Presented by: Joseph Granato B.S. M.P.H. Capstone Project
|
|
- James McDowell
- 5 years ago
- Views:
Transcription
1 Presented by: Joseph Granato B.S. M.P.H. Capstone Project
2 Relevant to the content of this presentation, I have nothing of importance to disclose.
3 Discuss tick biology & species in Tennessee Review risk factors and prevention methods Identify the signs &symptoms of tick-borne diseases in Tennessee Recognize current diagnostic and confirmatory tests for tick-borne diseases Examine current treatment guidelines for tick-borne diseases
4 Introduction to Acari Life Cycle Species of Public Health Importance Specific to Tennessee
5 Acari- taxonomic group including ticks & mites Blood sucking ectoparasites 2 nd only to mosquitoes in # diseases transmitted 2 types of ticks Hard ticks (Ixodidae) Soft ticks (Argasidae) 80 tick species in the US; 17 tick species documented in Tennessee <10 ever bite humans Currently >30 tick-borne diseases TN Human-biting ticks Lone Star tick American Dog tick Gulf Coast tick Blacklegged tick
6 Life cycles range from 1 to 3 yrs. Life cycle(*= feeds on host) Egg Larva (seed ticks)* Nymph* Adult* Each life stage requires a blood meal prior to molt Species/geography determine life cycle & preferred host Ixodes scapularis life cycle resulting in Borrelia burgdorfer infection Retrieved from: Little, S., Heise, S., Blagburn, B., Callister, S., & Mead, P. (2010). Lyme borreliosis in dogs and humans in the USA. Trends in Parasitology, 26(4),
7 American dog tick questing Retrieved from: Host location/identification Questing- posture increasing chance of locating a host Detect CO₂/body heat/vibrations Attachment Chelicerae/Denticles/Hypostome Saliva- contains Analgesics Immunosuppressors Anticoagulants Neurotoxins (may be present) Generalized mouthparts of a hard tick, based on a species of Ixodes. Illustration by: Scott Charlesworth, Purdue University
8 Disease Transmission Tick ingests pathogens from infected host via feedings Pathogens secreted in saliva during blood meal Transmission times may vary depending on tick species and pathogen (24-48hrs) Pathogenic organisms can be transmitted if tick is removed using improper technique Tick bites infrequently cause disease Changes as a lone star tick engorges Retrieved from:
9 Spotted Fever Rickettsiosis (Rocky Mountain Spotted Fever) Ehrlichiosis Anaplasmosis Tularemia Babesiosis Lyme Disease Powassen encephalitis Masters Disease (Southern Tick Associated Rash Illness or STARI) Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
10 US Reported cases: 2011 Tularemia reported cases: 2011 Spotted Fever Rickettsiosis reported cases: 2011 Ehrlichiosis chaffeensis reported cases: 2011 Babesiosis reported cases: 2011 Lyme Disease reported cases: 2011 Anaplasmosis reported cases: 2011 Maps retrieved from: Centers for Disease Control and Prevention. (2013). Summary of notifiable diseases- United States, MMWR, Morbidity and Mortality Weekly Reports, 60(53). Retrieved from
11 Spotted Fever Rickettsiosis Confirmed & Probable Reported Cases Tennessee, 2012 Confirmed case: A clinically compatible case (meets clinical evidence criteria) that is laboratory confirmed. Probable case: A clinically compatible case (meets clinical evidence criteria) that has supportive laboratory results. Retrieved from/more info:
12 Ehrlichiosis Confirmed & Probable Reported Cases Tennessee, 2012 Confirmed case: A clinically compatible case (meets clinical evidence criteria) that is laboratory confirmed. Probable case: A clinically compatible case (meets clinical evidence criteria) that has supportive laboratory results. Retrieved from/more info:
13 Lyme Disease Confirmed & Probable Reported Cases Tennessee, 2012 Confirmed case: a) a case of EM with a known exposure, or b) a case of EM with laboratory evidence of infection and without a known exposure or c) a case with at least one late manifestation that has laboratory evidence of infection. Probable case: any other case of physician-diagnosed Lyme disease that has laboratory evidence of infection. Retrieved from/more info:
14 Spotted Fever Rickettsiosis 2011 US: 0.91 cases 2012 TN: cases Ehrlichiosis/Anaplasmosis (combined) 2011 US: 1.22 cases 2012 TN: 1.25 cases Lyme Disease 2011 US: cases 2012 TN: 0.43 cases Retrieved from: Centers for Disease Control and Prevention. (2013). Summary of notifiable diseases- United States, MMWR, Morbidity and Mortality Weekly Reports, 60(53). Retrieved from Tennessee Department of Health. (2013). Reportable diseases and events, by Tennessee health region, year-to-date and MMWR week 52. Retrieved from United States Census Bureau. Annual estimates of the resident population: April 1, 2010 to July 1,2012. Retrieved from
15 Tick Species of Public Health Importance Vector: Amblyomma americanum Common name: Lone Star tick Pathogens: Ehrlichia chaffeensis; Ehrlichia ewingii; Francisella tularensis; Rickettsia rickettsii; Rickettsia parkeri Human diseases: Ehrlichia chaffeensis infection; Ehrlichia ewingii infection; Tularemia; Rocky Mountain Spotted Fever; Master s Disease or Southern Tick Associated Rash Illness Non-pathogens: Rickettsia amblyommi; R. andeanae; R. felis Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59, ; Dumler, J. S., Madigan, J., Pusterla, N., & Bakken, J. (2007). Ehrlichioses in humans: Epidemiology, clinical presentation, diagnosis, and treatment [Supplemental material]. Clinical Infectious Diseases, 45, S45-S51
16 Abundant in Tennessee Ehrlichiosis: most common disease transmitted Aggressive biter Characteristic white dot on back of adult females Irritating saliva Can cause allergic reaction Small red area of skin irritation (diameter <5 cm) Appears within 48 hours does not make disease transmission certain Lone star tick distribution Retrieved from: Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from
17 Tick Species of Public Health Importance Vector: Dermacentor variabilis Common name: American dog tick Pathogens: Rickettsia rickettsii; Francisella tularensis Human diseases: Rocky Mountain Spotted Fever; Tularemia Non-pathogens: Rickettsia amblyommii; R. montanensis Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
18 Abundant in Tennessee RMSF: most common disease transmitted by this species Dogs primary host Can survive 2yrs without host Dark brown with random silver streaks on back of adults RMSF transmission reduced: R. rickettsii has lethal effects D. variabilis produce rickettsiostatic proteins American dog tick distribution Retrieved from: Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
19 Tick Species of Public Health Importance Vector: Ixodes scapularis Common name: Blacklegged tick (deer tick) Pathogens: Borrelia burgdorferi; Anaplasma phagocytophilum; Babesia microti; Babesia duncani; Ehrlichia sp.; Powassen virus Human diseases: Lyme Disease; Anaplasmosis; Babesiosis; Ehrlichia muris-like infection; Powassen encephalitis Non-pathogens: Rickettsia massiliae (Italy) Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
20 Scarce in Tennessee Lyme Disease: most common disease transmitted in North Dark brown/distinct black legs Hypothesized to be preferred host in TN: Lizard/small mammals Note: Reptile blood is bacteriostatic for B. burgdorferi Birds/White-tailed deer Less likely to carry pathogens due to lack of pathogen in preferred host Blacklegged tick distribution Retrieved from: Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
21 Tick Species of Public Health Importance Vector: Rhipicephalus sanguineus Common name: Brown dog tick Pathogen: Rickettsia rickettsii Human disease: Rocky Mountain Spotted Fever (RMSF) Non-pathogen: Rickettsia massiliae (France) Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
22 Scarce in Tennessee RMSF: most common disease transmitted by this species Dark reddish-brown with no ornamentation on the back Not considered to be an important vector in TN Can spend entire life cycle indoors Infestations can be difficult to resolve Preferred habitat: Animal pens/human homes Human bites uncommon Brown dog tick distribution Retrieved from: Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59,
23 Rocky Mountain Spotted Fever Ehrlichiosis Lyme Disease Masters Disease
24 Rocky Mountain Spotted Fever: Case Presentation On April 27, a 65-year old woman from southeastern Tennessee was admitted to a community hospital with fever, nausea, vomiting and muscle aches. She rapidly developed septic shock and died on April 30. An acute-phase serum specimen was found to be reactive with Rickettsia rickettsii IgM antibody at a dilution of 1:256. On May 9, and May 28, two women presented to the same hospital with febrile illnesses and had R. rickettsii serologic tests yield positive results. On June 1, an internist in this same community saw a patient in his office who he suspected had RMSF. During the previous year, only one case of RMSF was diagnosed at this hospital.
