DOCSLIB.ORG

Rat-Bite Fever (Streptobac8dlu.S Monilnjiormh) : a Potential Emerging Disease Margot H

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rat-Bite Fever (Streptobac8dlu.S Monilnjiormh) : a Potential Emerging Disease Margot H Original Report Rat-Bite Fever (Streptobac8dlu.s monilnjiormh) : A Potential Emerging Disease Margot H. Graves, BS;” and J. Michael Janda, PhD* ABSTRACT Two distinct clinical syndromes have been identified in association with S. moniliformis infection. One, Haver- Objectives: To determine the relative prevalence of human infec- hill fever, originally recognized in 1926, is an infection tions attributable to Streptobacillus moniliformis in California transmitted to humans through the consumption of con- over the past 3 decades. taminated water, milk, or food previously in contact with Methods: A retrospective analysis of all the data collected was rats.‘,* The disease is characterized by a high incidence conducted on S. moniliformis cultures identified by the Micro- of pharyngitis and pronounced vomiting. bial Diseases Laboratory (MDL) from January 1970 to Decem- The more common syndrome associated with S. ber 1998. moniliformis infection, however, is rat-bite fever @RF). This illness is characterized by abrupt onset of high fevers, Results: Information on a total of 45 S. moniliformis isolates headaches, severe migratory arthralgia, vomiting, and a was analyzed. Overall, 91% of the isolates were from human rash (2-4 days later). The petechial rash develops over sources; 58% were received since 1990. These strains were the extremities, in particular the palms and the soles.’ The divided almost equally between males and females, with 50% onset of symptoms typically occurs 10 or more days after of the isolates from patients 9 years old or younger. In 75% of the cases of human infections where a diagnosis was given, exposure. Any related wound has usually healed by the rat-bite fever (RBF) was suspected; 83% of these suspected time symptoms develop. 1-4Estimates of the mortality rate cases involved either a known rat bite or exposure to rodents. associated with untreated cases of streptobacilliosis approach 13/o.o *z5x6Fatality is most often associated with Conclusions: As crowding becomes an increasing environ- cases in infants and patients with endocarditis.‘,5 mental reality, humans are more frequently being exposed to To date, most of the information regarding S. monil- zoonotic diseases as a result of encounters with “wild” ani- zjiwmis infection, and in particular RBF, stems from indi- mals. Domesticated animals also are exposed more frequently vidual case reports. In light of the increasing incidence to wild animals; thus, increasing human exposure to once rare of human contact with animals, including the care and zoonotic illnesses. Rat-bite fever is a disease that seems to be handling of unusual or exotic pets,’ a retrospective easily recognizable by clinicians, easily identified in the clinical review of the incidence of streptobacilliosis in California laboratory (if suspected), and successfully treated when the appropriate therapy is administered. Physicians should con- over the past 3 decades was conducted and serves as the sider RBF as a possible diagnosis when fever, rash, and expo- basis of this report. sure to rats are part of the patient’s history. MATERIALS AND METHODS Key Words: rat-bite fevel; Streptobacillus moniliformis, zoonotic infections The Microbial Diseases Laboratory (MDL) is the refer- ence laboratory for the state of California. The laboratory Int J Infect Dis 2001; 5151-154. is responsible for the isolation and identification of bac- A seldom encountered zoonotic pathogen seen by clini- terial, fungal, and parasitic pathogens of public health sig- cal laboratories is Streptobacillus moniliformis. This pleo- nificance throughout the state. A system of 39 county morphic, facultatively anaerobic, gram-negative bacterium public health laboratories serves as the conduit for the is traditionally associated with direct or indirect expo- submission of unusual, unidentified, or reportable isolates sure to rats, the natural reservoir for S. moniliformis. Its from clinical laboratories to the MDL. distribution is worldwide. I-3 The MDL identifies or confirms S monilz@m& isolates using four tests: (1) a growth requirement of 10 to 20% *State of California, Department of Health Services, Microbial Diseases serum; (2) the presence of typical gram-negative bacilli Laboratory, Berkeley, California. (sometimes in chains) and filaments with bulbous swellings Address correspondence to Dr. J. Michael Janda, California Department in a Gram stain (Figure 1); (3) growth in broth (thiogly- of Health Services, Microbial Diseases Laboratory, 2 15 1 Berkeley Way, collate medium) with “puff ball”-colony formation (Figure Berkeley, CA 94704. E-mail: [email protected]. 