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Sullivan MD, Glose K, Sward D. Tick-Borne Illnesses in Emergency and Wilderness Medicine. Emerg Med Clin North Am 2024; 42:597-611. [PMID: 38925777 DOI: 10.1016/j.emc.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This review highlights the causative organisms, clinical features, diagnosis, and treatment of the most common tick-borne illnesses in the United States, including Lyme disease, Rocky Mountain spotted fever, anaplasmosis, ehrlichiosis, tularemia, Powassan virus, and alpha-gal syndrome. Tick bite prevention strategies and some basic tick removal recommendations are also provided.
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Affiliation(s)
- Michael D Sullivan
- Department of Emergency Medicine, University of Maryland Medical Center, 6th Floor, Suite 200, 110 South Paca Street, Baltimore, MD 21201, USA
| | - Kyle Glose
- Department of Emergency Medicine, University of Maryland Medical Center, 6th Floor, Suite 200, 110 South Paca Street, Baltimore, MD 21201, USA
| | - Douglas Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, 6th Floor, Suite 200, 110 South Paca Street, Baltimore, MD 21201, USA.
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Szaroz D, Kulkarni M, Robayo González CX, Zinszer K. Study protocol for a scoping review of Lyme disease prediction methodologies. BMJ Open 2024; 14:e071402. [PMID: 38772589 PMCID: PMC11110606 DOI: 10.1136/bmjopen-2022-071402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 03/27/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION In the temperate world, Lyme disease (LD) is the most common vector-borne disease affecting humans. In North America, LD surveillance and research have revealed an increasing territorial expansion of hosts, bacteria and vectors that has accompanied an increasing incidence of the disease in humans. To better understand the factors driving disease spread, predictive models can use current and historical data to predict disease occurrence in populations across time and space. Various prediction methods have been used, including approaches to evaluate prediction accuracy and/or performance and a range of predictors in LD risk prediction research. With this scoping review, we aim to document the different modelling approaches including types of forecasting and/or prediction methods, predictors and approaches to evaluating model performance (eg, accuracy). METHODS AND ANALYSIS This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines. Electronic databases will be searched via keywords and subject headings (eg, Medical Subject Heading terms). The search will be performed in the following databases: PubMed/MEDLINE, EMBASE, CAB Abstracts, Global Health and SCOPUS. Studies reported in English or French investigating the risk of LD in humans through spatial prediction and temporal forecasting methodologies will be identified and screened. Eligibility criteria will be applied to the list of articles to identify which to retain. Two reviewers will screen titles and abstracts, followed by a full-text screening of the articles' content. Data will be extracted and charted into a standard form, synthesised and interpreted. ETHICS AND DISSEMINATION This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Daniel Szaroz
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
| | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Claudia Ximena Robayo González
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
| | - Kate Zinszer
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
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Eilbert W, Matella A. Tick-Borne Diseases. Emerg Med Clin North Am 2024; 42:287-302. [PMID: 38641392 DOI: 10.1016/j.emc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Ticks are responsible for the vast majority of vector-borne illnesses in the United States. The number of reported tick-borne disease (TBD) cases has more than doubled in the past 20 years. The majority of TBD cases occur in warm weather months in individuals with recent outdoor activities in wooded areas. The risk of contracting a TBD is also highly dependent on geographic location. Between 24 and 48 hours of tick attachment is required for most disease transmission to occur. Only 50% to 70% of patients with a TBD will recall being bitten by a tick, and TBDs are often initially misdiagnosed as a viral illness. Most TBDs are easily treated when diagnosed early in their course.
