Infectious diseases

Tick-Borne Diseases
Disease Description Clinical Features Diagnosis & Treatment
- Is a protozoal disease caused by the genus plasmodium, - Hallmark is cyclical fever (which it coincides with RBC lyses by parasites)  Dx is made from :
(which is a RBC parasite) . Fever patter : Giemsa-stained peripheral blood smear
 Fever occurs every 48 hours with vivax & ovale. TTT:
- Transmitted by tick bite of infected: anopheles mosquitoes. every 72 hours with malarieae, A) Treatment:
 Periodicity is NOT seen with falciparum (constant fever) - Chloroquine (safe in pregnancy) If chloroquine resistance :
- You have 4 species: a- Quinine & Tetracycline or
 Falciparum: Most deaths are due to falciparum (P. falciparum  IV Quinidine & Doxycycline)
Malaria  vivax, ovale: are responsible for several relapse.
- The typical episode consists of 3 stages :
1- Cold stage: chills & shivering  followed by b- & Mefloquine & Atovaquone–proguanil # in Pregnancy & CRD
 malariae. 2- Hot stage: high grade fever  2-6 hours later B) Prophylaxis : to all travels to malarious regions
3- Sweating stage: diaphoresis & resolution of the fever.
1- Mefloquine :is the DOC for chemoprophylaxis against
Contraindicated in Seizures & Psych. chloroquine-resistant malaria.
Add a 2-week regimen of : Primaquine
- Started 1 week before travel  continued until 4 weeks after
departure from an endemic area.
Contraindicated in patients with G6PD deficiency
2- Primaquine (both for prophylaxis & ttt ) is indicated against:
p. vivax or p. ovale, (which can cause persistence in the liver).
- Parasite enters the patient’s RBC and causes hemolysis.
Babesiosis - Is a protozoal disease caused by the genus babesia . - Clinical manifestations vary from :  Definitive dx is made from :
Giemsa-stained thick & thin blood smear.
 Asymptomatic infection to
- Transmitted by tick bite of infected: ixodes tick , in
Clinically significant illness  Hemolytic anemia associated with:
usually occurs in people: endemic area: TTT:
jaundice, hemoglobinuria, renal failure, and death.
1- Over age 40, pts Etiology: B. microti in the northern & midwestern of US. 1- Quinine-Clindamycin or
 Unlike other tick-borne illnesses, rash is NOT a feature of babesiosis,
2- Without a spleen, or 2- Atovaquone-Azithromycin.
except in severe infection where thrombocytopenia may cause a
3- Immunocompromised. secondary petechial or purpuric rash.
1- Early localized stage:  Dignosis clinical / +ve (ELISA) & Western Blot tests for antibodies.
- Is a tick-borne illness caused by the spirochete Borrelia - Skin: erythema chronicum migrans (Bull's eye) at site of tick
Burgdorferi . 2- Early disseminated stage: (days to weeks to months after skin rash) TTT:
- Fever + Chills, fatigue, arthralgias, headache
- Transmitted by tick bite of infected: ixodes scapularis - Early Lyme Disease (Rash / Joint / Bell's palsy) :
- Neuro : -- Bell palsy (Cranial neuritis)
Lyme disease - History of: Outdoor activities (e.g., hiking, camping). -- sensory-motor neuropathies 1- Doxycycline (Oral) for 21 days
 Contraindicated in: Pregnant / Child <8 y  Amoxicillin
-- Aseptic meningitis (Brudzinski & Kernig signs negative).
-- Encephalitis Allergy: Erythromycin
- Cardiac: AV block / Myocarditis / Pericarditis 2- Amoxicillin / Cefuroxime
3- Late disseminated stage: (few months to years later) :
- For Cardiac & CNS (other than Bell's palsy) :
- Joint: Monoarthritis(Large especially knee) / chronic synovitis
Ceftriaxone (IV)
- Neuro: Encephalitis / Transverse myelitis
Typically 1 week after the tick bite.  Dx requires a high index of clinical suspicion
- Is a tick-borne illness caused by the intracellular bacteria
Rickettsia Rickettsii - In the first 3 days: TTT:
Rocky - Transmitted by tick bite of ticks feeding on animals
Indistinguishable from a self-limiting viral illness
FAHM: Fever, Anorexia, Headache, Myalgias / Nausea, vomiting
ABC’s should always come first when treating any pt. check vitals
to make sure that the pt is stable.
mountain - History of: Outdoor activities - After 3 days of fever  Rash : - If signs of shock (hypotensive) :
1- Maculopapular rash: The best NEXT best step is: IV fluids to replete intravascular volume.
spotted fever Organisms enter the host cells via tick bites multiply in the Starts peripherally (palms & soles)  Spread centrally (limbs/trunk/face) - After he is stable: DOC :
vascular endotheliumDamage to the vascular endothelium Doxycycline (Oral/IV) for both adults & children.
2- then petechiae:
- The most serious tick- results in : microhemorrhages, and microinfarcts.
Micro vascular damage as disease progress : - In pregnant:
borne disease in the US
- Petechiate + Hypotension & Non-cardiogenic pulmonary edema Chloramphenicol
- Is a tick-borne illness caused by one of 3 different Incubation period varies from 1 to 3 weeks.
 Dx : Confirm by serology
Ehrlichiosis intracellular gram -ve bacteria , genus Ehrlichia - FAHM
- Transmitted by tick bite. - No Rash  its description as : “spotless rocky mountain spotted fever.” TTT:
- Complications: Renal Failure / GIT bleeding
It infects and kills WBCs  show - Doxycyline (for 1 week)
intracellular inclusions (morulae) LABS:
 leucopenia / thrombocytopenia  aminotransferases.