2); and (4) a positive direct fluorescent antibody test using 151 152 International Journal of Infectious Diseases / Volume 5, Number 3,200l Figure 2. Thioglycollate broth with “puff ball” colonies. Figure 1. Typical bacilli (some in chains) and filaments with bulbous 41 S. monilzjbrmis infections were from southern Cali- swellings (oil immersion; original magnification X1000). fornia (n = 14) the San Francisco Bay area (n = 11) the San Joaquin valley (n = 9), North San Francisco Bay area an in-house produced polyclonal antibody. The polyclonal (n = 3) Monterey Bay area (n = 3) and Sierra Foothills antibody was prepared from whole cell antigens of S. (n = 1). The male to female ratio was 1.0:1.2 with 19 monilzjbrmis strain MDL 56-3. Formalized whole cell anti- (46%) male and 22 (54%) female patients. The age ranged gen was washed and used to immunize rabbits. Rabbits from 6 weeks to 92 years (mean, 46 y) (Figure 4). The were immunized five times over a 2-week period by intm- average age was just under 19 years. venous injection through the marginal vein. Serum was The most common isolate source of S. moniliformis collected and fluorescein isothiocyanate @ITC) conjugated. in human infections was blood (78%) followed by aspi- Quality control was performed on the conjugate by test- rates (12%) and wounds (10%). Common media used to ing it against various S.monz’ZziformB strains at several work- isolate S. moniliformis from blood included pediatric ing dilutions. Original laboratory reports were reviewed BACTECTM Plus blood culture bottles (BD Diagnostics, and data from these were compiled to produce the results. Sparks, MD) (n = 5) trypticase soy blood culture bottles, with or without supplementation (n = 4) anaerobic blood RESULTS culture bottles (type not specified, n = 3) and thiogly- collate broth (n = 1). For nonblood isolates (e.g., wounds) Since 1970, the MDL has received 45 isolates of S. monil- blood agar was the most common media used to recover iform&. Forty-one (91%) isolates were from human S. moniliformis. Some of the histories included the num- sources; of these, 24 (58%) have been received since ber of times S. moniliformis was isolated from the blood 1990 (Figure 3). These 41 isolates were received from 19 per patient (n = 28); the results were as follows: 17 (61%) different local (county) jurisdictions, with a majority of were isolated once, eight (29%) were isolated twice, and strains (61%) received from four county and one city three (10%) were isolated three or more times. From the public health laboratories: Sacramento (n = 8) Los Ange- other sources with this information (n = 5) four (80%) les (n = 6) Santa Clara (n = 5) San Diego and San Fran- were isolated only once per patient, and the remaining cisco (n = 3 each). Most infections were centered around wound isolate was positive by culture more than three densely populated areas and no infections were reported times. The range of onset times (n = 9) was 2 to 7 days, from northern California counties. Geographically, the with four (44%) patients exhibiting symptoms within 3 Rat-Bite Fever / Graves and Janda 153 Table 1. Selected Characteristics of Patients with S. moni/i~omis Infections Percentage of Characteristic* Patients*+ Presenting diagnosis (n = 32) Rat-bite fever 63 RBFILeptospirosis or Kawasaki or septic arthritis 9 Streptobacillus bacteremia/rheumatic fever 3 Arthritis (reactive or rheumatoid) 9 Fever 6 Sepsis 3 Tendinitis 3 Wound infection 3 Presenting symptoms (n = 34) Fever 88 Arthritis/arthralgia 73 Rash 65 Fatigue/malaise 20 Headache 18 Chills 15 Animal exposure (n = 35) Pet rat 54 Figure 3. Prevalence of S. moniliformis infections by year in Califor- School rat 14 nia, 1970-98. Other rat exposure 11 Wild rat 9 days of exposure. Table 1 lists selected characteristics of Mouse 3 the patients in this study. Squirrel 3 Exposure not known 6 When patients presented with at least two of the three Rat exposure (n = 31) classic symptoms (fever, rash, arthritis) and a history of rat Bite 61 exposure, clinicians suspected RBF in 44% of the cases. Other rat association 26 Scratch 10 Another 19% were diagnosed with RBF if there was an Kiss 3 exposure to rats but only one of the three classic symp Therapy (n = 25) toms. One astute practitioner diagnosed RBF in a patient Penicillin alone 44 Penicillin along with other antibiotics 12 with no history of exposure to rats or any of the three Ampicillin or amoxicillin or clavulanic acid 12 major symptoms. In patients presenting with at least two Other antibiotics 32 of the major symptoms and having a history of a different *Based on 41 cases: r? In column one denotes the number of cases in which animal exposure (to a mouse and a squirrel, respectively), data were available. +Age range, 6 weeks to 92 years (mean, 46 y); male to female ratio of 41 two clinicians suspected RBF Several authors have reported patients was 1 .0:1.2. RBF following exposures to animals other than rats.‘,x Symptom combinations varied greatly in the cases included in this study. The greatest percentage of the In the present study, exposure to pet rats accounted patients exhibited fever with rash (28%), followed by for the greatest risk. All the pet rat exposures except one patients having all three classic symptoms: fever, rash, and took place in the owner’s or a friend’s home.
