Relapsing Fever in a Traveller Returning from Senegal
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Blood Smear Analysis in Babesiosis, Ehrlichiosis, Relapsing Fever, Malaria, and Chagas Disease
REVIEW STEVE M. BLEVINS, MD RONALD A. GREENFIELD, MD* MICHAEL S. BRONZE, MD CME Assistant Professor of Medicine, Section Professor of Medicine, Section of Infectious Professor of Medicine, Section of Infectious CREDIT of General Internal Medicine, Department Diseases, Department of Medicine, University Diseases, Chair of Department of Medicine, of Medicine, University of Oklahoma of Oklahoma Health Sciences Center and the University of Oklahoma Health Sciences Center Health Sciences Center, Oklahoma City Oklahoma City Veterans Administration and the Oklahoma City Veterans Administration Medical Center Medical Center Blood smear analysis in babesiosis, ehrlichiosis, relapsing fever, malaria, and Chagas disease ■ ABSTRACT LOOD SMEAR ANALYSIS, while commonly B used to evaluate hematologic condi- Blood smear analysis is especially useful for diagnosing tions, is infrequently used to diagnose infec- five infectious diseases: babesiosis, ehrlichiosis, relapsing tious diseases. This is because of the rarity of fever due to Borrelia infection, malaria, and American diseases for which blood smear analysis is indi- trypanosomiasis (Chagas disease). It should be performed cated. Consequently, such testing is often in patients with persistent or recurring fever or in those overlooked when it is diagnostically impor- who have traveled to the developing world or who have tant. a history of tick exposure, especially if accompanied by Nonspecific changes may include mor- hemolytic anemia, thrombocytopenia, or phologic changes in leukocytes and erythro- 1 hepatosplenomegaly. cytes (eg, toxic granulations, macrocytosis). And with certain pathogens, identifying ■ KEY POINTS organisms in a peripheral blood smear allows for a rapid diagnosis. In the United States, malaria and American This paper discusses the epidemiology, trypanosomiasis principally affect travelers from the clinical manifestations, laboratory findings, developing world. -
WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA). -
WHO GUIDELINES for the Treatment of Treponema Pallidum (Syphilis)
WHO GUIDELINES FOR THE Treatment of Treponema pallidum (syphilis) WHO GUIDELINES FOR THE Treatment of Treponema pallidum (syphilis) WHO Library Cataloguing-in-Publication Data WHO guidelines for the treatment of Treponema pallidum (syphilis). Contents: Web annex D: Evidence profiles and evidence-to-decision frameworks - Web annex E: Systematic reviews for syphilis guidelines - Web annex F: Summary of conflicts of interest 1.Syphilis – drug therapy. 2.Treponema pallidum. 3.Sexually Transmitted Diseases. 4.Guideline. I.World Health Organization. ISBN 978 92 4 154980 6 (NLM classification: WC 170) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (http://www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/ copyright_form/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. -
Tick-Borne Relapsing Fever CLAY ROSCOE, M.D., and TED EPPERLY, M.D., Family Medicine Residency of Idaho, Boise, Idaho
Tick-Borne Relapsing Fever CLAY ROSCOE, M.D., and TED EPPERLY, M.D., Family Medicine Residency of Idaho, Boise, Idaho Tick-borne relapsing fever is characterized by recurring fevers separated by afebrile periods and is accompanied by nonspecific constitutional symptoms. It occurs after a patient has been bitten by a tick infected with a Borrelia spirochete. The diagnosis of tick-borne relapsing fever requires an accurate characterization of the fever and a thorough medical, social, and travel history of the patient. Findings on physical examination are variable; abdominal pain, vomiting, and altered sensorium are the most common symptoms. Laboratory confirmation of tick-borne relapsing fever is made by detection of spirochetes in thin or thick blood smears obtained during a febrile episode. Treatment with a tetracycline or macrolide antibiotic is effective, and antibiotic resistance is rare. Patients treated for tick-borne relapsing fever should be monitored closely for Jarisch- Herxheimer reactions. Fatalities from tick-borne relapsing fever are rare in treated patients, as