Cestode
- Is a parasitic disease caused by larval stage of the pork If a person (rather than a pig"intermediate host") consumes the T. solium
tapeworm: Taenia solium eggs excreted in human feces  Cysticercosis results.

Normal Life cycle of Taenia Solium: - After ingestion, the embryos are released in the intestine  larvae
Cysticercosis * Definitive Host: Humans (only) invade the intestinal wall  disseminate hematogenously to encyst in:
1- Brain: Neurocysticercosis
TTT:
* Intermediate host: pig Treatment of Neurocysticercosis :
* Infective stage: larva -- multiple, small (usually <1cm ) , fluid-filled cysts in the brain
* Mode of infection: humans eat larvae in meat such as … parenchyma and have a membranous wall Albendazole
NCC is the most common
infected, undercooked pork. -- On neuroimaging: invaginated scolex
parasitic infection of brain
* Habitat: adult in upper jejunumexcretes its eggs into feces 2- Skeletal muscle
If a pig consumes these eggs, it becomes an 3- Subcutaneous tissue
intermediate host, with larvae encysting in its tissues. 4- Eye
- Echinococcus tape worm has two main species: - If a human (rather than sheep) consumes infectious eggs excreted by  Both be diagnosed with a combination of imaging and serology
1- E.Granulosus  causes: cystic echinococcosis (CE) dogs in the feces  Echinococcosis results.  In the absence of a positive serologic test: percutaneous aspiration
Echinococcosis 2- E. multilocularis causes: alveolar echinococcosis (AE) or biopsy (may be required to confirm the diagnosis).
- After ingestion, the oncospheres are hatched in the intestine 
Hydatid cyst is a fluid filled Normal Life cycle of E.Granlosus: penetrate the bowel wall  disseminate hematogenously to various
* Definitive Host: Dogs (& other canines) visceral organs  Formation Hydatid Cyst, mostly in : TTT:
cyst with an inner germinal
1- Liver : RUQ pain, rupture to peritoneal cavity  anaphylaxis 1- Surgical resection as in liver cycts.
layer and an outer acellular * Intermediate host: Cattle / Sheep
2- Lung: cough / chest pain / dyspnea / hemoptosis 2- Percutaneous management
laminated membrane * Infective stage: Embryonated Eggs in feces.
* Mode of infection: Eating food contaminated with egg. 3- Medical:
* Habitat: Small intestine  Germinal layer gives rise to numerous secondary daughter cysts. Albendazole: 1 week prior to surgery/ 4 weeks postoperatively

Nematode
- It is caused by the roundworm trichinella spiralis 3 phases + Eosinophilia.  Dx: Triad clinical symptoms confirmed by serology.
- It is acquired by eating undercooked pork that contains • Initial phase: in 1st week  larvae invade the intestinal wall.
GIT symptoms: abdominal pain, nausea, vomiting, diarrhea. TTT:
Trichinosis encysted trichenella larva
Triad :
• 2nd phase: in 2nd week of infection  larval migration : 1- mild infection : No Antiparasitics
Local & Systemic hypersensitivity reaction Symptomatic treatment with analgesia & Antipyretics
(trichinellosis)
1- Muscle pain (myositis) Nail : “splinter” hemorrhages, 2- In Systemic Symptoms :
2- Periorbital edema Eye: conjunctival & retinal hemorrhages/per orbital edema/chemosis. - Albendazole / Mebendazole
3- Eosinophilia • 3rd phase: larvae enter the pt’s skeletal muscle: - together with corticosteroids
after eating raw meat = Trichinella spiralis (trichinosis) Muscle symptoms: muscle pain, tenderness, swelling, weakness.
- It is caused by the roundworm Ascaris Lumbricoides Ascariasis often presents as :  Dx : Egg seen in stool examination.
- It is acquired by eating food that contains Embryonated egg 1- Lung phase with non productive cough  followed by : TTT:
(containing 2nd stage rhabditiform larva)
Ascariasis Notes :
2- Asymptomatic intestinal phase 1- First line: Albendazole / Mebendazole
 Contraindicated in: Pregnant  Pyrantel Pamoate
Symptoms result from obstruction caused by the organisms, as:
Ascariasis can also present with GIT symptoms + eosinophilia 2- Alternative: Ivermectin / Nitazoxanide
small bowel or biliary obstruction.
- It is caused by the pinworm Enterobius Vermicularais. At night, females migrate out through the rectum onto the perianal skin  Dx is by the “scotch tape test”  demonstrates presence of eggs.
Enterobiasis - Adult parasite thrives in the Cecum / appendix. to deposit eggs  Nocturnal Perianal Pruritis.  TTT: Albendazole or Mebendazole
- It is caused by dog & cat hookworm ancylostoma braziliense. - Initially :  Dx is clinical in cutaneous disease/ & pulmonary disease : dry cough
Cutaneous - It's acquired after skin contact with soil/sand contaminated multiple pruritic, erythematous papules at the site of larval entry TTT:
- Followed by: Migration 1- Preferred : Ivermectin
larva migrans with dog or cat feces containing the infective larvae
Notes :
Severely pruritic, elevated, serpiginous, reddish brown lesions on 2- Alternative: Albendazole
(creeping eruption) the skin, which elongate at the rate of several millimeters per day as
Most common seen in the LE / but the UE can also be involved. No Antiparasites in Pulmonary disease since illness is mild & self-limited
the larvae migrate in the epidermis.

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