Vector-Borne Diseases

Chapter 19
Objectives
Describe the etiology, epidemiology, signs and symptoms of Lyme
disease.
Discuss the immunologic manifestations and diagnostic evaluation of
Lyme disease.
Explain the treatment and prevention of Lyme disease.
Describe the etiology, epidemiology, signs and symptoms of
ehrlichiosis.
Discuss the immunologic manifestations and diagnostic evaluation of
ehrlichiosis.
Explain the treatment and prevention of ehrlichiosis.
Describe the etiology, epidemiology, signs and symptoms of
babesiosis.
Discuss the immunologic manifestations and diagnostic evaluation of
babesiosis.
Explain the treatment and prevention of babesiosis.
Lyme Disease: Etiology
Caused by tick-born spirochete Borrelia burgdorferi
Transmitted by ixodid ticks including I. scapularis, I.
pacificus, I. ricinus, I. persulcatus
Transmitted from the gut of the tick to human skin at the
site of a bite and then migrates outwardly on the skin
Creates a lesion called erythema migrans
Lyme Disease: Epidemiology
Accounts for 95% of all reported vector-borne illness in
the US
Cases remain concentrated in the northeastern, north-
central, and pacific coastal regions
Lyme Disease: Signs and Symptoms
60-80% of patients, disease begins with skin lesion
(erythema migrans) occurring at the tick bite site
Lesion is accompanied by flulike symptoms
Involves the skin, nervous system, heart, and joints
(arthritis)
Stage Length of Time Common Signs and
Symptoms
I 4 wks Cutaneous manifestations
(erythema migrans), flulike
syndrome, neurologic symptoms
II Follows a variable latent Nervous system, heart, eyes, and
period skin
III Weeks to years after Arthritis, late neurologic
infection complications
Lyme Disease: Immunologic Manifestations
Cell immune response to B. burgdorferi antigens begins
with early clinic illness
Lyme Disease: Diagnostic Evaluation
Culture of B. burgdorferi
Recognition of characteristic clinical findings, history of
exposure, and antibody response to B. burgdorferi
Lyme Disease: Treatment and Prevention
Unclear whether antibiotic treatment after a tick bite will
prevent Lyme Disease
Prevention:
Check daily for ticks
Tuck pants into socks
Human Ehrlichiosis: Etiology and
Epidemiology
Ehrlichia is caused by Ehrlichia
Incidence rates increase with age

Human Ehrlichiosis: Signs and Symptoms

Nonspecific symptoms which includes fever, chills,
headache, and skin rash
Human Ehrlichiosis: Diagnostic Evaluation
Definitive diagnosis is based on inclusions in WBCs

Human Ehrlichiosis: Treatment

Doxycycline
Babesiosis: Etiology and Epidemiology
Caused by Babesia (microscopic parasite that infects
RBCs)
In US, B. microti is transmitted by I. scapularis
Seen mostly in older patients, splenectomized patients, or
immunocompromised patients
Can be transmitted via blood transfusion
Babesiosis: Signs and Symptoms
Incubation period of 7-21 days
Ranges from asymptomatic to rapidly progressive and
fatal
Cause fever, fatigue, hemolytic anemia
Babesiosis: Diagnostic Evaluation
Increased reticulocyte count due to hemolytic
component of disease
Elevated lactate dehydrogenase, increased bilirubin,
decreased haptoglobin levels
2 rapid screening methods:
Visualization of intraerythrocytic organisms in blood smear =
gold standard**
Fields test is performed with a thick blood smear***
Acute and convalescent antibody titers
Babesia in Red Blood Cells
Babesiosis: Treatment and Prevention
Antimicrobial therapy recommended for splenectomized
or immunosuppressed patients
Clindamycin and oral quinine