Rickettsia 364D

Rickettsia species 364D (Rickettsia philipii), the etiologic agent of Pacific Coast tick (PCTF). Transmitted to people by the Pacific Coast tick, occidentalis. As of 2016, fourteen cases (14) cases reported (all in California); 1st case in 2008. Most cases in Northern CA. The Pacific Coast tick’s range includes most of California, southern Oregon, and northern Baja California, Mexico.

Symptoms: Fever, headache, eschar(s) [Eschar is dead tissue that falls off (sheds) from healthy skin.]

Click here for journal article on

Left: Pacific Coast Tick – Female, Male and Nymph (Photo: Ervic Aquino, CA Dept.

Public Health)

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Ehrlichiosis/ Scientists used to separate into two entities caused by the bacterium Ehrlichia: Human Monocytic Ehrlichiosis (HME) and Human Granulocytic Ehrlichiosis (HGE). After further study, they determined that HGE is actually caused by a bacterium, Anaplasma phagacytophilum. HME is caused by a bacterium, .

Symptoms of ehrlichiosis/anaplasmosis include: fever, malaise, headaches, chills, severe muscle aches, vomiting, anemia, lung infection, decreased white blood cells and platelets, elevated enzymes, seizures, encephalopathy, meningitis, confusion, ataxia and cranial nerve palsy. Co-infection with Lyme can cause more severe symptoms. Death can result.

Treatment is with .

Ticks that transmit anaplasmosis include scapularis (deer tick or black legged tick) and (western black legged tick).

Ticks that transmit ehrlichiosis (HME) includeAmblyomma americanum (lone star) and (American dog). (deer tick or black legged tick) and Ixodes pacificus (western black legged tick) ticks have been shown to carry the ehrlichiosis bacterium, but to date, transmission is still in question.

©LDA. 2014. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Colorado Tick Fever

Colorado tick fever (CTF) is a caused by an RNA , Colorado tick fever virus (CTFV).

Symptoms, which are often non-specific, begin 3 to 5 days after the bite with an abrupt onset of fever and any of these: headaches, chills, malaise, photophobia, , nausea, vomiting, diarrhea and abdominal pain. In 5 to 15% of cases a rash occurs. Neurologic complications may also occur. 50% of patients have single recurrence of fever (“saddleback” fever).

IFA titers for diagnosis. PCR (Polymerase Chain Reaction) is the test most often used to diagnose the disease. CTF is transmitted by (Rocky Mt. wood tick) which causes illness from the Western Black Hills to the West Coast in the USA. Some cases of transmission through blood transfusion have been reported. Treatment consists of supportive care.

©LDA. 2014. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Bourbon Virus

Five cases of the Bourbon virus, a thogotovirus, have been confirmed since it was first discovered in Bourbon County, Kansas, in 2014, and cases have since been found in Oklahoma and Missouri.

Transmission: The premise of americanum (lone star tick) as vector is supported.

Symptoms: Fever, headache, tiredness, rash, other body aches, nausea, vomiting, leukopenia, thrombocytopenia. May cause death due to acute illness.

No tests.

No treatment, except for supportive therapy for symptoms.

Electron microscopic images virus particles from virus from CDC.

©LDA. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Babesiosis is a Malaria-like illness caused by a parasite, either , B. duncani, B. divergens, MO-1.

It is sometimes fatal in the elderly or those with no spleen. Babesiosis may be more severe in patients with co-existing .

Symptoms include: fever, chills, fatigue, headache, muscle pain, sweats and anemia.

Tests for Babesiosis: blood smears, IFA (IgG & IgM), FISH (Flourescent in-situ Hybridization) and PCR may be ordered.*

* These tests were developed & performance characteristics determined by independent labs. They have not been cleared or approved by the FDA; however, the FDA has determined such clearance is not necessary. They are designd for clinical purposes and should not be regarded as investigational or for research.

Treatment is often atovaquone with azithromycin or clindamycin and oral quinine. Treatments vary, examples provided as information only.

Ticks that transmit babesiosis include Ixodes Scapularis (also called blacklegged tick or deer tick) andIxodes Pacificus (western blacklegged tick) both of which also transmit Lyme disease. Multiple infections may be transmitted from the bite of the same tick.

Babesiosis has also been transmitted to humans through blood transfusions. In 2018, the FDA approved a test to screen the blood supply for Babesia microti. See: FDA Approves Tests to Screen Blood Supply for Babesia

Resources for transplacental transmission of Babesia:

1. Fox, L.M.; Winger, S.; Ahmed, A.; Arnold, A.; Chou, J.; Rhein, L.; Levy, O. Neonatal babesiosis: Case report and review of the literature. Pediatr. Infect. Dis. J. 2006, 25, 169–173.

2. Cornett, J.K.; Malhotra, A.; Hart, D. Vertical transmission of babesiosis from a pregnant, splenectomized mother to her neonate. Infect. Dis. Clin. Pract. 2012, 20, 408–410.

3. Iyer, S.; Goodman, K. Congenital babesiosis from maternal exposure: A case report. J. Emerg. Med. 2009, 56, e39–e41.

4. Khangura, R.K.; Williams, N.; Cooper, S.; Prabulos, A.M. Babesiosis in pregnancy: An imitator of HELLP syndrome. AJP Reports 2019, 9, e147–e152.