are subsequent Jarisch-Herxheimer reactions. Persons in endemic regions should avoid rodent- and tick-infested areas and use insect repellents and protective clothing to prevent tick bites. (Am Fam Physician 2005;72:2039-44, 2046. Copyright © 2005 American Academy of Family Physicians.) S Patient information: ick-borne relapsing fever (TBRF) develop with TBRF, with long-term sequelae A handout on tick-borne is transmitted by Ornithodoros that may be permanent. Reviewing a broad relapsing fever, written by 1,3-6 the authors of this article, ticks infected with one of sev- differential diagnosis (Table 1 ) for fever is provided on page 2046. -
Lyme Disease and Tick-Borne Infections User Manual
SCOTTISH MICROBIOLOGY REFERENCE LABORATORY, INVERNESS: LYME DISEASE AND TICK-BORNE INFECTIONS USER MANUAL 1 Amended 23 September 2020 CONTENTS Section Page 1 Introduction 3 2 Contact details and key personnel 3 3 Opening hours 4 4 Service provided 4 4.1 Samples and turnaround times 4 4.2 Laboratory tests 5 4.3 Specialist advice 5 5 Clinical Information 6 6 Referral criteria 6 7 Specimen and request form labelling 7 8 Specimen transportation 8 9 Charges 8 10 Results 8 11 Treatment 8 12 Prevention 8 13 SLDTRL request form 8 (Form MF023) 14 SLDTRL developments 9 15 References 9 16 Laboratory diagnosis of Lyme borreliosis algorithm Appendix 2 Amended 23 September 2020 1.0 Introduction The newly established Scottish Lyme Disease and Tick-borne Infections Reference Laboratory (SLDTRL) is provided by NHS Highland at Raigmore Hospital, Inverness. The aim of SLDTRL is to provide more comprehensive and standardised testing for Lyme disease and other tick-borne infections and to improve the epidemiological data provided to Health Protection Scotland (HPS). Lyme disease is caused by bacteria from the Borrelia burgdorferi sensu lato complex. In the UK the bacteria is transmitted to humans through the bite of infected, hard bodied, Ixodes ricinus ticks. Borrelia miyamotoi disease, which presents as a relapsing fever, can also be transmitted by Ixodes ricinus ticks. It is an emerging disease caused by B. miyamotoi bacteria, which are from the relapsing fever group of borrelia, genetically distinct from those that cause Lyme disease. Human granulocytic anaplasmosis (HGA), also an acute febrile illness transmitted by Ixodid ticks, is an infection caused by the bacterium Anaplasma phagocytophilum. -
Microbiology & Infectious Diseases
Case Report Research Article Microbiology & Infectious Diseases Neuro Sarcoidosis Masquerading as Neuroborreliosis Chandra S Pingili1,2,4*, Saleh Obaid3,4,5 Kyle Dettbarn3,4,5, Jacques Tham6 and Greg Heiler7 1Infectious Diseases Department, Eau Claire, Wisconsin, USA. 2Prevea Health, Eau Claire, Wisconsin, USA. 3Eau Claire Medical Group, Eau Claire, Wi, USA. *Correspondence: Chandra Shekar Pingili MD, Infectious Diseases, Sacred Heart 4 Sacred Heart Hospital, Eau Claire, Wisconsin, USA. Hospital, 900 W Claremont Ave Eau Claire, WI 54701, USA, Tel: 917-373-9571; E-mail: [email protected]. 5Pulmonary & Critical Care, Sacred Heart Hospital, Eau Claire, Wisconsin, USA. Received: 13 September 2017; Accepted: 02 October 2017 6Department of Radiology, Sacred Geart Hospital, Eau Claire, Wisconsin, USA. 7Pathologist, Sacred Geart Hospital, Eau Claire, Wisconsin, USA. Citation: Chandra S Pingili, Saleh Obaid, Kyle Dettbarn, et al. Neuro Sarcoidosis masquerading as Neuroborreliosis. Microbiol Infect Dis. 2017; 1(2): 1-8. ABSTRACT Background: Medical syndromes often overlap in clinical presentations. Often there is one or more than underlying etiology responsible for the patient’s Clinical presentation. We are reporting a patient who was initially admitted with fevers and joint pains.Lymes IGG was positive .He was discharged home on Doxycycline and Prednisone suspecting gout. Patient however was re admitted twice within 3 weeks with cognitive impairment. Lymph node biopsy was positive for non Caseating granulomas suggesting Sarcoidosis. Clinically he responded dramatically to steroids. Case Report: 74 year old white male was admitted with fever and multiple joint pains. Tmax was 100.5.WBC was 15 with normal CBC. LFTs were elevated .Rest of the labs were normal.Lymes IGG was positive. -
Import of an Extinct Disease?
