Answers
Samar Razaq in Difficult Cases in Primary Care, 2021
Lyme disease is caused by the spirochete bacterium Borrelia burgdorferi. B. burgdorferi is transferred to humans via the hard tick Ixodes dammini, which feeds on animals infected with the bacterium. Introduction of the bacterium into the human bloodstream via tick saliva occurs during a tick bite. Patients may recall this tick bite and the resultant macular lesion that appears at the site of the bite. This lesion then expands over the course of a week and develops into the characteristic rash of Lyme disease: erythema chronicum migrans. While this is occurring the patient may suffer from a prodromal phase in which there is fever and general malaise. The appearance of the typical rash should raise suspicions and trigger appropriate investigations that may include serology (to look for antibodies against the bacterium) and culture from appropriate fluid or tissue. Untreated, there is a significant risk of developing the late manifestations of Lyme disease, which include neurological abnormalities (e.g. meningitis, cranial neuropathy, peripheral neuropathy), heart disease (e.g. myocarditis, pericarditis, atrioventricular block) and rheumatological disease such as arthritis and fatigue. Rarely, the eyes, liver, spleen and testicles may also be involved. Doxycycline is the first-choice antibiotic. Summer forest walkers should be advised to cover up well and remove attached ticks promptly. Q fever is another bacterial zoonosis caused by the bacterium Coxiella burnetii.
Mycotoxins and Tick-Borne Disease
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Lyme disease is traditionally described as having three forms: early localized Lyme disease (3–30 days from the bite), early disseminated Lyme disease (3–5 weeks from the bite), and late Lyme disease.8 In early localized Lyme disease, patients may present with (or without) a known tick bite and a characteristic rash (erythema migrans). They may also have some constitutional symptoms such as a headache, myalgias, neck stiffness, and a fever. In the early disseminated form, patients may have multiple erythema migrans rashes, cranial nerve palsies (like bell’s palsy), carditis with cardiac arrhythmia, or meningitis. Conjunctivitis is seen as well. In late Lyme disease, patients often develop monoarticular arthritis of a large joint. Even after treatment with antibiotics, some patients with Lyme arthritis continue to have pain. It has been proposed that an autoimmune mechanism is responsible.10 Encephalitis, encephalopathy, and polyneuropathy may be seen as well. The original paper11 describing these entities notes the fact that patients may improve with antibiotics and that later the symptoms may reoccur. It is the pattern of persistent, multi-system, and recurring symptoms in some patients which has resulted in Lyme disease being called “the great imitator.”
Infectious Skin Diseases
Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou in Dermatoscopy A–Z, 2019
Ixodes ricinus (commonly known as tick) is a parasite that causes several infectious diseases such as borreliosis and ehrlichiosis. The site of the tick bite clinically appears as a black dot of about 1 mm in diameter and in many cases can be misdiagnosed as a small melanocytic nevus. The diagnosis of a tick bite is straightforward with the use of dermatoscopy. Specifically, dermatoscopy allows for the recognition of the posterior part of the body and the posterior pair of the legs of the parasite that remain out of the human body at the site of the bite; in contrast, the head of the parasite is dipped into the skin (Figure 7.26). Beyond the diagnosis, dermatoscopy is also helpful for the evaluation of whether the attempt to remove the parasite was successful.
Management strategies for human babesiosis
Published in Expert Review of Anti-infective Therapy, 2020
Robert P. Smith, Klaus-Peter Hunfeld, Peter J Krause
In contrast to the more sporadic occurrence of B. venatorum cases in Europe, the disease is endemic in northeastern China with more than 48 reported cases [5,22–26,30,31,106]. All of these patients described a recent tick bite and all experienced viral-like symptoms [30,31]. Unlike European patients, they were all immunocompetent. Four of the 48 Chinese patients received clindamycin alone. No deaths were reported [5]. Nevertheless, clinicians should be aware that although the clinical course of B. venatorum generally seems to be milder than that of B. divergens, immunocompromised patients may experience relapse and persistence of infection despite antimicrobial treatment [22,25]. In such cases, it is important to monitor parasitemia by blood smear examination and PCR analysis and provide long-term clinical follow-up [22,25].
Diagnosis and management of Lyme neuroborreliosis
Published in Expert Review of Anti-infective Therapy, 2018
The third manifestation – and one that may be considerably underdiagnosed – is painful radiculitis. Just as was described in the original case report by Garin and Bujadoux, patients present with severe dermatomal pain, often with associated segmental weakness and muscle atrophy, mimicking a mechanical radiculopathy, but with no mechanical precipitant. As with many types of neuropathic pain, this is often particularly prominent at night. Involvement often includes several adjacent dermatomes, not just one nerve root. European authorities often emphasize that symptoms occur in the limb that was the site of the tick bite, suggesting that the spirochetes migrate to the CNS along the peripheral nerve. However, more recent series suggest this association is less consistent [13], perhaps indicating that this is more related to systemic bacterial dissemination. Similarly, although the European literature typically suggests that meningitis is a necessary contributor to radiculitis, more recent studies show that, just as in facial nerve palsy, nerve root inflammation is not necessary for this syndrome.
Tick-borne disease (babesiosis)
Published in Baylor University Medical Center Proceedings, 2021
Hanish Jain, Garima Singh, Rahul Mahapatra
Babesia infections range from asymptomatic to severe and are sometimes fatal.1 The severity of infection depends on the Babesia species and the immune status of the host.2 Babesiosis is a tick-borne disease that shares the Lyme disease tick vector. Other pathogens transmitted by Ixodes scapularis ticks include Borrelia burgdorferi, Anaplasma phagocytophilum, Borrelia miyamotoi, Borrelia mayonii, Powassan virus, and Ehrlichia muris–like agent. As many as two-thirds of patients with babesiosis experience concurrent Lyme disease, and one-third experience concurrent human granulocytic anaplasmosis.3B. microti is the predominant species that infects humans in the United States. The incubation period of B. microti infection following a tick bite is typically 1 to 4 weeks. This case highlights the importance of exchange transfusion in severe cases of babesiosis.
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