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Affiliation(s)
- Wesley Eilbert
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469, COME, 1819 West Polk Street, Chicago, IL 60612, USA.
| | - Andrew Matella
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469, COME, 1819 West Polk Street, Chicago, IL 60612, USA
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Thalmann P, Ehrhard S, Summerfield A, Ricklin ME. Retrospective Study of Tick Bites Associated with Neurological Disease in a Level Three University Hospital in Switzerland. Infect Dis Rep 2023; 15:150-157. [PMID: 36960968 PMCID: PMC10037620 DOI: 10.3390/idr15020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Ticks represent very important vectors of human and zoonotic pathogens, and tick-borne diseases (TBDs) are diagnosed with increasing frequency. Therefore, the aim of this retrospective study was to describe patients presenting with a complaint of tick bite in the emergency department (ED) of a large university hospital in Switzerland. METHODS Data were collected by searching for keywords in the routine clinic database to identify cases from 1 July 2012 to 30 June 2020. The patients' data were screened for preexisting diseases and demographic and clinical characteristics. RESULTS We included 415 patients collected over a period of 8 years, with highest admission frequencies from May to July. Of these, 82% were outpatients, 15.9% admitted to a hospital ward, and five to intensive care. The patients were allocated to three groups. The first group represented patients with erythema chronica migrans (ECM), which is pathognomonic for Lyme borreliosis (n = 45). Accordingly, 89% of cases in this group of patients were treated with antibiotics. The second group represented patients with other tick bite-associated erythema (n = 139). In this group, no particular clinical symptoms or laboratory findings were found. Finally, the largest group represented patients in which the tick bite was no longer visible (n = 201). This group of patients had significantly more evidence of neurological disorders (52%) and were treated at a higher rate with non-steroidal anti-inflammatory (29%) or antiviral (13%) drugs. Although the vaccination status for tick-borne encephalitis virus (TBEV) was not systematically evaluated, at least 10% of the latter group was vaccinated, indicating another source for neurological disease. Furthermore, only 14% of the tested patients were positive for IgM or IgG against TBEV. CONCLUSION This retrospective study indicates the presence of many undiagnosed neurological diseases following tick bites that could be caused by TBEV or an unknown infectious agent. Taken together, although tick bites were not very frequently seen in the present tertiary ED, the frequent presence of neurological symptoms demands a more systematic assessment of vaccination status and TBEV serology as well as further diagnostic evaluations in patients that report tick bites and neurological symptoms.
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Affiliation(s)
- Patrick Thalmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Artur Summerfield
- Department of Immunology, Institute of Virology and Immunology, 3147 Mittelhäusern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Hallerstrasse 6, 3012 Bern, Switzerland
| | - Meret Elisabeth Ricklin
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Kopsco HL, Duhaime RJ, Mather TN. Assessing Public Tick Identification Ability and Tick Bite Riskiness Using Passive Photograph-Based Crowdsourced Tick Surveillance. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:837-846. [PMID: 33146378 DOI: 10.1093/jme/tjaa196] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Tick identification is critical for assessing disease risk from a tick bite and for determining requisite treatment. Data from the University of Rhode Island's TickEncounter Resource Center's photo-based surveillance system, TickSpotters, indicate that users incorrectly identified their submitted specimen 83% of the time. Of the top four most commonly submitted tick species, western blacklegged ticks (Ixodes pacificus Cooley & Kohls [Ixodida: Ixodidae]) had the largest proportion of unidentified or misidentified submissions (87.7% incorrectly identified to species), followed by lone star ticks (Amblyomma americanum Linneaus [Ixodida: Ixodidae]; 86.8% incorrect), American dog ticks (Dermacentor variabilis Say [Ixodida: Ixodidae]; 80.7% incorrect), and blacklegged ticks (Ixodes scapularis Say [Ixodida: Ixodidae]; 77.1% incorrect). More than one quarter of participants (26.3%) submitted photographs of ticks that had been feeding for at least 2.5 d, suggesting heightened risk. Logistic regression generalized linear models suggested that participants were significantly more likely to misidentify nymph-stage ticks than adult ticks (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.23, 0.68, P < 0.001). Ticks reported on pets were more likely to be identified correctly than those found on humans (OR = 1.07, 95% CI: 1.01-2.04, P < 0.001), and ticks feeding for 2.5 d or longer were more likely to be misidentified than those having fed for one day or less (OR = 0.43, 95% CI: 0.29-0.65, P < 0.001). State and region of residence and season of submission did not contribute significantly to the optimal model. These findings provide targets for future educational efforts and underscore the value of photograph-based tick surveillance to elucidate these knowledge gaps.