25 Most fatal TBD in US 3-5% of reported cases are fatal Up to 80% fatal without treatment Causative agent Rickettsia rickettsii Gram-negative, obligate intracellular bacteria American/Brown dog ticks: most common vectors 2-14 day incubation period (mean 7) Included in Spotted Fever Rickettsiosis surveillance since 2010 Geography >60% of cases in TN, NC, MO, OK, AR Mostly rural/suburban areas Seasonality 90% of cases April- September 10% during winter month=danger: delayed or misdiagnosis Demographics Age > 40 years or <10 years Males 40% of cases don t recall tick bite Risk Factors Exposure to wooded/grassy areas Pets with exposure to tick habitat Professional/recreational activities Compromised immune system may increase risk of severe outcome Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Centers for Disease Control and Prevention. (2006). Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis---United States. MMWR, Morbidity and Mortality Weekly Reports, 55(RR04), Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.; Childs, J. (2002). Passive surveillance as an instrument to identify risk factors for fatal Rocky Mountain Spotted Fever: Is there more to learn? The American Society of Tropical Medicine and Hygiene, 66(5),
26 RMSF rash Retrieved from: (Picture #: Top: 14489; Bottom: 1962) Clinical Presentation High fever/chills/headache/myalgias/gi symptoms Classic triad Fever/rash/tick bite Appears <20% of cases Rash Develops 2-5 days (post fever onset) 10% of cases rash is absent or atypical Macules (pink in coloration) Start on wrists/forearms/ankles-spreads centrally 1 to 4mm in size Palms & soles characteristic Petechiae Develops 6 or more days post symptom onset Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.; Gayle, A., & Ringdahl, E. (2001). Tick-borne diseases. American Family Physician, 64(3), ; Centers for Disease Control and Prevention. (2006). Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis---United States. MMWR, Morbidity and Mortality Weekly Reports, 55(RR04), Retrieved from
27 RMSF: Diagnosis Laboratory Findings Normal WBC: increased bands Thrombocytopenia Hyponatremia Mildly elevated aminotransferases Hyperbilirubinemia Confirmatory Diagnosis Immunofluorescence assay (IFA) (Gold standard) R. rickettsii antibodies detectable 7-10 days after onset % sensitive after 14 days Cross reactivity possible Paired IgG antibody titers positive= 4-fold change Acute Convalescent (2-4 weeks post initial or acute sample draw) Note: Negative acute test does not rule out diagnosis of RMSF Note: Commercially available EIA tests are not quantitative=cannot be used to evaluate IgG titer changes Note: Must request reflexive titers (commercially available) Other available tests Immunohistochemical (IHC) staining of causative organism Polymerase Chain Reaction (PCR) Skin punch biopsy from rash site Antibiotic treatment decreases sensitivity of the assay Available at specialty labs Centers for Disease Control and Prevention. (2006). Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis--- United States. MMWR, Morbidity and Mortality Weekly Reports, 55(RR04), Retrieved from Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from
28 Guidelines: CDC and American Academy of Pediatrics Doxycycline (4.4mg/kg per day)-recommended treatment Adults- 100mg BID (maximum: 100mg/dose) Pediatric (<100lbs.)- 2.2mg/kg BID (maximum: 100mg/dose) Note: No teeth staining observed at this dose and duration 7day minimum treatment Continue treatment until 3 days post fever Chloramphenicol-Alternative treatment Tetracycline hypersensitivity Pregnancy Less effective: Increased risk of death/anaplastic anemia Effectiveness Treatment most effective before day 5 Begin treatment as soon as RMSF is suspected Do not wait for lab results/development of rash Use permission granted from AAP; Retrieved from: Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Childs, J. (2002). Passive surveillance as an instrument to identify risk factors for fatal Rocky Mountain Spotted Fever: Is there more to learn? The American Society of Tropical Medicine and Hygiene, 66(5),
29 Ehrlichiosis: Case Presentation In May, a 40 year old male construction worker sought medical attention with complaints of headache, fever, sore throat, and vomiting. He does not own pet and did not recall being bitten by a tick. The patient was diagnosed with pneumonia and prescribed 3 days of azithromycin and levofloxacin. Fevers >103º F persisted and he had an onset of confusion. Upon arrival to the ED skin examination revealed diffuse erythema with several scabs on the lower legs. CBC showed a slightly elevated white count 11,900 (normal 4,500 11,000), 3% lymphocytes (normal 16%-46%), and a decreased platelet count 50,000 (normal 150, ,000). Liver function tests were also abnormal; AST 439 (normal 10-40), ALT 471 (normal 10-55), and alkaline phosphatase 236 (normal ). Antibodies tests for R. rickettsii and E. chaffeensis were negative. Antibiotic therapy was initiated with ceftriaxone and vancomycin. Approximately 6 hours later the patient developed seizures; acyclovir and doxycycline were added to the drug therapy. Serum obtained 31 days after the initial signs and symptoms contained no antibodies to R. rickettsii, but had an IgG titer of 1:256 to E. chaffeensis.
