Tick-borne disease

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Tick-borne diseases
Tick bite.JPG
An eschar suggestive of tick bite

Tick-borne disease Microchapters

Overview

Classification

Bacterial

1-Lyme disease
2-Relapsing Fever]

Typhus (Rickettsia)

1-Rocky Mountain Spotted Fever
2-Helvetica Spotted Fever
3-Ehrlichiosis
4-Tularemia
5-Rickettsiosis
6-Q fever
7-Lymphangitis
more..

Viral

1-Tick-borne Meningoencephalitis
2-Colorado Tick Fever
3-Crimean-Congo Hemorrhagic Fever
4-Severe Febrile Illness
5-Bourbon virus infection
more..

Protozoal

1-Babesiosis

Pathophsiology

Epidemiology and Demographics

Differentiating Tick-Borne Diseases from other Diseases

Risk Factors

Diagnosis

Treatment

Tick Removal

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.; Kiran Singh, M.D. [2]

Overview

Tick-borne diseases are diseases or illnesses transmitted by ticks. As the incidence of tick-borne illnesses increases and the geographic areas in which they are found expand, it becomes increasingly important that health professionals be able to distinguish the diverse, and often overlapping, clinical presentations of these diseases.

Tick-borne disease Classification

Disease Organism Vector Endemic Regions
Bacterial Infection
Borreliosis (Lyme Disease) [1] Borrelia burgdorferi sensu lato (bacterium) and B. mayonii I. scapularis, I. pacificus, I. ricinus, and I. persulcatus United States:
  • Eastern Region
  • Southwest Region
Relapsing Fever [2] Borrelia Species; Borrelia hermsii, Borellia Parkeri, Borellia duttoni, Borrelia miyamotoi Ornithodoros species Widespread:
  • Spain
  • Saudi Arabia
  • Asia
  • Africa
  • Canada
  • Western United States
Typhus (Rickettsia)
Rocky Mountain Spotted Fever [3] Rickettsia Rickettsii Wood Tick (Dermacentor Variabilis), D. andersoni United States:
  • Eastern Region
  • Southwest Region
Helvetica Spotted Fever[4] Rickettsia Helvetica Ixodes Ricinus (European) Europe:
  • Sweden
  • Switzerland
  • France
  • Laos
Ehrlichiosis (Anaplasmosis) [5] Ehrlichia Chaffeensis, E. Equi Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis United States:
  • South Atlantic Regions
  • South-central Regions
Tularemia [6] Francisella Tularensis D. Andersoni, D. Variabilis United States:
  • Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
Human neoehrlichiosis [5] [4] Neoehrlichia mikurensis Lone Star Tick (Amblyomma Americanum)' Widespread:
  • Europe
  • Asia
Rickettsiosis [4] Rickettsia No specific species identified Widespread:
  • South Africa
  • Morocco
  • Mediterranean
African tick-bite fever [4] Rickettsia africae Amblyomma, Dermacentor, and Rhipicephalus species Africa:
  • Sub-Saharan
  • West Indies
Queensland tick typhus [7] [4] Rickettsia austalis Ixodes species Widespread:
  • Australia
  • Tasmania
Q fever (Typhus-like infection) [7] Coxiella burnetii (mimics the mechanisms of Rickettsia) Ixodes holocyclus and Amblyomma triguttatum Australia
  • Widespread throughout Australia
Mediterranean spotted fever (Boutonneuse fever) [8] [4] Rickettsia conorii Brown Dog Tick (Rhipicephalus sanguineus) Widespread:
  • Southern Europe
  • Southern and Western Asia
  • Africa
  • India
Far Eastern spotted fever [4] Rickettsia heilong-jiangensis Tick Widespread:
  • Far portions of Eastern Russia
  • Northern portions of China
  • Eastern Asia
Aneruptive fever [4] [9] Rickettsia helvetica Ixodes species Widespread:
  • Northern and Central portions of Europe
  • Non-specific portions of Asia
Flinders Island spotted fever (Thai tick typhus) [4] [7] Rickettsia honei Tick Widespread in Independent Regions
  • Australia
  • Thailand
Japanese spotted fever [4] Rickettsia japonica Tick Japan
  • Widespread yet isolated to portions of Japan
Mediterranean spotted fever-like disease [4] Rickettsia massiliae and R. monacensis Tick Widespread:

R.massiliae induced:

  • France
  • Greece
  • Spain
  • Portugal
  • Switzerland
  • Sicily
  • Central Africa
  • Mali

R.monacensis induced:

