{
 "topic": "Tick-Borne Illness",
 "slug": "tick-borne-illness",
 "category_id": 15139,
 "passage_count": 14,
 "source_chars": 11773,
 "enough_material": true,
 "references": [
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    1886,
    1916
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    5063,
    8609
   ]
  },
  {
   "title": "Red_Book_2021_2024_Report_of_the_Comm_z_library_sk,_1lib_sk,",
   "author": null,
   "pages": [
    225,
    360
   ]
  },
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    1255,
    1264
   ]
  },
  {
   "title": "Red Book Atlas 4th Ed.indb",
   "author": "American Academy of Pediatrics;Carol J. Baker, MD, FAAP;",
   "pages": [
    892
   ]
  },
  {
   "title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)",
   "author": null,
   "pages": [
    537
   ]
  },
  {
   "title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)",
   "author": null,
   "pages": [
    537
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    998
   ]
  }
 ],
 "passages": [
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1886",
   "text": "incubation period of tick- borne disease is usually 7 days (range: 2- 9 days). Each form of relapsing fever is characterized by sudden onset of high fever, lethargy, headache, photophobia, nausea, vomiting, myalgia, and arthralgia. Additional symptoms may appear later and include abdominal pain, a productive cough, mild respiratory distress, and bleeding manifestations, including epistaxis, hemoptysis, hematuria, and hematemesis. During the end of the primary febrile episode, a diffuse, erythematous, macular, or petechial rash lasting up to 2 days may develop over the trunk and shoulders. There may also be lymphadenopathy, pneumonia, and splenomegaly. Hepatic tenderness associated with hepatomegaly is a common sign, with jaundice in half of affected children. Central nervous system manifestations include lethargy, stupor, meningismus, convulsions, peripheral neuritis, focal neurologic deficits, and cranial nerve paralysis and may be the principal feature of late relapses in tick- borne disease. Severe"
  },
  {
   "source": "Cover, p. 5063",
   "text": "Nearly 100 species of ticks are capable of transmitting bacterial, viral, and protozoal diseases to humans. The most important tick-borne illnesses in the United States are Lyme disease, spotted fever rickettsioses (eg, Rocky Mountain spotted fever), ehrlichiosis, babesiosis, anaplasmosis, tularemia, endemic relapsing fever, and Colorado tick fever. Tick paralysis is a rare, potentially fatal sequela of tick bites that occurs more commonly in children than in adults. It is characterized by an ataxic gait followed by ascending flaccid paralysis that rapidly resolves with tick removal. Children become exposed to ticks via household pets or by contact with grasses or brush. Methods for preventing tick bites include avoiding densely"
  },
  {
   "source": "Red_Book_2021_2024_Report_of_the_Comm_z_library_sk,_1lib_sk,, p. 360",
   "text": "**CONTROL MEASURES:** Limiting exposures to ticks and tick bites is the primary means of prevention (see Prevention of Mosquitoborne and Tickborne Infections, p 175). Risk of transmission through blood transfusion or organ transplantation should be considered in areas with endemic infection. Prophylactic administration of doxycycline after a tick bite is not indicated because of the low risk of infection and lack of proven effectiveness. Cases of ehrlichiosis and anaplasmosis are notifiable diseases in the United States and should be reported to the local or state health department. Additional information is available on the CDC website **(www.cdc.gov/ehrlichiosis, www.cdc.gov/anaplasmosis,** and **www.cdc.gov/ticks),** including a collaborative report providing recommendations for the diagnosis and management of tickborne rickettsial diseases.[1] ## Serious Neonatal Bacterial Infections Caused by Enterobacteriaceae (Including Septicemia and Meningitis)"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1264",