OBSERVATION Pinta in Austria (or Cuba?) Import of an Extinct Disease? Ingrid Woltsche-Kahr, MD; Bruno Schmidt, PhD; Werner Aberer, MD; Elisabeth Aberer, MD Background: Pinta, 1 of the 3 nonvenereal treponema- detection of spirochetes in the trunk lesion indicated early toses, is supposed to be extinct in most areas in South and secondary syphilis, but an extensive case history and the Central America, where it was once endemic. Only scat- clinical appearance fulfilled all criteria for pinta. tered foci may still remain in remote areas in the Brazilian rain forest, and the last case from Cuba was reported in 1975. Conclusion: The acquisition of a distinct clinical en- tity, pinta, in a country where it was formerly endemic Observation: A native Austrian woman, who had lived but now is believed to be extinct raises the question of for 7 years in Cuba and was married to a Cuban native, whether the disease is in fact extinct or whether syphilis developed a singular psoriasiform plaque on her trunk and pinta are so similar that no definite distinction is pos- and several brownish papulosquamous lesions on her sible in certain cases. palms and soles during a visit to her home in Austria. Positive serological findings for active syphilis and the Arch Dermatol. 1999;135:685-688 HE NONVENEREAL trepone- after the appearance of pintids), lesions matoses yaws, endemic marked by vitiligolike depigmentation are syphilis (bejel), and pinta the leading feature. These lesions are not are caused by an organism believed to be infectious. Histopathologi- that is morphologically and cal investigations show moderate acan- Tantigenically identical to the causative agent thosis, spongiosis, sometimes hyperkera- of venereal syphilis, Treponema pallidum. -
IS IT LYME DISEASE, Or TICK-BORNE RELAPSING FEVER?
IS IT LYME DISEASE, or TICK-BORNE RELAPSING FEVER? Webinar Presented by Joseph J. Burrascano Jr. M.D. Joined by Jyotsna Shah PhD for the Q&A January 2020 Presenters Joseph J. Burrascano Jr. M.D. • Well-known pioneer in the field of tick-borne diseases, active since 1985 • Founding member of ILADS and ILADEF • Active in physician education on all aspects of tick-borne diseases Jyotsna Shah, PhD • President & Laboratory Director of IGeneX Clinical Laboratory • Over 40 Years of Research Experience in Immunology, Molecular Biology & Microbiology • Author of Multiple Publications & Holds More Than 20 Patents • Member of ILRAD as a Post-Doctoral Scientist • Started the First DNA Sequencing Laboratory in E. Africa 2 Poll Question Before we begin, we’d like to ask a poll question. Which one of these Borrelia causes Tick-Borne Relapsing Fever (TBRF)? a) B. mayonii b) B. turicatae c) B. burgdorferi d) B. andersonii e) B. garinii 3 Poll Question Before we begin, we’d like to ask a poll question. Which one of these Borrelia causes Tick-Borne Relapsing Fever (TBRF)? a) B. mayonii - Lyme b) B. turicatae - TBRF c) B. burgdorferi - Lyme d) B. andersonii - Lyme e) B. garinii – Lyme strain in Europe 4 What is TBRF? • Has been defined by clinical presentation • Has been defined by tick vector • Has been defined by genetics • Has been defined by serotype BUT • Each of these has exceptions and limitations! 5 Clinical Presentation of Classic TBRF • “Recurring febrile episodes that last ~3 days and are separated by afebrile periods of ~7 days duration.” • “Each febrile episode involves a “crisis.” During the “chill phase” of the crisis, patients develop very high fever (up to 106.7°F) and may become delirious, agitated, tachycardic and tachypneic. -
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. -
Syphilis Onset Seizures, a Head CT Reveals an Acute CVA • 85 Yo Woman C/O Shooting Pains Down Her Simon J
• 43 yo woman with RUQ pain is found to have a liver mass on U/S, biopsy of the mass reveals granulomas • 26 yo man presents to the ED with new- Syphilis onset seizures, a Head CT reveals an acute CVA • 85 yo woman c/o shooting pains down her Simon J. Tsiouris, MD, MPH Assistant Professor of Clinical Medicine and Clinical Epidemiology arms and in her face for 2 years duration Division of Infectious Diseases College of Physicians and Surgeons • 36 yo man presents to his PMD with an Columbia University enlarging lymph node in his neck 55 yo man presents to the ER with chest pain radiating to his back, 19 yo man is seen at an STD clinic shortness of breath and is found to have this on Chest CT for a painless ulcer on his penis Aortic aneurysm rupture. Axial postcontrast image through the aortic arch reveals an aortic aneurysm with contrast penetrating the thrombus within the aneurysm (open arrow). Note the high attenuation material within the mediastinal fat (arrowheads), representing blood and indicating the presence of aneurysm rupture. 