Load more

Recommended publications
  • Melioidosis in Birds and Burkholderia Pseudomallei Dispersal, Australia
    LETTERS 5. Mätz-Rensing K, Jentsch KD, Rensing S, Melioidosis in Birds However, these are mostly birds Langenhuynsen S, Verschoor E, Niphuis in captivity and often exotic to the H, et al. Fatal herpes simplex infection in and Burkholderia a group of common marmosets (Callithrix location, suggesting potential reduced jacchus). Vet Pathol. 2003;40:405–11. pseudomallei immunity. Little is known about doi:10.1354/vp.40-4-405 Dispersal, Australia melioidosis in wild birds. In Sabah, 6. Bruno SF, Liebhold M, Mätz-Rensing K, Malaysia, only 1 of 440 wild birds Romão MA, Didier A, Brandes A, et al. Herpesvirus infection in free-living black- To the Editor: Melioidosis is an admitted to a research center over 9 tufted-ear marmoset (Callithrix penicil- emerging infectious disease of humans years was found to have melioidosis lata E. Geoffroyi 1812) at the state park of and animals caused by the gram- (6). Serra da Tiririca, Niterói, Rio de Janeiro, negative bacterium Burkholderia Although birds are endotherms, Brazil. Berl Munch Tierarztl Wochenschr. 1997;110:427–30. pseudomallei, which inhabits soil and with high metabolic rates and body 7. Kalter SS, Heberling RL. Comparative surface water in the disease-endemic temperature (40°C–43°C) protecting virology of primates. Bacteriol Rev. regions of Southeast Asia and northern them from many diseases, some birds 1971;35:310–64. Australia (1). The aim of this study appear more susceptible to melioidosis. 8. Mansfi eld K. Emerging and re-emerging infectious diseases of nonhuman primates. was to assess the potential for birds Indeed, high body temperature would Proceedings of the American College to spread B.
    [Show full text]
  • Anaplasmosis: an Emerging Tick-Borne Disease of Importance in Canada
    IDCases 14 (2018) xxx–xxx Contents lists available at ScienceDirect IDCases journal homepage: www.elsevier.com/locate/idcr Case report Anaplasmosis: An emerging tick-borne disease of importance in Canada a, b,c d,e e,f Kelsey Uminski *, Kamran Kadkhoda , Brett L. Houston , Alison Lopez , g,h i c c Lauren J. MacKenzie , Robbin Lindsay , Andrew Walkty , John Embil , d,e Ryan Zarychanski a Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada b Cadham Provincial Laboratory, Government of Manitoba, Winnipeg, MB, Canada c Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada d Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Internal Medicine, Section of Medical Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada e CancerCare Manitoba, Department of Medical Oncology and Hematology, Winnipeg, MB, Canada f Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Pediatrics and Child Health, Section of Infectious Diseases, Winnipeg, MB, Canada g Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Internal Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada h Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada i Public Health Agency of Canada, National Microbiology Laboratory, Zoonotic Diseases and Special Pathogens, Winnipeg, MB, Canada A R T I C L E I N F O A B S T R A C T Article history: Human Granulocytic Anaplasmosis (HGA) is an infection caused by the intracellular bacterium Received 11 September 2018 Anaplasma phagocytophilum.