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Affiliation(s)
- Heather L Kopsco
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
| | - Roland J Duhaime
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
- Environmental Data Center, University of Rhode Island, Kingston, RI
| | - Thomas N Mather
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
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Garber B, Glauser J. Tick-Borne Illness for Emergency Medicine Providers. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Septfons A, Goronflot T, Jaulhac B, Roussel V, De Martino S, Guerreiro S, Launay T, Fournier L, De Valk H, Figoni J, Blanchon T, Couturier E. Epidemiology of Lyme borreliosis through two surveillance systems: the national Sentinelles GP network and the national hospital discharge database, France, 2005 to 2016. Euro Surveill 2019; 24:1800134. [PMID: 30892181 PMCID: PMC6425552 DOI: 10.2807/1560-7917.es.2019.24.11.1800134] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. AIM To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions. RESULTS From 2011 to 2016, the mean yearly incidence rate of LB cases was 53 per 100,000 inhabitants (95% CI: 41-65) ranging from 41 in 2011 to 84 per 100 000 in 2016. A mean of 799 cases per year were hospitalised with LB associated diagnoses 2005-16. The hospitalisation incidence rate (HIR) ranged from 1.1 cases per 100,000 inhabitants in 2005 to 1.5 in 2011 with no statistically significant trend. We observed seasonality with a peak during the summer, important inter-regional variations and a bimodal age distribution in LB incidence and HIR with higher incidence between 5 and 9 year olds and those aged 60 years. Erythema migrans affected 633/667 (95%) of the patients at primary care level. Among hospitalised cases, the most common manifestation was neuroborreliosis 4,906/9,594 (51%). CONCLUSION Public health strategies should focus on high-incidence age groups and regions during the months with the highest incidences and should emphasise prevention measures such as regular tick checks after exposure and prompt removal to avoid infection.
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Affiliation(s)
- A Septfons
- Santé publique France, Paris, France,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - T Goronflot
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - B Jaulhac
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - V Roussel
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - S De Martino
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Guerreiro
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - T Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - L Fournier
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - H De Valk
- Santé publique France, Paris, France
| | - J Figoni
- Santé publique France, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
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Yeung C, Baranchuk A. Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block. Healthcare (Basel) 2018; 6:healthcare6040119. [PMID: 30248981 PMCID: PMC6315930 DOI: 10.3390/healthcare6040119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/21/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022] Open
Abstract
Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with a highly favorable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.
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Affiliation(s)
- Cynthia Yeung
- Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
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Abstract
Lyme disease is the most common vector-borne illness in North America, with the majority of cases occurring in the Northeast and upper Midwest. Lyme arthritis is the most prevalent manifestation of late-stage Lyme disease. Lyme arthritis typically presents as a monoarthritis or oligoarthritis in large joints such as the knee. Accompanying positive 2-tier Lyme serologies or polymerase chain reaction from synovial fluid/tissue is considered diagnostic for patients from an endemic area. The mainstay of initial treatment is a prolonged course of oral antibiotics.
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Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL. Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement. J Vet Intern Med 2018; 32:617-632. [PMID: 29469222 PMCID: PMC5866975 DOI: 10.1111/jvim.15042] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.
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Affiliation(s)
- T J Divers
- Department of Clinical Sciences, Cornell University, Ithaca, NY
| | | | - J E Madigan
- Department of Medicine and Epidemiology, University of California - Davis, CA
| | - S G Witonsky
- Department of Large Animal Clinical Sciences, Virginia-Maryland Region CVM, Blacksburg, VA
| | - J J Bertone
- CVMm Western University of Health Sciences, Pomona, CA
| | | | - S E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - A L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA
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