30 Ehrlichiosis: Epidemiology Ehrlichia species most prevalent pathogens in Tennessee ticks Up to 5% of ticks infected 2-3% of cases are fatal Up to 62% of cases are hospitalized Causative agent Ehrlichia chaffeensis Gram-negative, obligate intracellular bacteria found in monocytes Lone star tick: most common vector 7-10 day incubation period (mean 8d) Ehrlichia chaffeensis infection- a.k.a. Human Monocytic Ehrlichia (HME) Ehrlichia ewingii infection-canine pathogen until 1999 Anaplasma phagocytophilum infection-formerly Human granulocytic Ehrlichiosis/Anaplasmosis (HGE/HGA) Geography Most cases in MO, OK, & AR TN Cumberland Plateau:1993 outbreak Seasonality April through September Peak in May & June Demographics Median age ~44 years Slightly more males than females ~68% of cases don t recall tick bite Risk Factors Exposure to wooded/grassy areas Pets with exposure to tick habitat Professional/recreational activities Compromised immune system may increase risk of severe outcome Stromdahl, E.Y., & Hickling, G. J. (2012). Beyond Lyme: Aetiology of tick-borne human diseases with emphasis on the south-eastern United States [Supplemental material]. Zoonoses and Public Health, 59, ; The Center for Food Security & Public Health. (2013). Ehrlichiosis and Anaplasmosis: Zoonotic species (pp. 1-14). Ames, Iowa: Iowa State University. Retrieved from Dumler, J. S., Madigan, J., Pusterla, N., & Bakken, J. (2007). Ehrlichiosis in humans: Epidemiology, clinical presentation, diagnosis, and treatment [Supplemental material]. Clinical Infectious Diseases, 45, S45-S51.; Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from
31 Ehrlichiosis: Signs & Symptoms Clinical Presentation Fever/headache i.e., an influenza-like illness after outdoor activity Malaise Less common symptoms Nausea/Vomiting/Diarrhea Altered mental state/confusion Rash Reported in 30% adults/60% children Appears on the trunk rarely on palms/soles Develops later in disease (average 5 days) Can resemble RMSF rash less prominent/more variable appearance Ehrlichiosis rash. Use permission granted from: Richard Jacobs, MD; Retrieved from: Ehrlichia and Anaplasma Infections (Human Ehrlichiosis and Anaplasmosis) Red Book 2012: Centers for Disease Control and Prevention. (2006). Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis--- United States. MMWR, Morbidity and Mortality Weekly Reports, 55(RR04), Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.; Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from The Center for Food Security & Public Health. (2013). Ehrlichiosis and Anaplasmosis: Zoonotic species (pp. 1-14). Ames, Iowa: Iowa State University. Retrieved from
32 Ehrlichiosis: Diagnosis Laboratory Findings Thrombocytopenia Leukopenia Anemia Elevated aminotransferases Confirmatory Diagnosis Immunofluorescence assay (IFA) (Gold standard) E. chaffeensis antibodies detectable 7-10 days after onset % sensitive after 14 days Cross reactivity possible Paired IgG antibody titers positive= 4-fold change Acute Convalescent (2-4 weeks post initial or acute sample draw) Note: Negative acute test does not rule out diagnosis of Ehrlichiosis Note: Commercially available EIA tests are not quantitative=cannot be used to evaluate IgG titer changes Note: Must request reflexive titers (commercially available) Other available tests Immunohistochemical (IHC) staining of organism Polymerase Chain Reaction (PCR) Skin punch biopsy from rash site Antibiotic treatment decreases sensitivity of the assay Available at specialty labs Ismail, N., Bloch, K., & McBride, J. (2010). Human Ehrlichiosis and Anaplasmosis. Clinics in Laboratory Medicine, 30(1), ; Centers for Disease Control and Prevention. (2006). Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis---United States. MMWR, Morbidity and Mortality Weekly Reports, 55(RR04), Retrieved from Centers for Disease Control and Prevention. (2013). Symptoms, diagnosis, and treatment. Atlanta, GA. Retrieved from Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from
33 Guidelines: CDC and American Academy of Pediatrics Committee Doxycycline-Recommended treatment (maximum: 100mg/dose) Adults- 100mg BID Pediatric (<100lbs.)- 2.2mg/kg BID Note: No teeth staining at this dose and duration 7day minimum treatment Continue treatment until 3 days post fever Rifampin-Alternative treatment Pregnancy/children/hypersensitivity Cautious use: resistance possible/may not cover differential diagnosis Effectiveness Treatment most effective within first 5 days Fever wanes 24-72hrs after treatment Note: If patient not responding consider alternative diagnosis Do not delay treatment for lab results/development of rash Persistent fever and malaise reported to occur in some cases Use permission granted from AAP; Retrieved from: The Center for Food Security & Public Health. (2013). Ehrlichiosis and Anaplasmosis: Zoonotic species (pp. 1-14). Ames, Iowa: Iowa State University. Retrieved from Centers for Disease Control and Prevention. (2013). Symptoms, diagnosis, and treatment. Atlanta, GA. Retrieved from Dumler, J. S., Madigan, J., Pusterla, N., & Bakken, J. (2007). Ehrlichioses in humans: Epidemiology, clinical presentation, diagnosis, and treatment [Supplemental material]. Clinical Infectious Diseases, 45, S45-S51.
34 Lyme Disease: Case Presentation In July, a 2 year old male Caucasian living in a rural area of southeastern Tennessee was seen by a pediatrician for lethargy, fever (102.2ºF), and a rash on his back. The child was placed on Doxycycline. The mother reported removing a tick from the child s back a few days before the rash appeared. The tick was attached approximately at the center of the circular rash. The family owned two outside dogs and both had a history of tick infestation. Laboratory analysis indicated an elevated erythrocyte sedimentation rate of 25mm/h (normal=25mm/h). The patients ELISA test results were equivocal with a value of 1.03 Lyme index units (range ). A Lyme Disease diagnosis was ultimately confirmed when a Western blot assay was found to be positive for Borrelia burgdorferi, with 6 bands observed (18, 28, 30, 41, 45, and 66 kda). Retrieved from:
35 Lyme Disease: Epidemiology Most common vector-borne illness in the United States Fatality with complications or secondary infections 1991:made nationally notifiable Causative agent Borrelia burgdorferi Spirochete bacteria 3-30 day incubation period Median 11 day incubation period Blacklegged tick: common vector Borreliosis taxonomy (*=not confirmed) Borrelia organisms that cause Lyme-like clinical manifestations Masters disease/southern Tick Associated Rash Illness (STARI)* Geography 95%:CT, VA, DE, ME, MD, MA, MN, NJ, NH, NY, PA, WI, VT Endemic in Upper Midwest and northeastern US Seasonality April to October Peak in June & July-50% of cases Demographics Young males 5-9 Adults years Risk Factors Exposure to wooded/grassy areas Pets with exposure to tick habitat Immunocompromised=increase risk of severe outcome Travel to endemic areas Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.
36 Early localized Summer flu 3-30 day incubation period Median 7-10 days Flu-like symptoms: Headache/ malaise/myalgia/ arthralgia Fever may or may not be present Erythema Migrans (EM) Bulls-eye lesion Up to 80% of cases Starts at bite site and expands to greater than 5cm in diameter Central clearing possible Early Disseminated (days-weeks) Multiple EM lesions possible anywhere (in 50% of cases) Transient, migratory arthritis Headache/neck stiffness/fatigue Cardiac: Myocarditis, pericarditis Neurologic: Meningitis/Bell s palsy Late Disseminated (untreated) Lyme arthritis (60% of cases) PTLDS (Post Treatment Lyme Disease Syndrome) Recurrent symptoms in up to 20% Antibiotic treatment shown to be unhelpful (possibly autoimmune) Longo, D. A., Fauci, D., Kasper, S., Hauser, J., Jameson, & Loscalzo, J.. (Eds.). (2013). Harrison s manual of medicine (18 th ed.). New York, NY: McGraw-Hill.; Gilbert, D.N., Moellering, R. C., Eliopolulos, G. M., Chambers, H.F., & Saag, M. S. (Eds.). (2013). The Sanford guide to antimicrobial therapy 2013 (43 rd ed.). Sperryville, VA: Antimicrobial Therapy.; Papadakis, M.A., & McPhee, S.J. (Eds.). (2014). Current medical diagnosis (53 rd ed.). New York, NY: McGraw-Hill.; Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.
37 Lyme Disease: Erythema Migrans (EM) Erythema Migrans examples Retrieved from: (Picture #s: Left top:14475; Left bottom:14479; Middle:14480; Right:14482
38 Laboratory findings Elevated erythrocyte sedimentation rate>20mm/h (50% of cases) Mild elevation of hepatic transaminases (30% of cases) Hematuria or proteinuria (<10% of cases) Confirmatory Diagnosis: Two step approach Screen: ELISA Negative results warrant no further testing Increased number of false positives due to low specificity If screen is positive or equivocal perform confirmatory Western blot Confirmatory: Western blot Positive=2 IgM bands or 5 IgG bands present Cross reactivity with spirochetal/viral infections/autoimmune diseases Patients with non-specific symptoms and without objective signs of Lyme Disease should not have serologic testing done More false positives than true positives Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association.