    [Show full text]
  • Reportable Disease Surveillance in Virginia, 2013
    Reportable Disease Surveillance in Virginia, 2013 Marissa J. Levine, MD, MPH State Health Commissioner Report Production Team: Division of Surveillance and Investigation, Division of Disease Prevention, Division of Environmental Epidemiology, and Division of Immunization Virginia Department of Health Post Office Box 2448 Richmond, Virginia 23218 www.vdh.virginia.gov ACKNOWLEDGEMENT In addition to the employees of the work units listed below, the Office of Epidemiology would like to acknowledge the contributions of all those engaged in disease surveillance and control activities across the state throughout the year. We appreciate the commitment to public health of all epidemiology staff in local and district health departments and the Regional and Central Offices, as well as the conscientious work of nurses, environmental health specialists, infection preventionists, physicians, laboratory staff, and administrators. These persons report or manage disease surveillance data on an ongoing basis and diligently strive to control morbidity in Virginia. This report would not be possible without the efforts of all those who collect and follow up on morbidity reports. Divisions in the Virginia Department of Health Office of Epidemiology Disease Prevention Telephone: 804-864-7964 Environmental Epidemiology Telephone: 804-864-8182 Immunization Telephone: 804-864-8055 Surveillance and Investigation Telephone: 804-864-8141 TABLE OF CONTENTS INTRODUCTION Introduction ......................................................................................................................................1
    [Show full text]
  • Leptospirosis Associated Equine Recurrent Uveitis Answers to Your Important Questions What Is Leptospirosis Associated Equine Recurrent Uveitis (LAERU)?
    Lisa Dauten, DVM Tri-State Veterinary Services LLC " Leptospirosis Associated Equine Recurrent Uveitis Answers to your Important Questions! What is Leptospirosis Associated Equine Recurrent Uveitis (LAERU)? Let’s start by breaking down some terminology.! Uveitis- inflammation of the uvea. Resulting in cloudiness of the eye, pain, and potential blindness. Also know as “Moon Blindness”. Caused by trauma, infection, or corneal disease.! Uvea- part of the eye containing the iris, ciliary body, and choroid. It keeps the lens of the eye in place, maintains fluid in the eye, and keeps things in the blood from entering the inside of the eye (blood-ocular barrier). ! Recurrent Uveitis- inflammation of the uvea that sporadically reoccurs through out a horses life time. Each time there is a reoccurring episode, the damage to the eye is made worse, eventually leading to permanent damage and potential blindness. ! Leptospirosis- bacteria found in the environment shed in the urine of wildlife and livestock. Horses usually are exposed when grazing pastures or drinking from natural water sources.! LAERU- Recurrent Uveitis in horses caused by Leptospirosis.! What are the clinical signs of Uveitis? Uveitis can come on very suddenly. A lot of times horses present with severe pain in the eye, tearing, squinting, and rubbing face. The eye itself is cloudy, white or blue in color. Sometimes the signs are not as dramatic. The color change of the eye may progress slowly. In these cases, horse owners may mistake the changes for cataracts.! What do I do if I think my horse has Uveitis? Call your veterinarian to request an appointment.
    [Show full text]
  • Tick-Borne Diseases in Maine a Physician’S Reference Manual Deer Tick Dog Tick Lonestar Tick (CDC Photo)
    tick-borne diseases in Maine A Physician’s Reference Manual Deer Tick Dog Tick Lonestar Tick (CDC PHOTO) Nymph Nymph Nymph Adult Male Adult Male Adult Male Adult Female Adult Female Adult Female images not to scale know your ticks Ticks are generally found in brushy or wooded areas, near the DEER TICK DOG TICK LONESTAR TICK Ixodes scapularis Dermacentor variabilis Amblyomma americanum ground; they cannot jump or fly. Ticks are attracted to a variety (also called blacklegged tick) (also called wood tick) of host factors including body heat and carbon dioxide. They will Diseases Diseases Diseases transfer to a potential host when one brushes directly against Lyme disease, Rocky Mountain spotted Ehrlichiosis anaplasmosis, babesiosis fever and tularemia them and then seek a site for attachment. What bites What bites What bites Nymph and adult females Nymph and adult females Adult females When When When April through September in Anytime temperatures are April through August New England, year-round in above freezing, greatest Southern U.S. Coloring risk is spring through fall Adult females have a dark Coloring Coloring brown body with whitish Adult females have a brown Adult females have a markings on its hood body with a white spot on reddish-brown tear shaped the hood Size: body with dark brown hood Unfed Adults: Size: Size: Watermelon seed Nymphs: Poppy seed Nymphs: Poppy seed Unfed Adults: Sesame seed Unfed Adults: Sesame seed suMMer fever algorithM ALGORITHM FOR DIFFERENTIATING TICK-BORNE DISEASES IN MAINE Patient resides, works, or recreates in an area likely to have ticks and is exhibiting fever, This algorithm is intended for use as a general guide when pursuing a diagnosis.
