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- FIGURE 1
Geographic distribution of nationally notifiable tickborne diseases, 2015.
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Pathogen: Rickettsia rickettsii Tick vectors: Dermacentor variabilis, Dermacentor andersoni, Rhipicephalus sanguineus Geographic distribution: Widespread; most common in south-central and south-Atlantic regions Classic presentation: Fever, headache, rash, weakness, malaise, myalgia, thrombocytopenia, anemia, hyponatremia, increased aminotransferase levels Diagnosis: Serologic antibody testing with a 4-fold increase between acute and convalescent serology with a minimum peak titer ≥ 1:64; polymerase chain reaction assay with low sensitivity; immunohistochemistry and cell culture rarely used Treatment: Doxycycline, typically for 7 days (range 5–10 days) Tick vector: Amblyomma maculatum Geographic distribution: Eastern and southern regions Classic presentation: Inoculation eschar, fever, headache, myalgia, rash, thrombocytopenia, leukopenia, increased aminotransferase levels Diagnosis: Same as for Rocky Mountain spotted fever Treatment: Same as for Rocky Mountain spotted fever Tick vector: Dermacentor occidentalis Geographic distribution: Northern California, Pacific coast Classic presentation: Inoculation eschar, fever, headache, myalgia Diagnosis: Same as for Rocky Mountain spotted fever Treatment: Same as for Rocky Mountain spotted fever Pathogen: Anaplasma phagocytophilum Tick vectors: Ixodes scapularis, Ixodes pacificus Geographic distribution: Northeast and upper Midwest, northern Pacific coast Classic presentation: Fever, headache, myalgia, malaise, cough, opportunistic infections in severe cases, thrombocytopenia, leukopenia, lymphopenia, elevated aminotransferase levels; laboratory abnormalities may no longer be present after 1 week of symptoms Diagnosis: Polymerase chain reaction assay available; 4-fold increase between acute and convalescent serology with a minimum peak titer ≥ 1:64; morulae in granulocytes on Giemsa- or Wright- stained peripheral smear; cell culture rarely used Treatment: Doxycycline, typically for 10 days (range 7–14 days) Pathogen: Ehrlichia chaffeensis Tick vectors: Primarily Amblyomma americanum Geographic distribution: Southeastern, south-central, and mid-Atlantic regions Classic presentation: Fever, headache, myalgia, malaise, cough, gastrointestinal symptoms, rash, meningitis, thrombocytopenia, leukopenia, lymphopenia, anemia, hyponatremia, elevated aminotransferase levels; laboratory abnormalities may no longer be present after 1 week of symptoms Diagnosis: Polymerase chain reaction assay available; 4-fold increase between acute and convalescent serology with a minimum peak titer ≥ 1:64; morulae in monocytes on Giemsa- or Wright-stained peripheral smear; cell culture rarely used Treatment: Doxycycline, typically for 7–14 days Pathogen: Ehrlichia ewingii Tick vector: Primarily Amblyomma americanum Geographic distribution: Southeastern and south-central regions Classic presentation: Similar to human granulocytic anaplasmosis and human monocytic erhlichiosis; laboratory abnormalities may no longer be present after 1 week of symptoms Diagnosis: Polymerase chain reaction assay Treatment: Doxycycline, typically for 7–14 days Tick vector: Ixodes scapularis (most likely) Geographic distribution: Limited to Wisconsin and Minnesota Classic presentation: Similar to human granulocytic anaplasmosis and human monocytic erhlichiosis; laboratory abnormalities may no longer be present after 1 week of symptoms Diagnosis: Polymerase chain reaction assay Treatment: Doxycycline, typically for 7–14 days Pathogen: Babesia microti (most likely) Tick vector: Ixodes scapularis Geographic distribution: Northeastern region and upper-midwestern states Classic presentation: Fever, fatigue, malaise, headache, myalgia, arthralgia, nausea, anorexia, cough, hemolytic anemia, thrombocytopenia, leukopenia, elevated aminotransferase levels Diagnosis: Babesia microti intraerythrocytic ring