©LDA. 2014. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Rickettsia parkeri Rickettsiosis

This disease is found in Eastern & Southern US & Gulf Coast.

It is transmitted by Amblyomma maculatum, Gulf Coast tick.

Symptoms include headache, fever, variable rash, eschar, which is dead tissue that falls off (sheds) from healthy skin.

Diagnosis through PCR testing. Doxycycline is used for treatment.

CDC website statement: Confirmation of the diagnosis is based on lab testing, but antibiotic therapy should not be delayed in patient with a suggested clinical presentation

©LDA 2015 This web site provides practical and useful information on the subject matter covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Heartland Virus Heartland Virus map

Heartland virus

The virus, a Phlebovirus, was discovered in humans in 2009 in the state of Missouri and has been found to date in Oklahoma, Kansas, Arkansas, Indianan, Illinois, Kentucky, Tennessee, North Carolina and Georgia.

It is transmitted by , lone star tick.

Symptoms: fever, leucopenia (decrease in the number of total white blood cells count), thrombocytopenia (low platelet), tiredness, headaches, muscle aches, diarrhea, loss of appetite.

Testing: No routine testing available but protocols are in place to allow people to be tested for evidence of Heartland virus RNA and IgM and IgG antibodies. Doctors should contact your state health department if you have a patient with an acute illness that may be compatible with Heartland virus disease.

Treatment: None but palliative care. 40 cases as of 9/18, at least 2 deaths.

©LDA. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary. Tick-Borne (TBRF)

Caused by a (either Borrelia hermsii, turicatae, or parkeri) and transmitted by the soft bodied tick, (either hermsi, turicata, or parkeri). The disease is characterized by recurring episodes (3 days on 7 off) of high fever, can be up to 106.7° during certain phases. Each fever episode is followed by signs/symptoms which may include headache, muscle and joint aches, nausea, chills, arthralgia, vomiting, abdominal pain, dry cough, eye pain, confusion. The diagnosis is by microscopy and treatment may be with , erythromycin, or other antibiotics.

The soft bodied ticks which transmit the disease are usually found in the Western US in higher altitudes in old cabins and animal burrows.

©LDA. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

STARI (Southern Tick- Associated Rash Illness)

Southern Tick-Associated Rash Illness (STARI) is also known as Masters Disease. STARI is a disease that looks and acts and is treated like Lyme disease. The causitive agent of STARI is unknown, although some people think the bacterium, Borrellia lonestari, could be the causative agent, and others think it is another form of Lyme disease.

Symptoms are similar to Lyme disease and can include a rash that looks like the bull’s eye rash of Lyme.

There is no generally accepted test for STARI at this time.

It is often found in the South and Midwest whereAmblyomma americanum (lone star), the tick that transmits STARI, is prevalent. STARI can also be found in the Northern portions of the USA.

The treatment is generally the same as for early Lyme disease, doxycycline.

For more information on STARI visit the Lyme and Tick-Borne Research Center Columbia University Medical Center Web site www.columbia-lyme.org/patients/tbd_stari.html

©LDA. 2014. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Bartonellosis (aka illness, cat scratch fever)

Ticks have been shown to carry Bartonella, although currently, CDC indicates there is no causal evidence that ticks can transmit Bartonella through a tick bite. There is a paper of a case which does show potential for tick transmission in a canine, although a case cannot prove causation. Many doctors who treat Lyme disease see Bartonella co-infections in their Lyme and tick-borne disease patients.

It is known that Bartonella is transmitted through the scratches of domestic or feral cats. Infected can carry the Bartonella bacteria and infect the cats and may spread it directly to people, although CDC says this is yet unproven. The disease is often called cat scratch disease. Another strain of Bartonella is transmitted by the human causing what is called . Another strain causes Carrion’s disease, formerly called , through the bite of a sand fly. It occurs in Western South America in high elevations of the Andes Mountains.

Ticks that can carry Bartonella include Ixodes Scapularis (also called the blacklegged tick or deer tick) andIxodes Pacificus (western blacklegged tick), both of which can transmit Lyme disease. More than one co-infection can be transmitted from the same tick bite. is associated with heartburn, abdominal pain, skin rash, mesenteric adenitis, gastritis and duodentis in children and adolescents. Symptoms can include visual problems, headaches, significant lymph node enlargement, resistant neurological deficits and the new onset of a seizure disorder.

Diagnosis is based on acute and convalescent antibody titers (IFA) and/or positive PCR analysis.

Treatment may be combination macrolides, TCNs, rifamycin, (also possible Bactrim or fluoroquinolones). Provided as information only.

Click album below for photos ofBartonella rashes /index.php/resources/medical-photos/category/27-bartonella

OTHER INFORMATION

Link to LDA Bartonella photos

Bartonellosis rash photos

Link to paper on Bartonella

Fried et al Bartonella

©Lyme Disease Association Inc. 2014. 2015. This web site provides practical and useful information on the subject matters covered. It is distributed with the understanding that the LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.