This information is not medical advice. Information is editorial and compiled using sources from the CDC, Mayo Clinic and ILADs. IDSA and ANA information was excluded due to the anti-trust investigation conducted by the Attorney General of Connecticut.
Going to see the infectious disease specialist? You will probably find them uneducated about Lyme and sometimes combative. They tend to focus on HIV and Hepatitis. Most infectious disease doctors graduated from Medical school before Lyme disease and other Tick Borne Illnesses where included in the curriculum. Many still think of Lyme as a disease of the joints.
If you have Lyme disease chances are you have another tick born disease too. One small thing Infectious Disease can help you with is ‘testing’. Testing for more than one tick born disease is important. However clinicians must understand that tests are not conclusive and they should rely on clinical observation. In other words you may have the disease even if you have a negative test. A Lyme literate doctor can help you determine what tests you should have and what treatment is right for you. It is very important that you get treated for all the infections that where passed to you via a tick bite. Lab result provided by Quest, Clongen and iGeneX are best. Avoid Lab Corp.
It’s not just Lyme Disease…
1. Babesiosis (Babesia Infection) Northeast, Midwest, Northwest,
Organism name: Babesiosis is a malaria-like parasitic disease caused by Babesia, a genus of protozoal piroplasms
Treatment: For ill patients, recent evidence suggests that a regimen of Atovaquone and Azithromycin 250 mg can be equally effective in treatment to a cocktail of Quinine and Clindamycin. For complete irradiation for the body duration of treatment is 3 months.
Test: Serologic testing for antibodies against Babesia (both IgG and IgM) should be use in conjunction with Clinical observation. Note to patients and physicians: Many tick bite harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Symptoms:
Most cases identified are late stage; months or even years after a tick bite. Common symptoms of Babesiosis include fatigue, muscle aches, joint aches, weight loss, fever and nausea.
Less Common; symptoms include chills, jaundice, and symptoms of anemia and enlarged liver or spleen.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
2. Southern Tick-Associated Rash Illness (STARI) Southeast,
Organism name: The cause of STARI is unknown. Studies have shown that is not caused by Borrelia burgdorferi, the bacterium that causes Lyme disease.
Treatment: There are currently no specific recommendations for treating STARI. However, in most published case reports todate, the rash and other accompanying symptoms resolved quickly after the initiation of doxycycline 100 mg 2x a day for 6 months for full irradiation. A 21 day dose kills one life cycle of the bacteria.
Test: No test is currently in development however the rash produced by a STARI tick bite is NOT the classic Bulls-eye rash associated with Lyme but rather a faint and amorphic version of the bulls-eye rash. Note to patients and physicians: Many tick bites harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Symptoms:
Early detection: Persons experiencing an expanding red, ring-like rash with central clearing (erythema migrans) following the bite of a lone star tick, Amblyomma
americanum, or following exposure to ticks even if there is not a known tick bite. This only occurs in 70% of patients. Absence of a rash is not conclusive.
Late Stage: Chronic illness characterized of fatigue, sever headache, encephalopathy, stiff neck, and reoccurring fever. Similar to late stage or chronic Lyme.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
3. Tick-Borne Relapsing Fever (TBRF) Rocky Mountains,
Bacteria name: Relapsing fever is an infection caused by bacteria called "Borrelia."
Treatment: Erythromycin, tetracyclines, chloramphenicol, or penicillins have all been shown to be effective for treating TBRF. Although duration of therapy has not been well studied for TBRF, the current recommendation is seven days of antibiotic therapy. Continue for 6 months for full eradication.
Test: Full test information click here. http://www.cdc.gov/ncidod/dvbid/RelapsingFever/TBRF_LabTesting.html
Note to patients and physicians: Many tick bite harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Symptoms:
Early Detection: Sudden fever, chills, headaches, and muscle or joint aches, and nausea; a rash may also occur. These symptoms continue for 2-9 days, then disappear. This cycle may continue for several weeks if the person is not treated. Untreated TBRF can cause serious complications
Late Stage: Chronic illness characterized of fatigue, sever headache, encephalopathy, stiff neck, and reoccurring fever.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
4. Rocky Mountain Spotted Fever (RMSF) Southeast,
Bacteria name: Rickettsia rickettsii.
Treatment: Appropriate antibiotic treatment should be initiated immediately when there is a suspicion of a tickborne rickettsial disease (TBRD) on the basis of clinical and epidemiological findings. Treatment should not be delayed until laboratory confirmation is obtained.