    [Show full text]
  • Tick-Borne Disease Working Group 2020 Report to Congress
    2nd Report Supported by the U.S. Department of Health and Human Services • Office of the Assistant Secretary for Health Tick-Borne Disease Working Group 2020 Report to Congress Information and opinions in this report do not necessarily reflect the opinions of each member of the Working Group, the U.S. Department of Health and Human Services, or any other component of the Federal government. Table of Contents Executive Summary . .1 Chapter 4: Clinical Manifestations, Appendices . 114 Diagnosis, and Diagnostics . 28 Chapter 1: Background . 4 Appendix A. Tick-Borne Disease Congressional Action ................. 8 Chapter 5: Causes, Pathogenesis, Working Group .....................114 and Pathophysiology . 44 The Tick-Borne Disease Working Group . 8 Appendix B. Tick-Borne Disease Working Chapter 6: Treatment . 51 Group Subcommittees ...............117 Second Report: Focus and Structure . 8 Chapter 7: Clinician and Public Appendix C. Acronyms and Abbreviations 126 Chapter 2: Methods of the Education, Patient Access Working Group . .10 to Care . 59 Appendix D. 21st Century Cures Act ...128 Topic Development Briefs ............ 10 Chapter 8: Epidemiology and Appendix E. Working Group Charter. .131 Surveillance . 84 Subcommittees ..................... 10 Chapter 9: Federal Inventory . 93 Appendix F. Federal Inventory Survey . 136 Federal Inventory ....................11 Chapter 10: Public Input . 98 Appendix G. References .............149 Minority Responses ................. 13 Chapter 11: Looking Forward . .103 Chapter 3: Tick Biology, Conclusion . 112 Ecology, and Control . .14 Contributions U.S. Department of Health and Human Services James J. Berger, MS, MT(ASCP), SBB B. Kaye Hayes, MPA Working Group Members David Hughes Walker, MD (Co-Chair) Adalbeto Pérez de León, DVM, MS, PhD Leigh Ann Soltysiak, MS (Co-Chair) Kevin R.
    [Show full text]
  • Tick-Borne Diseases
    Focus on... Tick-borne diseases DS20-INTGB - June 2017 With an increase in forested areas, The vector: ticks an increase in the number of large mammals, and developments in forest The main vector of these diseases are use and recreational activities, the hard ticks, acarines of the Ixodidae family. In France, more than 9 out of 10 ticks incidence of tick-borne diseases is on removed from humans are Ixodes ricinus the rise. and it is the main vector in Europe of human-pathogenic Lyme borreliosis (LB) In addition to Lyme disease, which has spirochaetes, the tick-borne encephali- an estimated incidence of 43 cases tis virus (TBEV) and other pathogens of per 100,000 (almost 30,000 new cases humans and domesticated mammals. identified in France each year), ticks can It is only found in ecosystems that are transmit numerous infections. favourable to it: deciduous forests, gla- des, and meadows with a temperate Although the initial manifestations of climate and relatively-high humidity. these diseases are often non-specific, Therefore, it is generally absent above a they can become chronic and develop height of 1200-1500 m and from the dry into severe clinical forms, sometimes Mediterranean region. with very disabling consequences. They Its activity is reduced at temperatures respond better to antibiotic treatment if above 25°C and below 7°C. As a result, it is initiated quickly, hence the need for its activity period is seasonal, reaching a early diagnosis. maximum level in the spring and autumn. Larva Adult female Adult male Nymph 0 1.5 cm It is a blood-sucking ectoparasite with 10 days.