  • Europe
  • North Africa
Maculatum infection Rickettsia parkeri Tick Americas:
  • United States
  • Portions of Canada
  • South America
Tick-borne necrosis and lymphadenopathy [10] Rickettsia raoultii Dermacentor marginatus Widespread:
  • Europe
  • Asia
North Asian Tick Typhus [4] Rickettsia sibirica Tick Widespread:
  • Russia
  • China
  • Mongolia
Lymphangitis [4] Rickettsia sibirica mogolotimonae 'No specific species identified Widespread:
  • Southern France
  • Portugal
  • China
  • Africa
TIBOLA [4] [10] Rickettsia slovaca Dermacentor species Widespread:
  • Southern and Eastern Europe
  • Asia
Viral Infection
Tick-borne Meningoencephalitis [11] TBEV virus Ixodes Scapularis, I. Ricinus, I.persulcatus Widespread:
  • Europe
  • Northern Asia
Colorado Tick Fever [12] CTF virus Dermacentor andersoni United States:
  • Western Region
Severe Fever with Thrombocytopenia Syndrome [12] SFTS virus
  • Haemaphysalis longicornis
  • Ixodes nipponensis
  • Amblyomma testudinarium
  • Rhipicephalus microplus
  • A recent case is being assiciated with SFTS virus transmitted by a cat
  • Wetern Japan
  • China
Crimean-Congo Hemorrhagic Fever [13] CCHF virus Hyalomma marginatum, Rhipicephalus bursa Widespread:
  • South Asia
  • North Africa
  • Southern Europe
Severe Febrile Illness [13] Heartland Virus Lone Star Tick (amblyomma americanum) United States:
  • Missouri
  • Tennessee
Bourbon virus infection Bourbon virus infection Lone Star Tick United States:
  • Midwest and southern States
Protozoan Infection
Babesiosis [14] Babesia microti, B divergens, B.equi Ixodes Scapularis, I. pacificus Widespread:
  • Northeastern United States
  • Europe
  • Asia

Pathophysiology

Tick-borne illnesses are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. Because ticks can harbor more than one disease-causing agent, patients can be infected with more than one pathogen at the same time, compounding the difficulty in diagnosis and treatment.

Life Cycle and Spread of Disease

General Tick Life Cycle

This image displays an example of the tick lifecycle, based on stages and the months that they are most likely to occur during.
  • A tick's life cycle is composed of four stages: hatching (egg), nymph (six legged), nymph (eight legged), and an adult.
  • Ticks require blood meal to survive through their life cycle.
  • Hosts for tick blood meals include mammals, birds, reptiles, and amphibians. Ticks will most likely transfer between different hosts during the different stages of their life cycle.
  • Humans are most often targeted during the nymph and adult stages of the life cycle.
  • Life cycle is also dependent on seasonal variation.
  • Ticks will go from eggs to larva during the summer months, infecting bird or rodent host during the larval stage.
  • Larva will infect the host from the summer until the following spring, at which point they will progress into the nymph stage.
  • During the nymph stage, a tick will most likely seek a mammal host (including humans).
  • A nymph will remain with the selected host until the following fall at which point it will progress into an adult.
  • As an adult, a tick will feed on a mammalian host. However unlike previous stages, ticks will prefer larger mammals over rodents.
  • The average tick life cycle requires three years for completion.
    • Different species will undergo certain variations within their individual life cycles. [15]





Spread of Tick-borne Disease

  • Ticks require blood meals in order to progress through their life cycles.
  • The average tick requires 10 minutes to 2 hours when preparing a blood meal.
  • Once feeding, releases anesthetic properties into its host, via its saliva.
  • A feeding tube enters the host followed by an adhesive-like substance, attaching the tick to the host during the blood meal.
  • A tick will feed for several days, feeding on the host blood and ingesting the host's pathogens.
  • Once feeding is completed, the tick will seek a new host and transfer any pathogens during the next feeding process. [15]

Epidemiology and Demographics

Incidence

  • Tick based infections are generally non-specific in regards to age, race, or gender. (However babesiosis is more frequently observed in older, male populations. An explanation for this has not yet been formulated.) [15]
  • Certain tick-borne illnesses will vary within patient populations when an auto-immune deficiency is present.
  • Tick bites are more frequently reported during the spring and summer months which are noted to be in correlation with high tick activity.
  • Higher risks are associated with individuals traveling within endemic areas.
  • Inoculation within endemic areas is usually the result of a tick bite however transmission has been identified as a result of transfusions or transplantation.

Species and Regions

United States

American Dog Tick (Dermacentor Variabilis) [16]

  • Pacific Coast and east of the Rocky Mountains.
  • Transmits tularemia and rocky mountain spotted fever.
  • Primarily infects humans during the spring and summer months.

Blacklegged tick (Ixodes Scapularis) [16]

Brown dog tick (Rhipicephalus Sanguineus) [16]

Gulf Coast Tick (Amblyomma Maculatum) [16]

  • Atlantic Coast and Gulf of Mexico (Along the coast of Northeastern Virginia until the Southern most portions of Florida. From Southeast Florida through the Gulf of Mexico into Texas).
  • Transmits Rickettsia parkeri rickettsiosis (spotted fever).

Lone Star Tick (Amblyomma Americanum) [16]

Rocky Mountain Wood Tick (Dermacentor Andersoni) [16]

Western Blacklegged tick (Ixodes Pacificus) [16]

International

Hyalomma Marginatum [17]

  • Widespread: North Africa, Europe, and Asia.
  • Transmits Crimean-Congo hemorrhagic fever.

Ixodes Ricinus [17]

  • Widespread throughout Europe and parts of North Africa.
  • Transmits encephalitis and Lyme Disease.