Doxycycline is the drug of choice for treatment of all TBRD in children and adults. The recommended dose is 100 mg per dose administered twice daily (orally or intravenously) for adults or 2.2 mg/kg body weight per dose administered twice daily (orally or intravenously) for children weighing <>
Test: Treatment should not be delayed until laboratory confirmation is obtained. Note to patients and physicians: Many tick bites harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Symptoms: Initial symptoms generally include fever, chills, severe headache, malaise, and muscle aches. Diarrhea might occasionally occur. Sensitivity to light might be observed in adult patients. In patients with Rocky Mountain spotted fever, a rash first appears 2-5 days after the onset of fever, but may not present or may be very subtle when the patient is initially seen by a physician. Younger patients usually develop the rash earlier than older patients. Most often it begins as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles. These spots turn pale when pressure is applied and eventually become raised on the skin.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
5. Tularemia All States except
Bacteria name: Francisella tularensis
Testing: There are several serological tests for tularemia that should be used in conjunction with clinical observation. Note to patients and physicians: Many tick bites harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Treatment: Antibiotics used to treat tularemia include Streptomycin, Gentamicin, Doxycycline, and Ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
Exposure Warning: Usually occurs following a tick or deerfly bite or after handing of an infected animal. Pneumonia form is from breathing dusts or aerosols containing the organism. People who inhale the bacteria can experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated.
Symptoms:
Ulceroglandular: A skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
Glandular: Similar to ulceroglandular tularemia but without an ulcer. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of eye and swelling of lymph glands in front of the ear.
Oropharyngeal: This form results from eating or drinking contaminated food or water. Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.
Pneumonic: This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the blood stream to the lungs.
6. Ehrlichiosis East, Southeast, Central. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used
Bacteria name: Two ehrlichial bacteria species that are known to cause disease in humans: Ehrlichia chaffeensis and Ehrlichia ewingii
Test: No laboratory test is currently considered definitive for the presence of ehrlichial bacteria species. Clinical observation is the standard. However iGenix markets a PCR test for Ehrlichiosis. Note to patients and physicians: Many tick bites harbor more than one harmful bacteria or organism. Multiple tests maybe required to determine the full spectrum of infection.
Treatment: Doxycycline 100 mg 2x a day for 6 months for full irradiation.
Symptoms: Some people infected with ehrlichiosis may have symptoms so mild that they never seek medical attention. However ehrlichiosis with persistent symptoms can result in an illness serious enough for hospitalization. Presentation with Mild fever, Headache, Muscle aches, Nausea, Vomiting, Diarrhea, Cough, Joint pain and Confusion.
* Rash — rare in adults, but more frequent in children
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
7. Lyme Disease Northeast, North Central,
Bacteria name: Borrelia burgdorferi
Treatment: Doxycycline 100 mg 2x a day for 21 days to eradicate on life cycle or 6 months for full irradiation. Treatment should not be withheld while waiting for confirmatory test.
Test: No laboratory test is currently considered definitive for the presence of Borrelia burgdorferi bacteria. Most laboratory test finding are valuable only for stage 1 Lyme Disease. Clinical observation is the standard. However iGenix markets a PCR test for burgdorferi bacteria.
Symptoms:
Stage 1 Lyme - localized infection.
Common bullseye rash pattern associated with Lyme Disease. Characteristic "bulls-eye"-like rash may be warm, but is generally painless. The true bullseye occurs in as few as 9% of cases. Flu-like symptoms such as headache, muscle soreness, fever, and malaise.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
Stage 2 Lyme – Early disseminated infection
Within days to weeks after the onset of local infection, the borrelia bacteria may begin to spread through the bloodstream. Bulls eye rash maybe present in random areas on the body. Migrating pain in muscles, joint, and tendons, and heart palpitations and dizziness caused by changes in heartbeat.
Acute neurological problems, which appear in 15% of untreated patients, encompasses a spectrum of disorders. Facial Bell's palsy and meningitis. Radiculoneuritis causes shooting pains. Sleep disturbance and abnormal skin sensations. Mild encephalitis may lead to memory loss and mood changes. Altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
Stage 3 Chronic Lyme – Late persistent infection
After several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms affecting many organs of the body including the brain, nerves, eyes, joints and heart. Myriad disabling symptoms can occur, including permanent paraplegia in the most extreme cases. Chronic neurological symptoms occur in up to 5% to 8% of untreated patients. A polyneuropathy manifested primarily as shooting pains, numbness, and tingling in the hands or feet may develop. A neurological syndrome called Lyme encephalopathy, cognitive problems such as difficulties with concentration and short term memory, profound fatigue, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases, psychosis has been attributed to chronic Lyme disease.
