Tick-Borne Illness for Emergency Medicine Providers

Abstract

Purpose of Review Ticks are the most important vectors of human diseases after mosquitoes. Emergency physicians throughout the USA can be expected to encounter Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, and other disorders based upon geographic location. Recent Findings The number of identifiable disorders transmitted by these arthropods has increased in recent years. Severe fever with thrombocytopenia syndrome has only been described within the past decade, and the new millennium has seen over 10 new species of rickettsial disease discovered. Summary Ticks transmit more pathogenic species than any other group of blood-feeding arthropods. This review provides an update on the diagnosis and management of the diseases most likely to be encountered in clinical practice. Keywords Tick-borne illness. Rocky Mountain spotted fever. Babesiosis. Febrile illness. Lyme disease This article is part of the Topical Collection on Infectious Disease

Recognition of Cutaneous Symptoms of Common Tick-Borne Illness in the Emergency Department

“…After about 6 days postexposure, a petechial rash may develop. This appears as purple and red pinpoint spots (CDC, 2022a;Garber & Glauser, 2019). Rash appearance is reflective of the infectious small vessel vasculitis that occurs with RMSF (CDC, 2020; Garber & Glauser, Diagnosis is confirmed by serologic testing after sufficient clinical suspicion is identified.…”

“…Lyme disease has become the most common tick-borne illness in the United States (Alkishe et al, 2021; Andersen & Davis, 2017; CDC, 2022a; Garber & Glauser, 2019; Pace & O'Reilly, 2020). Initial presentation may resemble a flu-like syndrome, which progresses to neurologic symptoms without intervention (Garber & Glauser, 2019). The classic rash of Lyme disease is called “erythema migrans.” Erythema migrans begins with an erythematous macule or papule at the site of the tick bite and then gradually expands outward over the following days to form a so-called bull's-eye lesion, with a central erythema surrounded by rings of varying shades of red (Wolff, Johnson, Saavedra, & Roh, 2013).…”

“…Advanced Emergency Nursing Journal Tick encounters and tick-borne illnesses seem to be increasing (Alkishe, Raghavan, & Peterson, 2021;Garber & Glauser, 2019;Zellner & Huntley, 2019). With increasing temperatures globally, the active season for ticks has lengthened.…”

“…TICKS ARE A SPECIES of arachnid that is prevalent throughout the world, with dozens of species in the United States alone (National Pest Management Association, 2023). Most ticks are very small and are obligate parasites that feed on the blood of vertebrates, including humans (Garber & Glouser, 2019). Although there are more than 900 species of ticks worldwide, a much smaller number in the United States causes such significant morbidity that they are commonly of interest to the medical community.…”

“…Within these are a subset of tick-borne illnesses that cause hallmark skin rashes that can help guide diagnosis. Early recognition is important as delay in diagnosis can lead to permanent, irreversible damage in some illnesses (Garber & Glouser, 2019). Although patients may arrive with a tick attached, or even bring it in with them, this may not always aid in distinguishing the type of illness.…”