Tick Bite

Epidemiology

  • xxxxx

Clinical Manifestations

Allergic Reactions

  • Anaphylaxis (see Anaphylaxis)
    • Epidemiology
      • Rarely Occurs
    • Associated Ticks
      • Argas Reflexus (European Pigeon Tick)
      • Ixodes Holocyclus Tick (Australian Paralysis Tick)
      • Other Ixodes Ticks
    • Physiology: likely involves allergenic salivary proteins
  • Allergic Reaction/Anaphylaxis Due to Tick Bite-Induced Sensitization to Alpha-Galactosidase (see Anaphylaxis)
    • Physiology: tick bite sensitizes the patient to the carbohydrate, alpha-galactosidase
      • Alpha-Galactosidase is Found in Cetuximab (Erbitux) (see Cetuximab)
      • Alpha-Galactosidase is Found in Red Meats
    • Clinical
      • Alpha-Galactosidase Associated Cetuximab (Erbitux) Allergy (see Cetuximab): may occur on first exposure and may be severe, resulting in anaphylaxis
      • Alpha-Galactosidase Associated Read Meat Allergy: unusual in that it has a delayed onset (occurring 4-6 hrs after meat ingestion)

Infectious Transmission

  • Anaplasmosis (Human Granulocytic Anaplasmosis, HGA) (see Anaplasmosis)
    • Organisms
      • Anaplasma Phagocytophilum
    • Animal Reservoir: deer, white-footed mouse
    • Vectors
      • Ixodes Scapularis Tick (Blacklegged Tick): Connecticut, Maryland, Minnesota, New York, Rhode Island, and Wisconsin
      • Ixodes Pacificus Tick (Western Blacklegged Tick): Western US
      • Ixodes Ricinus Tick: Europe
  • Babesiosis (see Babesiosis)
    • Organisms
      • Babesia Microti
        • Geography: Northeastern and Upper Midwest US
        • Animal Reservoir: white-tailed deer and mice
        • Tick Vector: Ixodes Scapularis (Blacklegged Tick)
        • Incubation Period: 5-33 days
      • Babesia Divergens
        • Geography: Europe
        • Animal Reservoir: cattle
        • Tick Vector: Ixodes Ricinus
      • Other Babesia Species
  • Bourbon Virus Infection (see Bourbon Virus)
    • Vector
      • Amblyomma Americanum Tick (Lone Star Tick): eastern Kansas, Missouri
  • Ehrlichiosis (Human Monocytic Ehrlichiosis, HME) (see Ehrlichiosis)
    • Organisms
      • Ehrlichia Chafeensis: most common etiology of Ehrlichiosis
      • Ehrlichia Ewingii less common etiology of Ehrlichiosis
      • Ehrlichia Muris-Like Species
    • Vector
      • Amblyomma Americanum Tick (Lone Star Tick)
  • Lyme Disease (see Lyme Disease)
    • Epidemiology: Lyme disease is the most common tick-borne illness in the US and Europe
    • Organisms
      • Borrelia Burgdorferi: US, Europe
      • Borrelia Mayonii: Upper Midwest US
      • Borrelia Afzelii: Europe, Asia
      • Borrelia Garinii: Europe, Asia
    • Vectors
      • Ixodes Scapularis (Blacklegged Tick): in Eastern and North Central North America
        • Primary Animal Reservoir (in Northeastern US): white-footed mouse
      • Ixodes Pacificus (Western Blacklegged Tick): in Western North America (Northern California and Oregon)
      • Ixodes Persculatus: in Asia
      • Ixodes Ricinus: in Europe
  • Relapsing Fever (Tick-Borne) (see Relapsing Fever)
    • Organisms
      • Borrelia Hermsii: in Mountainous Western US
      • Borrelia Turicatae: in Southwest and South Central US
      • Other Borrelia Species
    • Vectors
      • Argasid/Soft-Bodied Ticks: usually Ornithodoros
  • Rocky Mountain Spotted Fever (see Rocky Mountain Spotted Fever)
    • Organism: Rickettsia Ricketsii (see Rickettsia)
    • Vectors
      • Amblyomma Aureolatum Tick (Yellow Dog Tick): Brazil
      • Amblyomma Cajennense Tick: Central and South America
      • Dermacentor Andersoni Tick (Rocky Mountain Wood Tick): US Mountain States West of the Mississippi
      • Dermacentor Variabilis Tick (American Dog Tick): Eastern US, South Central US, Southern Canada
      • Rhipicephalus Sanguineus Tick (Brown Dog Tick): Central America, Mexico, Southwestern US
  • Tick-Borne Encephalitis Virus (see Tick-Borne Encephalitis Virus)
    • Organism: XXXX
    • Vector
      • XXXX
  • Tularemia (see Tularemia)
    • Epidemiology: most common in Central and Western US
    • Organisms
      • Francisella Hispaniensis
      • Francisella Philomiragia
      • Francisella Tularensis
      • Other Francisella Species
    • Vector
      • XXXXX

Diagnosis

  • xxxx

Clinical

  • Rash and tick bite history are often absent

Treatment

  • Lyme Disease: Tetracycline, Ceftriaxone
  • Babesiosis: Clinda + Quinine (for life-threatening illness), Atovaquone+Azithro (for non-life threatening illness
  • Ehrlichiosis: Tetracycline
  • Tularemia: Gentamicin
  • Rocky Mountain Spotted Fever: Tetracycline, Chloramphenicol

References

  • Tick-Borne Pulmonary Disease; Chest, 1999: 116: 222-230
  • The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol. 2011;127(5):1286. Epub 2011 Mar 31 [MEDLINE]
  • Human babesiosis.  N Engl J Med.  2012;366:2397–2407 [MEDLINE]
  • The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135(3):58 [MEDLINE]
  • Diagnosis, treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis.  JAMA.  2016;315:1767–1777 [MEDLINE]
  • CDC Tickborne Diseases of the United States (Accessed 7/17) [LINK]