Lyme arthritis usually affects the knees and neck. In a minority of patients arthritis can occur in other joints, including the ankles, elbows, wrist, hips, and shoulders. Pain is often mild or moderate and is the lesser of complaints patients refer to when presenting with Chronic Stage 3 Lyme.
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
8. Anaplasmosis: Northeast, North Central,
Bacteria Name: Anaplasma phagocytophilum. Formerly known human granulocytic ehrlichiosis
Treatment: Treatment should not be withheld while waiting for confirmatory tests. Doxycycline therapy 100 mg three time daily for 6 months. Other tetracycline drugs also are likely to be effective. Patients with unexplained fever after a tick exposure should receive empiric doxycycline therapy, particularly if they experience leucopenia (decreased white blood cells) and/or thrombocytopenia (few platelets).
Testing: Currently test catch only 12 to 25% of blood culture confirmed cases and is even less using CSF. Test may be helpful but treatment should be determined on a clinical basis. An indirect immunofluorescence assay (IFA) is the principal test used to detect HA infection. Acute and convalescent phase serum samples can be evaluated to look for a four-fold change in antibody titer to HA. Intracellular inclusions (morulae) also may be visualized in granulocytes of Wright- or Giemsa- stained blood. Lastly, polymerase chain reaction (PCR) assays are being used increasingly to detect HA DNA.
Symptoms
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
9.
Bacteria Name:
Treatment
Test
Symptoms
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
10. Powassan Encephalitis: North American tick-borne illness caused by Powassan (POW) virus. POW virus is just one of many viruses that are transmitted by arthropods (known as arboviruses) such as mosquitoes and ticks. POW virus is classified as a ‘flavavirus’ and it is closely related to tick-borne encephalitis viruses found in the
Organism Name: Powassan (POW) virus
Treatment: There is currently no effective treatment for Powassan. If you have Powassan, your doctor will have you kept at the hospital so that you can receive supportive care.
Test: There are no accurate tests for Powassan Virus.
Symptoms: Signs generally are seen about 4-18 days after the tick bite. Powassan usually include headache, fever, nausea, vomiting, stiff neck, and sleepiness. In later stages, signs such as respiratory distress, tremors, confusion, seizures, coma, paralysis, and sometimes even death can occur
Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms my not resolve with treatment.
11. Q Fever
Organism Name: C. burnetii
Treatment: Doxycycline is the treatment of choice for acute Q fever. Antibiotic treatment is most effective when initiated within the first 3 days of illness. A dose of 100 mg of doxycycline taken orally three times daily for 15-21 days is a frequently prescribed therapy. Quinolone antibiotics have demonstrated good in vitro activity against C. burnetii and may be considered by the physician. Therapy should be started again immediately if the disease relapses.
Test: The CHEKIT Q-Fever ELISA Test Kit is an enzyme immunoassay for the detection of antibodies against Coxiella burnetii. This test has no reports of false negative but may miss up to 50% of the cases of Q Fever.
Symptoms: People with acute Q fever may have no symptoms at all, while chronic Q fever typically affects the heart and other major organs.
Acute Q Fever: More than half the people infected with acute Q fever never show symptoms. If you do have symptoms, you'll notice them about two to three weeks after exposure to the bacteria. The infection may mimic the flu, causing these signs and symptoms:
- High fever (104 degrees Fahrenheit, or 40 degrees Celsius)
- Severe headache
- Fatigue
- Sore throat
- Chills
- Sweats
- Cough, which may be dry or productive
- Chest pain
- Abdominal pain
- Nausea
- Vomiting
- Diarrhea
- Purplish rash (not always present)
- Severe muscle pain
Chronic Q fever
If you have had Q fever for more than six months, it's considered chronic. Chronic Q fever can develop anytime between one and 20 years after you first had acute Q fever, even if you didn't show symptoms initially.
The symptoms of chronic Q fever vary depending on how it manifests itself. Different ways chronic Q fever can affect you include:
- Q fever endocarditis. With endocarditis, the heart's inner lining is inflamed, which can lead to damage of the heart's valves. Signs and symptoms include prolonged fever, night sweats, chills, fatigue and shortness of breath.
- Blood vessel infections. When the bacteria that cause Q fever infect your blood vessels, you may have a fever, fatigue, loss of appetite and weight loss.
- Other types of chronic Q fever. Rarely, chronic Q fever can manifest itself as a bone infection (osteomyelitis), chronic lung infection or chronic fatigue, each with its own set of symptoms.
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Presentation Warning: Patients can present with mild to extreme mental illness, depression or cognitive impairment. These symptoms should resolve with treatment.
Information above is editorial and compiled using source from the CDC, Mayo Clinic and ILADs
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