   "text": "Complications and death result from severe vasculitis, especially in the brain, heart, and lungs. The mortality rate is 5%\u20137%. Persistent neurologic deficits occur in 10%\u201315% of children who recover. Delay in therapy is an important determinant of sequelae and mortality. Because tick attachment lasting 6 hours or longer is associated with transmission of the pathogen, frequent tick removal is a preventive measure. Mukkada S, Buckingham SC: Recognition and prompt treatment ~~for tick-born infection in children. Infect Dis Clin North Am~~ 2015;29:539 [PMID: 26188606]. ## **ENDEMIC TYPHUS (MURINE TYPHUS)** ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Residing in endemic area. - \u00bb Fever for 10\u201314 days. - \u00bb Headache, chills, myalgia. - \u00bb Maculopapular rash spreading from trunk to extremities (not on palms and soles) 3\u20137 days after fever onset. - \u00bb Definitive diagnosis by serology. **1232** **CHAPTER 40**"
  },
  {
   "source": "Red Book Atlas 4th Ed.indb, p. 892",
   "text": "neonatal, 90, 94 _i,_ 96 _i_ in older children and adolescents, 90\u201391 oral, 89\u201390 treatment of, 89\u201391 Thyroiditis from mumps, 441 Tickborne encephalitis, 25 _t,_ 28 _t_ Tickborne lymphadenopathy (TIBOLA), 571 Tigecycline for _Enterobacteriaceae_ infections, 184 Tinea capitis, 704\u2013705, 706\u2013707 _i_ clinical manifestations of, 704 diagnostic tests for, 704\u2013705 epidemiology of, 704 etiology of, 704 incubation period of, 704 treatment of, 705 Tinea corporis, 708\u2013709, 709\u2013711 _i_ clinical manifestations of, 708 diagnostic tests for, 708 epidemiology of, 708 etiology of, 708 incubation period of, 708 treatment of, 709"
  },
  {
   "source": "Red_Book_2021_2024_Report_of_the_Comm_z_library_sk,_1lib_sk,, p. 225",
   "text": "176 PREVENTION OF MOSQUITOBORNE AND TICKBORNE INFECTIONS _variabilis_ , or _A americanum_ . Soft-bodied ticks ( _Ornithodoros_ species) transmit _Borrelia hermsii_ and other spirochetes causing tickborne relapsing fever. Prevention of infection depends on avoiding known areas of disease, reducing arthropod habitats, using repellents and clothing to protect against biting arthropods, and limiting the amount of time that ticks are attached to the skin. Vaccines for yellow fever and Japanese encephalitis are licensed and available in the United States for use in travelers. A dengue vaccine is licensed in the United States for use in children 9 to 16 years of age living in areas with endemic infection, but it is not yet available. Chemoprophylactic drugs are available to protect against malaria. ## General Protective Measures Pediatricians can educate about taking the following measures to reduce exposures to vectorborne diseases:"
  },
  {
   "source": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital), p. 537",
   "text": "- **A. Congenital, Perinatal, and Neonatal Infections (Table 17.1)** - **B. Pediatric Infections by System (Table 17.2)** - **C. Pediatric Viral Illnesses (Table 17.3)** - **D. Pediatric Tick- Borne Diseases (Table 17.4)** - **E. Tuberculosis: Diagnosis and Treatment (Boxes 17.1 and 17.2)[1][,][2]** 1. Diagnosis - a. See Box 17.1 for screening guidelines and Box 17.2 for information on interpretation of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs). - b. If positive screening test, obtain chest X- ray. - c. If symptoms indicate active tuberculosis (TB) disease, determine source. - (1) Consider pediatric protocol chest CT over X-ray when available. - (2) Specimen sources include sputum, bronchial washings, gastric aspirates (morning aspirate before feeding/ambulation x 3 specimens), pleural fluid, cerebrospinal fluid, urine, tissue biopsy."