39 Lyme Disease: Treatment Guidelines: CDC and American Academy of Pediatrics Treatment based on clinical manifestations and disease stage Doxycycline Adults-100mg BID Pediatric- 4mg/kg/day divided into 2 doses (100mg/dose maximum) Treatment duration: days Cefuroxime axetil Adults- 500mg BID Pediatric- 30mg/kg/day divided into 2 doses (500mg/dose maximum) Treatment duration: days Amoxicillin Adults- 500mg, TID Pediatric- 50mg/kg/day divided into 3 doses (100mg/ dose maximum) Treatment duration: days Macrolides-Alternative treatment Azithromycin/Clarithromycin/Erythromycin Less effective/relapse possible Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed., pp ). Washington: American Public Health Association. Use permission granted from AAP; Retrieved from:
40 Causative agent- No etiological agent identified Most common vector: Lone Star tick Southern Tick Associated Rash Illness (STARI) or Lyme-like illness Incubation period 6-9 days Geography Across the southern US From TX north to OK and eastward Seasonality 90% of cases April- September Peak in June & July Demographics unknown Risk Factor No known fatal cases Masters, E., Grigery, C., & Masters, R. (2008). STARI, or Masters Disease: Lone star tick-vectored Lyme-like illness. Infectious Disease Clinics of North America, 22,
41 Clinical Presentation Fatigue Likely to recall tick bite compared to Lyme Disease cases Occasional symptoms- less likely than Lyme Disease Fever/Headache/Stiff neck Myalgia/joint pain Unlikely symptoms Lymphadenopathy Tender/pruritic rash Rash Small Erythema Migrans (Bull s eye) ~6-10 cm diameter Appears quick ~6 days Multiple lesions unlikely Nearly impossible to differentiate from Lyme Disease EM Central clearing more common Masters, E., Grigery, C., & Masters, R. (2008). STARI, or Masters Disease: Lone star tick-vectored Lyme-like illness. Infectious Disease Clinics of North America, 22, ; Lone star tick a concern, but not for Lyme disease. In Southern Tick-Associated Rash Illness. Atlanta, GA. Retrieved from
42 Masters Disease: Erythema Migrans Masters Disease rash pictures Retrieved from: Masters, E., Grigery, C., & Masters, R. (2008). STARI, or Masters Disease: Lone star tick-vectored Lyme-like illness. Infectious Disease Clinics of North America, 22,
43 Diagnosis Clinical presentation Lack of plasma cells in biopsy Identification of tick most important in differentiation Amblyomma americanum- Lone Star Tick Not Ixodes scapularis- Blacklegged tick Treatment Observation in the south and southeastern states Same as Lyme Disease-Mid-Atlantic states (Maryland/Virginia) Unknown if antibiotic treatment is effective Increased risk of serious reaction and increased cost with treatment in non-lyme Disease endemic areas Lantos, P. M., Brinkerhoff, R. J., Wormser, G. P., & Clemen, R. (2013). Empiric antibiotic treat of Erythema Migrans- Like skin lesions as a function of geography: A clinical and cost effectiveness modeling study. Vector-Borne and Zoonotic Diseases, 13(0).; Masters, E., Grigery, C., & Masters, R. (2008). STARI, or Masters Disease: Lone star tickvectored Lyme-like illness. Infectious Disease Clinics of North America, 22, ; Feder, H., Jr., Hoss, D., Zemel, L., Telford, S., III, Dias, F., & Wormser, G. (2011). Southern Tick-Associated Rash Illness (STARI) in the North: STARI following a tick bite in Long Island, New York. Clinical Infectious Diseases, 53(10), e142-e146.
44 TN Incidence Rate (per 100,000) Spotted Fever Rickettsiosis ~10 times higher than United States Lyme Disease ~10 times less than the United States Lone Star tick-most abundant species in Tennessee Ehrlichia species-most prevalent pathogen in TN 90% of cases April-September Symptoms-sudden onset Fever/headache Malaise/myalgia Rash in 30-90% of all Ehrlichiosis/RMSF cases 40-68% do not recall tick bite Laboratory (RMSF & Ehrlichiosis) Elevated aminotransferases Thrombocytopenia Diagnosis (RMSF & Ehrlichiosis) IFA (gold standard) testing sensitivity % after 14 days of illness Antibodies detected 7-10 days after onset of illness False negative/positive/crossreactivity possible Treatment-Doxycycline Adults-100mg/kg Children-2.2mg/kg; 4mg/kg (Borreliosis) Most effective within 5 days after symptom onset
45 Recent Developments-TBD Gulf Coast Tick-Amblyomma maculatum Western TN; Gulf of Mexico & Atlantic Ocean boarders Vectors Rickettsia parkeri-recently found to be pathogenic 2002 WV confirmed case Classic TBD febrile presentation Rash (trunk/palms/soles) Eschars-similar to African tickbite fever or rickettsialpox Culture-based or molecular based testing for diagnosis Responds to Doxycycline treatment Heartland Virus- Amblyomma americanum New Phlebovirus-2009 in MO Documented cases in MO & TN Fatal case with comorbidities 14 day incubation period Fever/headache/myalgia/nausea Leukopenia/Thrombocytopenia RT-PCR & PRNT: laboratory testing Borrelia miyamotoi-ixodes scapularis New relapsing-fever spirochete Disease endemic areas Progressive mental deterioration ± classic Lyme symptoms Diagnostic and treatment protocols unknown Gugliotta, J. L., Goethert, H. K., Berardi, V. P., & Telford, S. R. (2013). Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. The New England Journal of Medicine, 368(3), ; Paddock, C. D., Sumner, J. W., Comer, J. A., Zaki, S. R., Goldsmith, C. S., Gooddard, J., & McLellan, S. L. F. (2004). Rickettsia parkeri: A newly recognized cause of Spotted Fever Rickettsiosis in the United States. Clinical Infectious Diseases, 38, ; Centers for Disease Control and Prevention. (2014). Notes from the field: Heartland Virus Disease-United States, MMWR, Morbidity and Mortality Weekly Reports, 63(12). Retrieved from
46 Prophylaxis No vaccines in US No treatment recommended Observe asymptomatic tick bite patients Protect yourself/pets 20-50% DEET/Monthly preventatives Long sleeves/pants Tick checks Proper removal Protect your yard Limit tick habitat/wildlife Chemical treatment How to remove a tick permission granted from: Scott Leighton / medicusmedia.com; Retrieved from: tch/2009/june/recognizing-and-avoiding-tick-borne-illness Centers for Disease Control and Prevention. (2013). Tickborne diseases of the United States: A reference manual for health care providers (1st ed.). U.S. Department of Health and Human Services. Retrieved from
47 Dr. Lorinda Sheeler-South College Vanessa Ross-Des Moines University Iowa Medical Society Additional resources American Academy of Pediatrics. Rocky mountain spotted fever. In: Pickering LK, editor. Red book: 2012 report of the committee on infectious diseases. 29 th edition. Elk Grove Village (IL): American Academy of Pediatrics; p Longo, D. A., Fauci, D., Kasper, S., Hauser, J., Jameson, & Loscalzo, J.. (Eds.). (2013). Harrison's manual of medicine (18th ed.). New York, NY: McGraw-Hill. Gilbert, D. N., Moellering, R. C., Eliopoulos, G. M., Chambers, H. F., & Saag, M. S. (Eds.). (2013). The Sanford guide to antimicrobial therapy 2013 (43rd ed.). Sperryville, VA: Antimicrobial Therapy. Papadakis, M. A., & McPhee, S. J. (Eds.). (2014). Current medical diagnosis (53rd ed.). New York, NY: McGraw-Hill. Heymann, D.L. (Ed.). Control of communicable diseases manual (19th ed.). Washington: American Public Health Association. Centers for Disease Control and Prevention Tennessee Department of Health University of Rhode Island Tick Encounter Resource Center
