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Diagnosis and Treatment of Four Tickborne Diseases

Lyme disease, Ehrlichiosis, Anaplasmosis and Babesiosis


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Larva, Nymph, adult male and female Ixodes scapularis ticks AKA blacklegged or deer ticks
[1] (L to R) Larva, Nymph, adult male and female Ixodes scapularis ticks (AKA blacklegged or deer ticks) on a dime

by Stuart M. Caplen, MD


This article explores the diagnosis and treatment of four tick borne illnesses: Lyme disease, ehrlichiosis, anaplasmosis and babesiosis. Diagnosis can be challenging, as the tick bite may not have been noticed, clinical symptoms may be non-specific, and laboratory confirmation of infection can be problematic, especially early in the course of these diseases. At times clinicians may need to treat on clinical suspicion alone.


Lyme Disease


Although there are only about 30,000 cases of Lyme disease reported to the CDC per year, the CDC estimates the actual total is about 476,000 cases per year in the United States.[2]


As can be seen on the map below, most cases of Lyme disease occur in the Mid-Atlantic states, New England and the Midwest, although there is significant distribution around the country. The geographic distribution of the three other tickborne infections under discussion can also be seen below.




Tick Life Cycle and Infection Transmission


Lyme disease is a tick transmitted disease, with protean manifestations, usually caused by the spirochete, Borrelia burgdorferi, although it can rarely be caused by Borrelia mayonii.


Ticks go through four life stages: egg, six-legged larva, eight-legged nymph, and adult. After hatching from the eggs, ticks must eat blood to survive. Ticks can take up to 3 years to complete their full life cycle, although the Ixodes scapularis tick, also known as the blacklegged or deer tick, that typically spreads Lyme disease has a 2-year life cycle. Most nymph infections occur in the spring and summer, with adult tick caused infections typically occurring during the cooler months. Nymph ticks are much harder to detect, as they are typically less than 2 mm in size, and may be more likely to feed unnoticed, as opposed to an adult tick.[4] For Lyme disease to occur, the tick needs to be attached for a significant time, typically 36-48 hours before an infection can be transmitted.[5] The more engorged the tick the higher the likelihood of an infection being transmitted.


Most tick bites do not result in Lyme disease infections. In some studies, only...


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ABOUT THE AUTHOR


Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a former emergency physician and emergency department medical director, now retired from clinical practice. His current interests include how quality is produced and maintained in health care, and he has greenbelt certification in lean/six sigma.


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