    [Show full text]
  • Mechanisms Affecting the Acquisition, Persistence and Transmission Of
    microorganisms Review Mechanisms Affecting the Acquisition, Persistence and Transmission of Francisella tularensis in Ticks Brenden G. Tully and Jason F. Huntley * Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA; [email protected] * Correspondence: [email protected] Received: 29 September 2020; Accepted: 21 October 2020; Published: 23 October 2020 Abstract: Over 600,000 vector-borne disease cases were reported in the United States (U.S.) in the past 13 years, of which more than three-quarters were tick-borne diseases. Although Lyme disease accounts for the majority of tick-borne disease cases in the U.S., tularemia cases have been increasing over the past decade, with >220 cases reported yearly. However, when comparing Borrelia burgdorferi (causative agent of Lyme disease) and Francisella tularensis (causative agent of tularemia), the low infectious dose (<10 bacteria), high morbidity and mortality rates, and potential transmission of tularemia by multiple tick vectors have raised national concerns about future tularemia outbreaks. Despite these concerns, little is known about how F. tularensis is acquired by, persists in, or is transmitted by ticks. Moreover, the role of one or more tick vectors in transmitting F. tularensis to humans remains a major question. Finally, virtually no studies have examined how F. tularensis adapts to life in the tick (vs. the mammalian host), how tick endosymbionts affect F. tularensis infections, or whether other factors (e.g., tick immunity) impact the ability of F. tularensis to infect ticks. This review will assess our current understanding of each of these issues and will offer a framework for future studies, which could help us better understand tularemia and other tick-borne diseases.
    [Show full text]
  • Fads and Epidemics in Infectious Disease: Syphilis, Lyme and Bartonella Laura J
    Fads and Epidemics in Infectious Disease: Syphilis, Lyme and Bartonella Laura J. Balcer, M.D. Philadelphia, PA Objectives preantibiotic era estimated that syphilis would infect as At the conclusion of this program, participants will be able many as 10% of Americans during their lifetimes.1 to With the development of antibiotics (particularly 1. Identify the neuro-ophthalmologic and ocular manifes- penicillin) and the institution of public health measures to tations of syphilis, Lyme disease, and Bartonella control the spread of disease, incidence rates of primary henselae infection. and secondary infection reduced dramatically, reaching a 2. Apply current techniques for the diagnosis and treat- nadir in 2000 when only 5979 cases were reported in the ment of syphilis, Lyme disease, and Bartonella U.S.1 Since that time, overall incidence rates have again henselae infection with neurologic or ocular involve- increased, with marked variation with respect to geo- ment. graphic, racial, and other demographic factors. Epidemio- 3. Discuss important aspects of the epidemiology and logic studies have also suggested that syphilis increases pathogenesis of syphilis, Lyme disease, and Bartonella susceptibility to human immunodeficiency virus (HIV) henselae infection. infection, and increases the likelihood that patients with both syphilis and HIV will transmit HIV infection.1 To CME Questions control increases in the incidence of primary and second- 1. Which of the following neuro-ophthalmologic manifes- ary syphilis, the U.S. Centers for Disease Control and tations may occur in patients with syphilis, Lyme Prevention (CDC) have launched a National Plan to disease, or Bartonella henselae infection (i.e., which Eliminate Syphilis, with the goal of reducing the annual are common to all three disorders)? number of cases to 1,000 (incidence rate of 0.4/100,000/ a.
    [Show full text]
  • Lyme Disease Borrelia Burgdorferi Anaplasmosis Anaplasma
    TICKBORNE DISEASES IN MICHIGAN: A REFERENCE FOR HEALTH CARE PROVIDERS Lyme disease Anaplasmosis Borrelia burgdorferi Anaplasma phagocytophillum Blacklegged (deer) tick Blacklegged (deer) tick Vector Incubation Period 3 – 30 days 1 – 2 weeks Early localized disease: • Characteristic erythema migrans (EM) rash . Fever, chills • Fever & chills . Severe headache • Headache . Malaise • Myalgia & arthralgia . Myalgia • Lymphadenopathy . Gastrointestinal symptoms Signs and Disseminated disease (weeks to months after . Cough Symptoms exposure): . Rash (rare cases) • Multiple EM lesions . Stiff neck* • Nervous system abnormalities including nerve . Confusion* paralysis (facial muscles), meningitis • Arthritis in large joints, especially the knee *May present later (5 days after onset of symptoms) • Myocarditis, pericarditis, or atrioventricular node and may be prevented by early treatment block Typically observed during the first week of clinical disease: • Mild anemia • Elevated erythrocyte sedimentation rate • Thrombocytopenia • Mildly elevated hepatic transaminases General • Leukopenia (characterized by relative and absolute • Microscopic hematuria or proteinuria lymphopenia and a left shift) Laboratory • In Lyme meningitis, CSF typically shows • Mild to moderate elevations in hepatic Findings lymphocytic pleocytosis, slightly elevated transaminases may occur in some patients protein, and normal glucose • Visualization of morulae in the cytoplasm of granulocytes is highly suggestive of a diagnosis; however, blood smear examination is insensitive. Antibodies to A. phagocytophillum are detectable 7- • Demonstration of diagnostic IgM or IgG 10 days after illness onset. antibodies in serum. A two-tier testing protocol • Demonstration of a four-fold change in IgG-specific is recommended – EIA or IFA should be antibody titer by IFA test in paired serum samples; Laboratory performed first; if positive or equivocal it is or followed by a Western blot.