The Essentials of Ticks and Tick-borne Diseases
The Essentials of Ticks and Tick-borne Diseases Presenter: Bobbi S. Pritt, M.D., M.Sc. Director, Clinical Parasitology Laboratory Co-Director, Vector-borne Diseases Laboratory Services Vice Chair of Education
More informationTopics. Ticks on dogs in North America. Ticks and tick-borne diseases: emerging problems? Andrew S. Peregrine
Ticks and tick-borne diseases: emerging problems? Andrew S. Peregrine E-mail: aperegri@ovc.uoguelph.ca Topics Ticks on dogs in Ontario and the pathogens they transmit? Should dogs be routinely screened
More informationLearning objectives. Case: tick-borne disease. Case: tick-borne disease. Ticks. Tick life cycle 9/25/2017
Learning objectives Medically Significant Arthropods: Identification of Hard-Bodied Ticks ASCLS Region V October 6, 2017 1. Describe the tick life cycle and its significance 2. Compare anatomical features
More informationUpdate on Lyme disease and other tick-borne disease in North Central US and Canada
Update on Lyme disease and other tick-borne disease in North Central US and Canada Megan Porter, DVM Michigan State University 2018 CIF-SAF Joint Conference Tick season is here! Today s objectives: To
More informationWes Watson and Charles Apperson
Wes Watson and Charles Apperson Ticks are not insects! Class Acarina Order Parasitiformes Family Argasidae soft ticks (5 genera) Family Ixodidae hard ticks (7 genera) Genus Dermacentor 30 species Amblyomma
More informationOn People. On Pets In the Yard
*This information is provided by the Center for Disease Control as part of the public domain. Avoiding Ticks Reducing exposure to ticks is the best defense against Lyme disease, Rocky Mountain spotted
More informationTick-Borne Infections Council
Tick-Borne Infections Council of North Carolina, Inc. 919-215-5418 The Tick-Borne Infections Council of North Carolina, Inc. (TIC-NC), a 501(c)(3) non-profit organization, was formed in 2005 to help educate
More informationVector-Borne Disease Status and Trends
Vector-Borne Disease Status and Trends Vector-borne Diseases in NY 2 Tick-borne Diseases: Lyme disease Babesiosis Ehrlichiosis/Anaplasmosis Rocky Mountain Spotted Fever Powassan Encephalitis STARI Bourbon
More informationPage 1 of 5 Medical Summary OTHER TICK-BORNE DISEASES This article covers babesiosis, anaplasmosis, and ehrlichiosis. See Rickettsial Infections (tick-borne rickettsia), Lyme Disease, and Tick-Borne Encephalitis
More informationAbout Ticks and Lyme Disease
About Ticks and Lyme Disease Ticks are small crawling bugs in the spider family. They are arachnids, not insects. There are hundreds of different kinds of ticks in the world. Many of them carry bacteria,
More informationBloodsuckers in the woods... Lyric Bartholomay Associate Professor Department of Entomology Iowa State University
Bloodsuckers in the woods... Lyric Bartholomay Associate Professor Department of Entomology Iowa State University Characteristics Adapted for ectoparasitism: Dorsoventrally flattened Protective exoskeleton
More informationTick-Borne Disease. Connecting animals,people and their environment, through education. What is a zoonotic disease?
Tick-Borne Disease Connecting animals,people and their environment, through education What is a zoonotic disease? an animal disease that can be transmitted to humans (syn: zoonosis) dictionary.reference.com/browse/zoonotic+disea
More informationVector Borne and Animal Associated Infections. Kimberly Martin, DO, MPH Assistant Professor of Pediatrics Pediatric Infectious Diseases
Vector Borne and Animal Associated Infections Kimberly Martin, DO, MPH Assistant Professor of Pediatrics Pediatric Infectious Diseases 1 Conflict of Interest I have no relevant financial relationships
More informationFall 2017 Tick-Borne Disease Lab and DOD Human Tick Test Kit Program Update
Fall 2017 Tick-Borne Disease Lab and DOD Human Tick Test Kit Program Update Robyn Nadolny, PhD Laboratory Sciences US U.S. Tick-Borne Disease Laboratory The views expressed in this article are those of
More informationTick-borne Disease Testing in Shelters What Does that Blue Dot Really Mean?
Tick-borne Disease Testing in Shelters What Does that Blue Dot Really Mean? 2017 ASPCA. All Rights Reserved. Your Presenter Stephanie Janeczko, DVM, MS, DABVP, CAWA Senior Director of Shelter Medical Programs
More informationEXHIBIT E. Minimizing tick bite exposure: tick biology, management and personal protection
EXHIBIT E Minimizing tick bite exposure: tick biology, management and personal protection Arkansas Ticks Hard Ticks (Ixodidae) Lone star tick - Amblyomma americanum Gulf Coast tick - Amblyomma maculatum
More informationMarch)2014) Principal s News. BV West Elementary Orbiter. Upcoming)Events)
May2014 BV West Elementary Orr WestElementarySchool 61N.ThirdSt. Ostrander,Ohio43061 Phone:(74066642731 Fax:(74066642221 March2014 DevinAnderson,Principal CharleneNauman,Secretary KimCarrizales,Secretary
More informationTICKS AND TICKBORNE DISEASES. Presented by Nicole Chinnici, MS, C.W.F.S East Stroudsburg University Northeast Wildlife DNA Laboratory
TICKS AND TICKBORNE DISEASES Presented by Nicole Chinnici, MS, C.W.F.S East Stroudsburg University Northeast Wildlife DNA Laboratory PA Lyme Medical Conference 2018 New Frontiers in Lyme and Related Tick
More information29 JANUARY 2014 CHAPTER 129 CHAPTER 132 RABIES TICK-BORNE ILLNESSES
29 JANUARY 2014 CHAPTER 129 CHAPTER 132 RABIES TICK-BORNE ILLNESSES 1. Which of the following is true? A. Worldwide, dogs are the most commonly rabiesinfected animals. B. Despite similarities to dogs,
More informationWhat You Need to Know about Tick-Borne Illness
What You Need to Know about Tick-Borne Illness Marie George, MD Keith Michl, MD, FACP Bradley Tompkins, MS, MPH Trey Dobson, MD, FACEP Why we re here What we ll cover Tick-Borne Illness Introduction and
More informationBorreliae. Today s topics. Overview of Important Tick-Borne Diseases in California. Surveillance for Lyme and Other Tickborne
Surveillance for Lyme and Other Tickborne Diseases in California with emphasis on Laboratory role Anne Kjemtrup, D.V.M., M.P.V.M., Ph.D. Vector-Borne Disease Section California Department of Public Health
More informationCanine Anaplasmosis Anaplasma phagocytophilum Anaplasma platys
Canine Anaplasmosis Anaplasma phagocytophilum Anaplasma platys It takes just hours for an infected tick to transmit Anaplasma organisms to a dog. What is canine anaplasmosis? Canine anaplasmosis is a disease
More informationHow to talk to clients about heartworm disease
Client Communication How to talk to clients about heartworm disease Detecting heartworm infection early generally allows for a faster and more effective response to treatment. Answers to pet owners most
More informationMultiplex real-time PCR for the passive surveillance of ticks, tick-bites, and tick-borne pathogens
Multiplex real-time PCR for the passive surveillance of ticks, tick-bites, and tick-borne pathogens Guang Xu, Stephen Rich Laboratory of Medical Zoology University of Massachusetts Amherst TICKS ARE VECTORS
More informationDiscuss the reservoirs and vectors of the causative organisms of Lyme disease and other tick-borne
Brian S. Murphy, MD, MPH November 5, 2008 40th Annual Family Medicine Review Discuss the reservoirs and vectors of the causative organisms of Lyme disease and other tick-borne diseases Discuss the distribution
