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Spirochetal Infections and Other Tick-Borne Febrile Illnesses in Canadaa

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Spirochetal Infections and Other Tick-Borne Febrile Illnesses in Canadaa Appendix 1 (as supplied by the authors): Spirochetal infections and other tick-borne febrile illnesses in Canadaa *Tick Borne Relapsing *Louse Borne Leptospirosis4,5 Lyme disease6,7 Rocky Mountain Spotted Fever1,2 Relapsing Fever3 Fever8,9 Causative agent Borrelia hermsii Borrelia recurrentis Leptospira spp. (eg. L. Borrelia burgdorferi Rickettsia rickettsii interrogans) Arthropod vector Ornithodoros spp. ticks Pediculus humanus None Ixodes ticks (scapularis on Dermacentor andersoni (Argasid ticks, “soft (human body louse) East coast, pacificus on (Rocky Mountain Wood ticks”) West coast) Tick) in Canada Animal reservoir Small mammals: mice, None Rodents, small mammals. East coast: White-footed None rats, squirrels, chipmunks Can also infect livestock, mice, chipmunks, white- dogs and cats. tailed deer. West coast: deer mice, wood rats Appendix to: Hussein H, Showler A, Tan DHS. Canadian “cabin fever”: tick-borne relapsing fever in pregnancy. CMAJ 2013; DOI:10.1503/cmaj.122053. Copyright © 2014 The Author(s) or their employer(s). To receive this resource in an accessible format, please contact us at [email protected] Geographic Southern British Columbia No North American Limited data in Canada. Southern parts of Quebec, Southeastern Alberta, distribution in outbreaks since 19th New Brunswick, Nova Southwestern Canada century. Few cases associated with Scotia, Ontario, Manitoba Saskatchewan, Southern direct occupational exposure and British Columbia British Columbia and Exposure to rustic housing to urine of infected animals: with rodent infestations veterinarians, butchers, risk factors for Occurs in epidemics in hunters, any animal acquisition populations with poor handlers. Exposure to wooded areas, Exposure to wooded areas, hygiene. periurban areas. periurban areas. Cases in returning travellers Occasional transmission in Occasional transmission in from tropical and subtropical urban centers. urban centers. areas with indirect exposure to wet soil or water, often following floods or fresh- water sports. Clinical clues Recurrent paroxysmal Similar to TBRF but Fever, myalgias (calves, low Early infection: Fever, headache. fever associated with longer fever episodes. back), headache, nausea, myalgias, and Typically 1 relapse only. conjunctival suffusion Erythema migrans rash, Maculopapular rash headache with More likely to have malaise, fever, fatigue, beginning on wrists and asymptomatic periods hemorrhagic myalgias. ankles, spreading to palms between febrile episodes. complications. and soles and then to entire Weil’s disease – hepatorenal Can present with body. failure, hemorrhage, arthralgias, heart block, pneumonitis and neurologic symptoms including bell’s palsy. Diagnostic tests of Peripheral blood smear Peripheral blood smear Leptospira PCR (blood, Epidemiologic history and Skin biopsy examination choice during febrile episode during febrile episode urine) clinical presentation are with direct (spirochetes observed on (numerous spirochetes mainstay of diagnosis. immunofluorescence light microscopy using observed on light Serology is test of choice but Serology (ELISA followed Wright-Giemsa stain or microscopy using not useful in early disease by Western blot) helpful in PCR for R. ricketsii on dark field microscopy). Wright-Giemsa stain or certain circumstances. blood or skin biopsy. dark field microscopy). Borrelia PCR Serologic testing not Borrelia PCR helpful in early disease Excluding Treponema pallidum, the causative agent of syphilis a * Organisms can be observed under light microscopy using a Wright-Giemsa stain Center for Disease Control and Prevention. Tick-borne relapsing fever: information for clinicians [homepage on the internet]. 1 C2012 [updated 2012 Mar 13; cited 2012 Dec 7]. Available from: http://www.cdc.gov/relapsing-fever/clinicians/ Dworkin MS, Schwan TG, Anderson DE Jr. Tick-borne relapsing fever in North America. Med Clin North Am 2002;86:417– 2 33, viii–ix Raoult D, Roux V. The Body Louse as a Vector of Reemerging Human Diseases. Clin Infect Dis 1999;29:888-911 3 Brown K, Prescott J. Leptospirosis in the Family Dog: a public health perspective. CMAJ 2008:178(4):399-401 4 Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease. 7 ed. 5 th Philadelphia: Churchill Livingstone; 2009. Ogden NH, Lindsay LR, Morshed M, et al. The emergence of Lyme disease in Canada. CMAJ 2009;180(12):1221-1224 6 Wormser GP, Raymond RJ, Shapiro ED, et al. The Clinical Assessment, Treatment and Prevention of Lyme Disease, Human 7 Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43:1089-134 8 Alberta Health. Public Health Notifiable Disease Management Guidelines – Rickettsial Infections [document on the internet]. Jan 2013 [cited 2013 Apr 13]. Available from: http://www.health.alberta.ca/documents/Guidelines-Rickettsial-Infections- 2013.pdf 9 Duncan JH. Rocky Mountain Spotted Fever in Canada. CMAJ 1937;37(6):575-577 .
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