    [Show full text]
  • 1. Ticks/Lyme Disease 2. Leptospirosis & Weil's Disease
    Risks of Infection in the Countryside 2. Leptospirosis (Weil’s Disease) Can Leptospirosis be prevented? This is a bacterial infection contracted through Wearing appropriate clothing, covering skin breaks DORSET contact with soil or water contaminated by the (with a waterproof plaster) and washing out eye WILDLIFE urine of infected animals, such as cattle, pigs and splashes with clean, soapy water reduces the risk. TRUST rodents (Weil’s Disease) If no clean water is available, then complete drying of the skin is advised. Thorough washing of hands before eating or drinking is good practice. 1. Ticks/Lyme Disease Can Leptospirosis be treated? If, within 30 days of possible exposure, you are unwell, with muscle pain and chills, contact your GP and mention that you may have been exposed to infected water. Outcome depends on early Brown rat © Steve Davis diagnosis and treatment. How common Treatment involves the use of antibiotics. In severe cases admission to hospital is required. is Leptospirosis? Courtesy PHE © Nicky Hoar There are usually less than 40 cases in England and Wales each year, although there were 76 cases Further information recently. Most patients have contracted the 2. Leptospirosis & condition from freshwater sources and animal or www.gov.uk/leptospirosis fsh feed contaminated with rat urine.. www.nhs.uk/Conditions/Leptospirosis Weil’s Disease How is it caught? This work has been supported by The bacteria may enter the body through skin Public Health England. (PHE). breaks, cuts and scratches, and through the skin lining the mouth and covering the eyes. Symptoms of Leptospirosis Dorset Wildlife Trust Brooklands Farm, Forston, Dorchester, Dorset.
    [Show full text]
  • Health Alert Network Advisory: Tick-Borne Diseases in Nebraska
    TO: Primary care providers, infectious disease, laboratories, infection control, and public health FROM Thomas J. Safranek, M.D. Jeff Hamik, MS State Epidemiologist Vector-borne Disease Epidemiologist 402-471-2937 PHONE 402-471-1374 PHONE 402-471-3601 FAX 402-471-3601 FAX RE: TICK-BORNE DISEASES IN NEBRASKA DATE: May 6, 2020 The arrival of spring marks the beginning of another tick season. In the interest of public health and prevention, our office seeks to inform Nebraska health care providers about the known tick- borne diseases in our state. Spotted fever rickettsia (SFR) including Rocky Mountain spotted fever (RMSF) SFR is a group of related bacteria that can cause spotted fevers including RMSF. Several of these SFR have similar signs and symptoms, including fever, headache, and rash, but are often less severe than RMSF. SFR are the most commonly reported tick-borne disease in Nebraska. Our office has reported a median of 26 cases (range 16-48) with SFR over the last 5 years (2015- 2019), an increase from 10 median cases (range 5-18) reported during 2010-2014. SFR, especially RMSF NEEDS TO BE A DIAGNOSTIC CONSIDERATION IN ANY PERSON WITH A FEVER AND A HISTORY OF EXPOSURE TO ENVIRONMENTS WHERE TICKS MIGHT BE PRESENT. The skin rash is not always present when the patient first presents to a physician. RMSF is frequently overlooked or misdiagnosed, with numerous reports of serious and sometimes fatal consequences. Nebraska experienced a fatal case of confirmed RMSF in 2015 where the diagnosis was missed and treatment was delayed until the disease was well advanced.
    [Show full text]