More informationElizabeth Gleim, PhD. North Atlantic Fire Science Exchange April 2018
Elizabeth Gleim, PhD North Atlantic Fire Science Exchange April 2018 Ticks & Tick-borne Pathogens of the Eastern United States Amblyomma americanum AKA lone star tick Associated Diseases: Human monocytic
More informationTicks, Tick-borne Diseases, and Their Control 1. Ticks, Tick-Borne Diseases and Their Control. Overview. Ticks and Tick Identification
Ticks, Tick-Borne Diseases and Their Control Jeff N. Borchert, MS ORISE Research Fellow Bacterial Diseases Branch Division of Vector-Borne Infectious Diseases Centers for Disease Control and Prevention
More informationREPORT TO THE BOARDS OF HEALTH Jennifer Morse, M.D., Medical Director
Ticks and Tick-borne illness REPORT TO THE BOARDS OF HEALTH Jennifer Morse, M.D., Medical Director District Health Department #10, Friday, May 19, 2017 Mid-Michigan District Health Department, Wednesday,
More informationSuggested vector-borne disease screening guidelines
Suggested vector-borne disease screening guidelines SNAP Dx Test Screen your dog every year with the SNAP Dx Test to detect exposure to pathogens that cause heartworm disease, ehrlichiosis, Lyme disease
More informationTick-borne Diseases 2018 Update. Thomas A. Moore, MD, FACP, FIDSA Clinical Professor of Medicine U of Kansas School of Medicine-Wichita Campus
Tick-borne Diseases 2018 Update Thomas A. Moore, MD, FACP, FIDSA Clinical Professor of Medicine U of Kansas School of Medicine-Wichita Campus Tick overview Common themes Tick-borne Diseases Cases (well-recognized
More informationThree Ticks; Many Diseases
Three Ticks; Many Diseases Created By: Susan Emhardt-Servidio May 24, 2018 Rutgers NJAES Cooperative Extension NJAES is NJ Agricultural Experiment Station Extension mission is to bring research based information
More informationThings That Camp. Prevention, Treatment & Parent Communication about Ticks, Mosquitos & Lice
Things That Bite @ Camp Prevention, Treatment & Parent Communication about Ticks, Mosquitos & Lice Contents Why discuss this? Tick Talk Mosquitos Lice Camp Considerations Dialogue and Questions Why Talk
More information2/12/14 ESTABLISHING A VECTOR ECOLOGY SITE TO UNDERSTAND TICK- BORNE DISEASES IN THE SOUTHEASTERN UNITED STATES LIFECYCLE & TRANSMISSION
2/12/14 ESTABLISHING A VECTOR ECOLOGY SITE TO UNDERSTAND TICK- BORNE DISEASES IN THE SOUTHEASTERN UNITED STATES Becky Trout Fryxell, Ph.D. Assistant Professor of Medical & Veterinary Entomol. Department
More informationMinnesota Tick-Borne Diseases
Dr. Neitzel indicated no potential conflict of interest to this presentation. He does not intend to discuss any unapproved/investigative use of a commercial product/device. Minnesota Tick-Borne Diseases
More informationTicks and Tick-borne Diseases: More than just Lyme
Ticks and Tick-borne Diseases: More than just Lyme http://www.scalibor-usa.com/tick-identifier/ Katherine Sayler and A. Rick Alleman Important Emerging Pathogens Increase in disease prevalence in pets
More informationGregory DeMuri M.D. Department of Pediatrics School of Medicine and Public Health
Gregory DeMuri M.D. Department of Pediatrics School of Medicine and Public Health I have no financial disclosures relevant to this presentation. I will reference non-fda approved indications for medications
More informationWhat are Ticks? 4/22/15. Typical Hard Tick Life Cycle. Ticks of the Southeast The Big Five and Their Management
Ticks of the Southeast The Big Five and Their Management LT Jeff Hertz, MSC, USN PhD Student, Entomology and Nematology Dept., University of Florida What are Ticks? Ticks are MITES.really, really ig mites.
More informationTicks 101. Tick-Borne Illness 10/18/2018. Tick-Borne Illnesses in North America
Tick-Borne Illness Paul Carson, MD, FACP Tick-Borne Illnesses in North America Lyme Disease Anaplasmosis Ehrlichiosis Babesiosis Rocky Mountain Spotted Fever Tularemia Powassan Virus Relapsing Fever STARI
More informationTicks and tick-borne diseases
Occupational Diseases Ticks and tick-borne diseases Ticks Ticks are small, blood sucking arthropods related to spiders, mites and scorpions. Ticks are only about one to two millimetres long before they
More informationVector Hazard Report: Ticks of the Continental United States
Vector Hazard Report: Ticks of the Continental United States Notes, photos and habitat suitability models gathered from The Armed Forces Pest Management Board, VectorMap and The Walter Reed Biosystematics
More information5/21/2018. Speakers. Objectives Continuing Education Credits. Webinar handouts. Questions during the webinar?
Tick-borne Diseases: What NJ Public Health Professionals Need to Know Speakers Kim Cervantes, Vectorborne Disease Program Coordinator, New Jersey Department of Health Andrea Egizi, Research Scientist,
More informationAnnual Screening for Vector-borne Disease. The SNAP 4Dx Plus Test Clinical Reference Guide
Annual Screening for Vector-borne Disease The SNAP Dx Plus Test Clinical Reference Guide Every dog, every year For healthier pets and so much more. The benefits of vector-borne disease screening go far
More informationTick-Borne Disease Diagnosis: Moving from 3Dx to 4Dx AND it s MUCH more than Blue Dots! indications implications
Tick-Borne Disease Diagnosis: Moving from 3Dx to 4Dx Richard B. Ford, DVM, MS Professor of Medicine Diplomate ACVIM and (Hon) ACVPM North Carolina State University Raleigh, NC In just the past 3 to 5 years,
More informationUNDERSTANDING THE TRANSMISSION OF TICK-BORNE PATHOGENS WITH PUBLIC HEALTH IMPLICATIONS
UNDERSTANDING THE TRANSMISSION OF TICK-BORNE PATHOGENS WITH PUBLIC HEALTH IMPLICATIONS A. Rick Alleman, DVM, PhD, DABVP, DACVP Lighthouse Veterinary Consultants, LLC Gainesville, FL Tick-transmitted pathogens
More informationMichigan Lyme Disease Risk
1 Michigan Lyme Disease Risk Lyme disease risk in this map is based on known, field confirmed populations of infected Black-Legged ticks or confirmed human cases. 2 Red color indicates endemic counties
More informationPanel & Test Price List
Effective October 16, 2017 we are offering our new tests for Lyme IGXSpot, Lyme Borreliosis, and Tick-borne Relapsing Fever Borreliosis The new ImmunoBlot tests have replaced the original Western Blot
More informationVectorborne Diseases in Maine
Vectorborne Diseases in Maine Presented by: Maine Center for Disease Control and Prevention Emer Smith, MPH Field Epidemiologist Presentation Agenda Tick biology Lyme disease Other tick-borne diseases
More informationLyme Disease (Borrelia burgdorferi)
Lyme Disease (Borrelia burgdorferi) Rancho Murieta Association Board Meeting August 19, 2014 Kent Fowler, D.V.M. Chief, Animal Health Branch California Department of Food and Agriculture Panel Members
More informationIntroduction. Ticks and Tick-Borne Diseases. Emerging diseases. Tick Biology and Tick-borne Diseases: Overview and Trends
Introduction Tick Biology and Tick-borne Diseases: Overview and Trends William L. Nicholson, PhD Pathogen Biology and Disease Ecology Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention
More informationClinical Manifestations and Treatment of Plague Dr. Jacky Chan. Associate Consultant Infectious Disease Centre, PMH
Clinical Manifestations and Treatment of Plague Dr. Jacky Chan Associate Consultant Infectious Disease Centre, PMH Update of plague outbreak situation in Madagascar A large outbreak since 1 Aug 2017 As