Ixodes Persulcatus [17]

Dermacentor Reticulatus [17]

Differentiating Tick-Borne Diseases from other Diseases

Disease Symptoms
Bacterial Infection
Borreliosis (Lyme Disease) [1] Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
Relapsing Fever [2] Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
Typhus (Rickettsia)
Rocky Mountain Spotted Fever Fever, alterations in mental state, myalgia, rash, and headaches.
Helvetica Spotted Fever [3] Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis Anaplasmosis [5] Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia [6] Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.
Viral Infection
Tick-borne meningoencephalitis [11] Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Colorado Tick Fever [13] Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis [14] Non-specific flu like symptoms.

Risk Factors

  • The greatest risk factor associated with tick-borne diseases is actually being bitten by a tick.
  • Traveling or residing within endemic regions will increase chances of infection.
  • Tick activity is generally heightened during certain the spring and summer months.
  • Within endemic regions, tick may choose an animal host, including a domesticated animal such as a dog or cat.
  • Although rare, cases of blood transfusion and organ transplantation have been recorded as methods of transmission.
  • All together, individuals who spend time outdoors and/or have pets that go outdoors in endemic regions are at risk for tick-borne disease. [18]

Diagnosis

Physical Examination

A round red rash with a 2-5 mm central black area (eschar, an area of dead tissue) as shown in the photo is suggestive of a tick bite.

Laboratory Findings

In general, specific laboratory tests are not available to rapidly diagnose tick-borne diseases. Serological tests are frequently performed, but may be unreliable in differentiating acute from chronic conditions.

Treatment

Medical Therapy

  • Antibiotic treatment is often justified based on clinical presentation alone. However all clinical treatments must be tailored according to a patients personal profile; considering age, immunocompetance, pregnancy, allergen profile, splenic function, and current medical status. [19]
  • If there is a collection of pus, the area will need to be incised and drained.
Disease Treatment
Bacterial Infection
Borreliosis (Lyme Disease) [1] Antibiotics
Relapsing Fever [2] Antibiotics
Typhus (Rickettsia)
Rocky Mountain Spotted Fever [3] Antibiotics
Helvetica Spotted Fever Antibiotics
Ehrlichiosis Anaplasmosis [5] Antibiotics
  • Doxycycline, dosages should begin prior to lab results if ehrlichiosis is suspected.
  • Adults: 100 mg PO q12h for 7-14 days
  • Children (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days
Tularemia [6] Antibiotics
Other Spotted Fevers (Rickettsia bacterial infections) [4] Antibiotics
  • Adults: 100 mg PO q12h for 7-14 days
  • Children (under 100lbs/45kg): 2.2 mg/kg PO q12h for 7-14 days
Viral Infection
Tick-borne meningoencephalitis [11] No specific drug therapy. May require hospitalization and supportive care, including anti-inflammatory drugs, corticosteroids, or, if necessary, incubation and ventilator support.
Colorado Tick Fever [13] There are no current therapies associated with Colorado Tick Fever. The majority of patients exhibiting symptoms recover completely, however severe cases require hospitalization.
Crimean-Congo Hemorrhagic Fever Treatment for Crimean-Congo Hemorrhagic Fever is primarily supportive including balancing electrolytes, oxygen abnormalities, and if necessary, hemodynamic support. In vitro, Crimean-Congo Hemorrhagic Fever is responsive to an antiviral treatment with Ribavirin.
Protozoan Infection
Babesiosis [14] Antibiotics
  • Atovaquone AND Azithromycin
  • Clindamycin AND Quinine

The best way to remove a tick

  1. Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
  2. Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. (If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.)
  3. After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
Tick removal process
  • Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.
Removal of an embedded tick using fine-tipped tweezers
  • Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag. [20]

Gallery

References

  1. 1.0 1.1 1.2 Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
  2. 2.0 2.1 2.2 Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
  3. 3.0 3.1 3.2 Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 Disease Index General Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015
  5. 5.0 5.1 5.2 5.3 Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
  6. 6.0 6.1 6.2 Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
  7. 7.0 7.1 7.2 Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz Accessed on December 30, 2015
  8. Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015
  9. Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015
  10. 10.0 10.1 Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015
  11. 11.0 11.1 11.2 General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
  12. 12.0 12.1 CTF Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
  13. 13.0 13.1 13.2 13.3 General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015
  14. 14.0 14.1 14.2 Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
  15. 15.0 15.1 15.2 Life Cycle of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/life_cycle_and_hosts.html Accessed on December 30, 2015
  16. 16.0 16.1 16.2 16.3 16.4 16.5 16.6 Geographic Distribution of Ticks that Bite Humans (2015). http://www.cdc.gov/ticks/geographic_distribution.html Accessed on December 30, 2015
  17. 17.0 17.1 17.2 17.3 Ticks that Bite Humans (2015). http://ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx Accessed on December 30, 2015
  18. General Information (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
  19. Tick-borne diseases of the United States. Treatment Information Center for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/index.html Accessed on December 30, 2015
  20. Tick Removal. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015
  21. 21.0 21.1 21.2 "Dermatology Atlas".

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