form (trophozoites) or merozoites in tetrads (Maltese cross) identified on Giemsa- or Wright-stained peripheral smear; polymerase chain reaction assay; serology Treatment: Atovaquone with azithromycin for mild to moderate disease and clindamycin with quinine for severe disease; consider exchange transfusion in severe disease; typical treatment course is 7-10 days and at least 6 weeks in highly immunocompromised patients Pathogen: Borrelia hermsii Tick vectors: Ornithodoros hermsi; less commonly Ornithodoros parkeri and Ornithodoros turicata Geographic distribution: Pacific coast, north-western and southwestern regions Classic presentation: Relapsing fever, headache, myalgia, arthralgia, gastrointestinal symptoms Diagnosis: Detection of spirochetes on peripheral smear with either Wright or Giemsa stain or darkfield microscopy; fourfold increase between acute and convalescent serology with a minimum peak titer ≥ 1:64; polymerase chain reaction assay in research settings. Treatment: Tetracycline for 10 days (based on expert opinion) Tick vectors: Ixodes scapularis, Ixodes pacificus Geographic distribution: Northeastern, north- central, and far western regions Classic presentation: Fever, headache, myalgia, arthralgia, gastrointestinal symptoms, meningoencephalitis, thrombocytopenia, elevated aminotransferase levels Diagnosis: No validated test available, though culture, polymerase chain reaction, and serology are performed in research settings Treatment: Doxycycline for 2–4 weeks (based on expert opinion) Pathogen:Unknown Tick vector: Amblyomma americanum Geographic distribution: Southeastern, southcentral, mid-Atlantic, and midwestern regions Classic presentation: Fever, headache, fatigue, myalgia, erythema migrans rash (similar to Lyme disease) Diagnosis: No diagnostic tests are available since the pathogen is unknown; diagnosis based on symptoms, geographic location, and possibility of a tick bite; a known tick bite by A americanum is helpful in distinguishing from Lyme disease. Treatment: Doxycycline is often given, though it is unknown whether antibiotics are necessary or beneficial Pathogen: Francisella tularensis Tick vectors: Amblyomma americanum, Dermacentor variabilis, Dermacentor andersoni Geographic distribution: South-central region Classic presentation:
Ulceroglandular: Red painful papule at the site of tick exposure that evolves into a black eschar; fever, headache, myalgia, malaise, lymphadenopathy
Glandular: Same as ulceroglandular except primary lesion not recognizedDiagnosis: 4-fold increase between the acute and convalescent sera or a single titer ≥ 1:160; culture may also be performed Treatment: Streptomycin or gentamicin for at least 10 days; for less severe disease, ciprofloxacin or doxycycline for 14 days Tick vectors: Lineage I: Ixodes cookei; lineage II (also known as deer tick virus): Ixodes scapularis Geographic distribution: Great Lakes and northeastern regions Classic presentation: Fever, confusion, seizures, focal neurologic deficits, rash, gastrointestinal symptoms Diagnosis: Cerebrospinal fluid testing for virus- specific IgM and neutralizing antibodies; serum antibody testing; nucleic acid amplification; immunohistochemistry on autopsy tissue and viral culture are options Treatment: Supportive care Tick vector: Amblyomma americanum (most likely) Geographic distribution: Limited to Missouri and Tennessee Classic presentation: Fever, fatigue, headache, myalgia, gastrointestinal symptoms, leukopenia, thrombocytopenia Diagnosis: No diagnostic tests are currently available; rule out ehrlichioses Treatment: Supportive care
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- Article
- ABSTRACT
- ROCKY MOUNTAIN SPOTTED FEVER
- OTHER SPOTTED FEVER GROUP RICKETTSIAL INFECTIONS
- EHRLICHIOSES: EHRLICHIOSIS AND ANAPLASMOSIS
- BABESIOSIS
- TICKBORNE RELAPSING FEVER
- BORRELIA MIYAMOTOI INFECTION
- SOUTHERN TICK-ASSOCIATED RASH ILLNESS
- TULAREMIA
- TICKBORNE VIRAL INFECTIONS
- COINFECTION
- PREVENTION
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