More informationLABORATORY ASSAYS FOR THE DIAGNOSIS OF TICK-TRANSMITTED HUMAN INFECTIONS
LABORATORY ASSAYS FOR THE DIAGNOSIS OF TICK-TRANSMITTED HUMAN INFECTIONS Stephen R. Graves, Gemma Vincent, Chelsea Nguyen, Haz Hussain-Yusuf, Aminul Islam & John Stenos. Australian Rickettsial Reference
More informationGeographic and Seasonal Characterization of Tick Populations in Maryland. Lauren DiMiceli, MSPH, MT(ASCP)
Geographic and Seasonal Characterization of Tick Populations in Maryland Lauren DiMiceli, MSPH, MT(ASCP) Background Mandated reporting of human tick-borne disease No statewide program for tick surveillance
More informationTickborne Diseases. CMED/EPI-526 Spring 2007 Ben Weigler, DVM, MPH, Ph.D
Tickborne Diseases CMED/EPI-526 Spring 2007 Ben Weigler, DVM, MPH, Ph.D Reports of tick-borne disease in Washington state are relatively few in comparison to some areas of the United States. Though tick-borne
More informationColorado s Tickled Pink Campaign
Colorado s Tickled Pink Campaign Leah Colton, PhD Medical Entomology & Zoonoses Epidemiologist Instituting a Statewide Passive Surveillance Program for Ticks Colorado s medically important ticks Tick-borne
More informationDRUG & DISEASE INFORMATION ALERT
Paul Davis From: Sent: To: Subject: TSHP Tuesday, September 03, 2013 4:00 AM paul.davis@tshp.org 9-3-13 Drug & Disease Info Alert - Lyme Disease in Texas DRUG & DISEASE INFORMATION
More informationLyme Disease Prevention and Treatment Information for Patients
What is Lyme disease? Lyme disease is an infection caused by a bacteria carried by some ticks. It can occur after a black-legged or deer tick bite. Lyme disease cannot be transferred from one person to
More informationTicks and Lyme Disease
Ticks and Lyme Disease Get Tick Smart Know the bug Know the bite Know what to do Know the Bug Ticks are external parasites Arachnid family Feed on mammals and birds Found Worldwide Two groups hard and
More informationUnderstanding Ticks, Prevalence and Prevention. Tim McGonegal, M.S. Branch Chief Mosquito & Forest Pest Management Public Works
Understanding Ticks, Prevalence and Prevention Tim McGonegal, M.S. Branch Chief Mosquito & Forest Pest Management Public Works Outline Brief overview of MFPM program Tick Biology Types of ticks and disease
More informationLyme Disease. Lyme disease is a bacterial infection spread by tick bites from infected blacklegged
Lyme Disease Lyme disease is a bacterial infection spread by tick bites from infected blacklegged ticks. The bacteria that causes the disease is Borrelia burgdorferi, a spirochete. The earliest symptoms
More informationScreening for vector-borne disease. SNAP 4Dx Plus Test clinical reference guide
Screening for vector-borne disease SNAP 4Dx Plus Test clinical reference guide Every dog, every year The Companion Animal Parasite Council (CAPC) Guidelines recommend annual comprehensive screening for
More informationMichele Stanton, M.S. Kenton County Extension Agent for Horticulture. Asian Longhorned Beetle Eradication Program Amelia, Ohio
Michele Stanton, M.S. Kenton County Extension Agent for Horticulture Asian Longhorned Beetle Eradication Program Amelia, Ohio Credits Dr. Glen Needham, Ph.D., OSU Entomology (retired), Air Force Medical
More informationsoft ticks hard ticks
Ticks Family Argasidae soft ticks Only 4 genera of Argasidae Argas, Ornithodoros, Otobius (not covered) and Carios (not covered) Family Ixodidae hard ticks Only 4 genera of Ixodidae covered because of
More informationScreening for vector-borne disease. SNAP 4Dx Plus Test clinical reference guide
Screening for vector-borne disease SNAP 4Dx Plus Test clinical reference guide Every dog, every year The Companion Animal Parasite Council (CAPC) Guidelines recommend annual comprehensive screening for
More informationLyme disease: diagnosis and management
National Institute for Health and Care Excellence Final Lyme disease: diagnosis and management [D] Evidence review for the management of erythema migrans NICE guideline 95 Evidence review April 2018 Final
More informationLyme Disease in Brattleboro, VT: Office Triage and Community Education
University of Vermont ScholarWorks @ UVM Family Medicine Block Clerkship, Student Projects College of Medicine 2016 Lyme Disease in Brattleboro, VT: Office Triage and Community Education Peter Evans University
More informationClinical Protocol for Ticks
STEP 1: Comprehensive Overview Clinical Protocol for Ticks Chris Adolph, DVM, MS Southpark Veterinary Hospital Broken Arrow, Oklahoma Even astute owners may not detect tick infestation until ticks have
More informationAre Long-Term Antibiotic Treatments Safe And Effective In Treating Patients 16 And Older With Disseminated Lyme Disease?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Are Long-Term Antibiotic Treatments Safe
More informationEffectiveness of doxycycline for lyme disease
Effectiveness of doxycycline for lyme disease The Borg System is 100 % Effectiveness of doxycycline for lyme disease Mar 30, 2016. How long to treat patients with Lyme remains an issue of controversy.
More informationLYME DISEASE IN MICHIGAN:
Erik Foster AND Veronica Fialkowski LYME DISEASE IN MICHIGAN: what does the future hold? Objectives Attendees will gain knowledge regarding tick ecology and its importance in understanding emerging tick-borne
More informationTick Talk: It s Lyme Time. Jill Hubert-Simon, Public Health Educator Sullivan County Public Health Services
Tick Talk: It s Lyme Time Jill Hubert-Simon, Public Health Educator Sullivan County Public Health Services Lyme and Tick-borne Illness Numbers Why do we talk about ticks? The 2011-2013 statistics show
More informationDeer Ticks...One bite can
Deer Ticks...One bite can change your life... Marion Garden Group February 7, 2017 Larry Dapsis Deer Tick Project Coordinator - Entomologist www.capecodextension.org 508-375-6642 Incidence Rate Lyme: 2014
More informationCommon Ticks of Oklahoma and Tick-Borne Diseases
Oklahoma Cooperative Extension Service F-7001 Common Ticks of Oklahoma and Tick-Borne Diseases Russell E. Wright Professor Emeritus of Entomology Robert W. Barker Professor Emeritus of Entomology Ticks
More informationThe Ehrlichia, Anaplasma, Borrelia, and the rest.
The Ehrlichia, Anaplasma, Borrelia, and the rest. Southern Region Conference to Assess Needs in IPM to Reduce the Incidence of Tick-Borne Diseases Michael J. Yabsley D.B. Warnell School of Forestry and
More informationWelcome to Pathogen Group 9
Welcome to Pathogen Group 9 Yersinia pestis Francisella tularensis Borrelia burgdorferi Rickettsia rickettsii Rickettsia prowazekii Acinetobacter baumannii Yersinia pestis: Plague gram negative oval bacillus,
More informationEhrlichia and Anaplasma: What Do We Need to Know in NY State Richard E Goldstein DVM DACVIM DECVIM-CA The Animal Medical Center New York, NY
Ehrlichia and Anaplasma: What Do We Need to Know in NY State Richard E Goldstein DVM DACVIM DECVIM-CA The Animal Medical Center New York, NY Learning Objectives The attendees will be familiar with the
More informationBlood protozoan: Plasmodium
Blood protozoan: Plasmodium Dr. Hala Al Daghistani The causative agent of including Plasmodium vivax P. falciparum P. malariae P. ovale. malaria in humans: four species are associated The Plasmodium spp.
