introduction to tickborne diseases · tickborne diseases •diseases spread by bites from infected...
TRANSCRIPT
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Introduction to Tickborne
Diseases
Rachel Radcliffe, DVM, MPH
CDC Career Epidemiology Field Officer
Division of Infectious Disease Epidemiology
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Overview of Tickborne Diseases
• Introduction
• Lyme disease
• Tickborne rickettsial diseases
• Babesiosis
• Prevention of tickborne diseases
• Case ascertainment exercise
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Tickborne Diseases
• Diseases spread by bites from infected ticks
• Can be caused by bacteria, viruses, and
parasites
• Most infections occur in the spring and
summer months
• Geographic distribution of tick species
impacts location of human infections
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Tick Life Cycle
• Hard ticks have four life stages
– Egg
– Six-legged larvae
– Eight-legged nymph
– Adult
• Most ticks prefer to feed on different hosts at
each life stage
• Ticks can feed on mammals, birds, reptiles,
and amphibians
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Symptoms of Tickborne Diseases
• Many diseases produce similar symptoms
• Asymptomatic or mild to life-threatening illness
• Most common symptoms
– Fever/chills
– Aches and pains
– Rash
• Proportion of people with rash varies among diseases
• Distinctive rash appearance among diseases
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Treatment of Tickborne Diseases
• Supportive therapy
• Antibiotic therapy for bacterial tickborne
diseases
– Doxycycline commonly used
– Duration of therapy varies by disease
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Diagnosis of Tickborne Diseases
• Can be difficult to diagnose
• Clinical signs and symptoms
• Patient history
– Tick bite or tick exposure
• Laboratory findings
• Diagnostic tests
– Serology
– Polymerase chain reaction (PCR)
– Immunohistochemistry (IHC)
– Culture
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Tickborne Diseases in the United States
• Lyme disease
• Rocky Mountain Spotted Fever
• Other Spotted Fevers
• Ehrlichiosis
• Anaplasmosis
• Babesiosis
• STARI
• Powassan
• Tularemia
• Others
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Lyme Disease
• Most common tickborne disease in US
• Bacterial disease
– Borrelia burgdorferi
• Transmitted by blacklegged tick and western
blacklegged tick
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Geographic Distribution of Blacklegged
Tick
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Rocky Mountain Spotted Fever and Other
Spotted Fevers
• Bacterial diseases
– Rickettsia rickettsii
– Rickettsia parkeri
– Rickettsia phillipi (proposed)
• Transmitted by American dog tick, Rocky
Mountain wood tick, brown dog tick, Pacific
coast tick, and Gulf coast tick
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Geographic Distribution of American Dog
Tick
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Geographic Distribution of Brown Dog
Tick
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Ehrlichiosis and Anaplasmosis
• Bacterial diseases
– Ehrlichia chaffeensis
– Ehrlichia ewingii
– Anaplasma phagocytophilum
• Transmitted by blacklegged tick, lone star
tick, and western blacklegged tick
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Geographic Distribution of Lone Star Tick
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Babesiosis
• Caused by parasites that infect red blood
cells
– Species found to infect humans include
Babesia microti, B. divergens, and B.
duncani
• Transmitted by blacklegged tick
• Less commonly congenital transmission and
blood donor-associated cases have been
identified
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STARI (Southern Tick Associated Rash
Illness)
• Cause is unknown
• Rash appearance similar to Lyme disease
• Has not been linked to arthritic, neurologic,
or chronic symptoms
• Transmitted by lone star tick
• Most cases found in southeastern US
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Powassan
• Arbovirus
• Causes encephalitis
• Most cases in northern US
• Transmitted by blacklegged tick and a related
tick, Ixodes cookei
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Tularemia
• Less common tickborne disease
• Bacterial disease
– Francisella tularensis
• Transmitted by American dog tick, lone star
tick, and Rocky Mountain wood tick
• Other transmission routes include deer fly
bites, inhalation, ingestion, skin contact with
infected animals
• Cases found in every state except Hawaii
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Other Tickborne Diseases
• Tickborne relapsing fever
• Colorado tick fever
• Tickborne diseases abroad
– Tickborne encephalitis
– Crimean-Congo hemorrhagic fever
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Summary
• Numerous tickborne diseases can infect
humans and cause disease
• Several tick species transmit tickborne
diseases
– Found in various geographic regions
• Symptoms can be similar among tickborne
diseases
• Diagnosis can be difficult
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More Information to Come…
• Lyme disease
• Tickborne Rickettsial diseases
– Rocky Mountain Spotted Fever
– Ehrlichiosis
– Anaplasmosis
• Babesiosis
• Prevention of tickborne diseases
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Case Investigation Procedure
Positive lab report received at health
department 1
Call healthcare provider
2
Collect clinical data, patient history,
supplemental labs
3
Follow up if no response after 3-4
days If needed, attempt to contact patient
7
Collect exposure and other relevant information from
case
Attempt patient contact for 5-10
days 9
Enter all data into WVEDSS and send
case to regional review
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