
![](https://pbs.twimg.com/media/EcvDWUDWAAA_bG3.jpg)
![](https://pbs.twimg.com/media/EcvDWUSXYAMOqcP.jpg)
7️⃣ Lyme
▪️Clinical phases and treatment outlined 👇
▪️Most common TBI in this region
Related topic (European Lyme):
WuidQ tweetorial: bit.ly/2Wa95KA
#idcoretopics
![](https://pbs.twimg.com/media/EcvDWxNWsAQxO80.jpg)
![](https://pbs.twimg.com/media/EcvDWxqWoAAV55i.jpg)
8️⃣ Anaplasma
▪️Indistinguishable clinically from Ehrlichia
⚡️For your boards, know about inclusion bodies found in Ehrlichia and Anaplasma 👇
#idcoretopics
![](https://pbs.twimg.com/media/EcvDXPdXYAEx4pl.jpg)
![](https://pbs.twimg.com/media/EcvDXP3XYAE8dTx.jpg)
9️⃣ Babesiosis
▪️Hemolytic anemia is a hallmark feature
WuidQ tweetorial here: bit.ly/3gMjSCw
#idcoretopics
Babesiosis for the boards:
⚡️Ring forms on blood smear w/ no travel history 👉 Babesia
⚡️Patient w/ EM but looks really sick 👉 Lyme & Babesia co-infxn
⚡️Patient w/ Anaplasma not responding to doxy 👉 Anaplasma & Babesia co-infection
#idcoretopics
🔟 Borrelia miyamotoi
▪️Can manifest similarly as Anaplasma; relapsing fever in 10% of patients
▪️Dx: serology,Tx: doxy
11. Powassan virus
▪️Tickborne encephalitis
▪️Mimics other causes of arthropod-borne encephalitis (e.g. WNV, EEE)
▪️Dx: serology,Tx: supportive
OTHER IMORTANT Tickborne illness:
12. Tick paralysis
▪️Ascending paralysis, afebrile, no sensory involvement, intact mental status
WuidQ tweetorial on how to differential this from other “paralytic” infections: bit.ly/2ZkvIOv
13. Colorado tick fever
▪️Mainly in the West coast 👇
▪️In about 1/2 of patients, a biphasic illness
More on biphasic illness, WuidQ tweetorial (⚡️leptospirosis)
bit.ly/3gNXQiT
![](https://pbs.twimg.com/media/EcvDX79WkAEUR5q.jpg)
In summary, TBI:
Best way to learn TBI is learning according to geography
Maintain high index of suspicion; no perfect test; prompt initiation of doxy important (esp for RMSF, Erhlichia, Anaplasma)
Not responding to doxy – Heartland, Bourbon, Babesia, Powassan
Are there any other tickborne infections/illnesses you want to highlight (esp. in your area, not limited to the US)?
@UAB_ID @IUIDfellowship @BIDMC_IDFellows @mgh_id @MayoClinicINFD @UNMC_ID @TempleID1