More informationTICK-BORNE DISEASES IN NORTH CAROLINA: SEROEPIDEMIOLOGY OF SPOTTED FEVER GROUP RICKETTSIAE AND PREVENTION OF TICK BITES AMONG OUTDOOR WORKERS
TICK-BORNE DISEASES IN NORTH CAROLINA: SEROEPIDEMIOLOGY OF SPOTTED FEVER GROUP RICKETTSIAE AND PREVENTION OF TICK BITES AMONG OUTDOOR WORKERS Meagan F. Vaughn A dissertation submitted to the faculty of
More informationThe War on Lyme Patients
Who has declared war on Lyme patients? The War on Lyme Patients Infectious Disease Society of America (IDSA) Douglas W. Fearn Lyme Disease Association of Southeastern Pennsylvania, Inc. Infectious Disease
More informationSara Coleman Kansas Department of Health & Environment Bureau of Epidemiology and Public Health Informatics MPH Field Experience
The Identification of the Range of Ixodidae Ticks in Kansas and the Epidemiological Evaluation of Lyme Disease and Spotted Fever Rickettsiosis in Kansas from 2008 to 2012 Sara Coleman Kansas Department
More informationS. ll IN THE SENATE OF THE UNITED STATES A BILL
TH CONGRESS ST SESSION S. ll To provide for the expansion of Federal efforts concerning the prevention, education, treatment, and research activities related to Lyme and other tick-borne diseases, including
More informationTHE ENHANCED SURVEILLANCE FOR TICK-BORNE DISEASES: CHATHAM COUNTY, 2005 AND TICK-BORNE DISEASE UPDATE, DECEMBER 2005
THE ENHANCED SURVEILLANCE FOR TICK-BORNE DISEASES: CHATHAM COUNTY, 2005 AND TICK-BORNE DISEASE UPDATE, DECEMBER 2005 In December 2005 I attended a presentation, Tick-borne Disease Update, given to state
More informationMidsouth Entomologist 2: ISSN:
Midsouth Entomologist 2: 47 52 ISSN: 1936-6019 www.midsouthentomologist.org.msstate.edu Report The Discovery and Pursuit of American Boutonneuse Fever: A New Spotted Fever Group Rickettsiosis J. Goddard
More informationLyme Disease in Vermont. An Occupational Hazard for Birders
Lyme Disease in Vermont An Occupational Hazard for Birders How to Prevent Lyme Disease 2 Lyme Disease is a Worldwide Infection Borrelia burgdoferi B. afzelii; and B. garinii www.thelancet.com Vol 379 February
More informationPractice Guidelines for the Treatment of Lyme Disease
S1 GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA Practice Guidelines for the Treatment of Lyme Disease Gary P. Wormser, 1 Robert B. Nadelman, 1 Raymond J. Dattwyler, 2 David T. Dennis, 6 Eugene
More informationOutline 4/25/2009. Cytauxzoonosis: A tick-transmitted parasite of domestic and wild cats in the southeastern U.S. What is Cytauxzoonosis?
Cytauxzoonosis: A tick-transmitted parasite of domestic and wild cats in the southeastern U.S. Michelle Rosen Center for Wildlife Health Department of Forestry, Wildlife, & Fisheries What is Cytauxzoonosis?
More informationRISK OF VECTOR- BORNE DISEASES FROM CLIMATE CHANGE
RISK OF VECTOR- BORNE DISEASES FROM CLIMATE CHANGE OBJECTIVES 1. Describe the effects of climate change on vectorborne diseases 2. Discuss the new and most important vectorborne infections 3. Identify
More informationEvaluation of Three Commercial Tick Removal Tools
Acarology Home Summer Program History of the Lab Ticks Removal Guidelines Removal Tools Tick Control Mites Dust Mites Bee Mites Spiders Entomology Biological Sciences Ohio State University Evaluation of
More informationBlood protozoan: Plasmodium
Blood protozoan: Plasmodium The causative agent of including Plasmodium vivax P. falciparum P. malariae P. ovale. malaria in humans:four species are associated The Plasmodium spp. life cycle can be divided
More informationRESULTS OF 5 YEARS OF INTEGRATED TICK MANAGEMENT IN RESIDENTIAL FAIRFIELD COUNTY, CT
RESULTS OF 5 YEARS OF INTEGRATED TICK MANAGEMENT IN RESIDENTIAL FAIRFIELD COUNTY, CT Scott C. Williams Center for Vector Biology & Zoonotic Diseases The CT Agricultural Experiment Station Pioneer Press:
More informationEMPLOYEE RIGHT-TO-KNOW. Preventing Tick-Borne Illness
EMPLOYEE RIGHT-TO-KNOW Preventing Tick-Borne Illness LEARNING OBJECTIVES How tick-borne illnesses are transmitted Common tick-borne illnesses in Minnesota Areas of highest risk in Minnesota Options for
More informationThe latest research on vector-borne diseases in dogs. A roundtable discussion
The latest research on vector-borne diseases in dogs A roundtable discussion Recent research reinforces the importance of repelling ticks and fleas in reducing transmission of canine vector-borne diseases.
More informationEmerging Tick-borne Diseases in California
Emerging Tick-borne Diseases in California Moral of my story today is Good taxonomy is good public health practice Kerry Padgett, Ph.D. and Anne Kjemtrup, DVM, MPVM, Ph.D. Vector-Borne Disease Section,
More informationEarly warning for Lyme disease: Lessons learned from Canada
Early warning for Lyme disease: Lessons learned from Canada Nick Hume Ogden, National Microbiology Laboratory @ Saint-Hyacinthe Talk outline The biology of Lyme disease emergence in the context of climate
More informationVector-borne Diseases in Minnesota
Vector-borne Diseases in Minnesota David Neitzel, MS Hannah Friedlander, MPH Minnesota Department of Health Acute Disease Investigation and Control Morrison-Todd-Wadena Board of Health Meeting April 27,
More information11-ID-10. Committee: Infectious Disease. Title: Creation of a National Campylobacteriosis Case Definition
11-ID-10 Committee: Infectious Disease Title: Creation of a National Campylobacteriosis Case Definition I. Statement of the Problem Although campylobacteriosis is not nationally-notifiable, it is a disease
More informationThree patients with fever and rash after a stay in Morocco: infection with Rickettsia conorii
Three patients with fever and rash after a stay in Morocco: infection with Rickettsia conorii Stylemans D 1, Mertens R 1, Seyler L 1, Piérard D 2, Lacor P 1 1. Department of Internal Medicine, UZ Brussel
More informationBrucellosis in Kyrgyzstan
Centers for Disease Control and Prevention Case Studies in Applied Epidemiology No. 053-D11 Brucellosis in Kyrgyzstan Participant's Guide Learning Objectives After completing this case study, the participant
More informationBRUCELLOSIS. Morning report 7/11/05 Andy Bomback
BRUCELLOSIS Morning report 7/11/05 Andy Bomback Also called undulant, Mediterranean, or Mata fever, brucellosis is an acute and chronic infection of the reticuloendothelial system gram negative facultative
More informationLyme Disease Treatment Antibiotic Treatment
Medical Coverage Policy Effective Date... 8/15/2017 Next Review Date... 8/15/2018 Coverage Policy Number... 0400 Lyme Disease Treatment Antibiotic Treatment Table of Contents Coverage Policy... 1 Overview...
More informationZoonotic Diseases. Risks of working with wildlife. Maria Baron Palamar, Wildlife Veterinarian
Zoonotic Diseases Risks of working with wildlife www.cdc.gov Definition Zoonoses: infectious diseases of vertebrate animals that can be naturally transmitted to humans Health vs. Disease Transmission -
More information