26 yo man presents to an ophthalmologist with progressive loss of vision in his Left eye, his fundoscopic exam looks like the picture on the left: Mercutio: “… a pox on your houses!” Romeo and Juliet, 1st Quarto, 1597, William Shakespeare Normal MID 15 Famous people who (probably) had syphilis • Ivan the Terrible • Henry VIII •Cortes • Francis I • Charles Baudelaire • Meriwether Lewis • Friedrich Nietzche • Gaetano Donizetti • Toulouse Lautrec • Al Capone Old World disease which always existed and happened •… New NewWorld World agent disease which mutatedwhich was and transmitted created a newto the Old Old World World? disease? to flare up around the time of New World exploration? The Great Pox – Origins of syphilis Syphilis in the 1500s • Pre-Colombian New World skeletal remains have bony lesions consistent with syphilis • T. -
Tick-Borne Relapsing Fever Epidemiology
Tick-borne Relapsing Fever Epidemiology Tick-borne Relapsing Fever (TBRF) occurs in the western United States and is usually linked to sleeping in rustic, rodent-infested cabins in mountainous areas and high elevations1,2,3,4. TBRF is not very common in Arizona, and usually sporadic cases occur, with the exception of two small outbreaks in 2005 and 20141,2,3,4. A. Agent: Tick-borne relapsing fever (TBRF) is most commonly caused by Borrelia hermsii, but can be caused by at least 14 other Borrelia species. These bacteria are gram negative spirochetes (cork-screw shaped) and are visible with light microscopy1,2,3,4. B. Clinical Description: Relapsing fever is a systemic spirochetal disease in which periods of fever lasting 2-7 days alternate with afebrile periods of 4-14 days; the number of relapses varies from 1-10 without treatment1,2,3,4. Febrile periods are often associated with shaking chills, sweats, headache, muscle and joint pain, and can be associated with a rash. Photophobia, eye pain, dizziness, dry cough, nausea, vomiting, or lack of appetite can also occur. Symptoms can be more severe without treatment1,2,3,4. Optimal management of TBRF requires both prompt diagnosis and careful observation during the initial phases of treatment1,2,3,4. With appropriate treatment the mortality rate is very low. The mortality rate without treatment is estimated at 5-10%1,2,3,4. TBRF contracted during pregnancy can cause spontaneous abortion, premature birth, and neonatal death1,2,3,4. In general, pregnant women have higher spirochete loads and more severe symptoms than non- pregnant women. -
Sexually Transmitted Infections Treatment Guidelines, 2021
Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 70 / No. 4 July 23, 2021 Sexually Transmitted Infections Treatment Guidelines, 2021 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS Introduction ............................................................................................................1 Methods ....................................................................................................................1 Clinical Prevention Guidance ............................................................................2 STI Detection Among Special Populations ............................................... 11 HIV Infection ......................................................................................................... 24 Diseases Characterized by Genital, Anal, or Perianal Ulcers ............... 27 Syphilis ................................................................................................................... 39 Management of Persons Who Have a History of Penicillin Allergy .. 56 Diseases Characterized by Urethritis and Cervicitis ............................... 60 Chlamydial Infections ....................................................................................... 65 Gonococcal Infections ...................................................................................... 71 Mycoplasma genitalium .................................................................................... 80 Diseases Characterized