  },
  {
   "source": "The Harriet Lane Handbook (The Johns Hopkins Hospital), p. 537",
   "text": "- **A. Congenital, Perinatal, and Neonatal Infections (Table 17.1)** - **B. Pediatric Infections by System (Table 17.2)** - **C. Pediatric Viral Illnesses (Table 17.3)** - **D. Pediatric Tick- Borne Diseases (Table 17.4)** - **E. Tuberculosis: Diagnosis and Treatment (Boxes 17.1 and 17.2)[1][,][2]** 1. Diagnosis - a. See Box 17.1 for screening guidelines and Box 17.2 for information on interpretation of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs). - b. If positive screening test, obtain chest X- ray. - c. If symptoms indicate active tuberculosis (TB) disease, determine source. - (1) Consider pediatric protocol chest CT over X-ray when available. - (2) Specimen sources include sputum, bronchial washings, gastric aspirates (morning aspirate before feeding/ambulation x 3 specimens), pleural fluid, cerebrospinal fluid, urine, tissue biopsy."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1916",
   "text": "## **CLINICAL MANIFESTATIONS** Louse- borne typhus can be mild or severe in children. The incubation period is usually <14 days. The typical clinical manifestations include fever, severe headache, abdominal tenderness, and rash in most patients, as well as chills (82%), myalgias (70%), arthralgias (70%), anorexia (48%), nonproductive cough (38%), dizziness (35%), Downloaded for mohamed ahmed (dr.mms2020@gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 21, 2024. For personal use only. No other uses without permission. Copyright \u00a92024. Elsevier Inc. All rights reserved. Chapter 277 u Ehrlichiosis and Anaplasmosis 1911"
  },
  {
   "source": "Red Book Atlas 4th Ed.indb, p. 892",
   "text": "neonatal, 90, 94 _i,_ 96 _i_ in older children and adolescents, 90\u201391 oral, 89\u201390 treatment of, 89\u201391 Thyroiditis from mumps, 441 Tickborne encephalitis, 25 _t,_ 28 _t_ Tickborne lymphadenopathy (TIBOLA), 571 Tigecycline for _Enterobacteriaceae_ infections, 184 Tinea capitis, 704\u2013705, 706\u2013707 _i_ clinical manifestations of, 704 diagnostic tests for, 704\u2013705 epidemiology of, 704 etiology of, 704 incubation period of, 704 treatment of, 705 Tinea corporis, 708\u2013709, 709\u2013711 _i_ clinical manifestations of, 708 diagnostic tests for, 708 epidemiology of, 708 etiology of, 708 incubation period of, 708 treatment of, 709"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 998",
   "text": "4. What other problems are associated with Tourette syndrome that also warrant intervention? A _tic_ is a brief, abrupt, nonpurposeful movement or utterance. Tics occur in a background of normal activity and are repetitive and involuntary but can be suppressed. Tourette syndrome (TS) is the most common etiology of tics in children. It is defined by multiple types of tic displayed over time, including motor tics and vocal tics. Tourette syndrome most frequently manifests solely as a nondisabling movement disorder but may also be associated with other neurobehavioral problems, which may include attention-deficit/ hyperactivity disorder (ADHD), obsessive-compulsive disorder, mood and rage disorders, anxiety, personality and conduct difficulties, and sleep disorders. ## **Epidemiology**"
  },
  {
   "source": "Pediatric Board Study Guide, p. 1154",
   "text": "purpura, 349 Thumb-sucking, 186 Thyroglossal cyst, 611 Thyroglossal duct cyst (TDC), 1011 Thyroid-binding globulin (TBG) deficiency, 411 Thyroid carcinoma, 613 Thyroid disorders, 410, 414, 415 congenital hypothyroidism, 410, 411 graves disease, 413, 414 Hashimoto, lymphocytic thyroiditis, 411, 412 neonatal thyrotoxicosis, 414 solitary thyroid nodules, 414 subacute (de Quervain) thyroiditis, 412, 413 thyroid-binding globulin (TBG) deficiency, 411 thyroid disorders, 414, 415 thyroid storm, 415 Thyroid storm, 415 Tibial shaft fracture, 478, 479 Tick paralysis, 557 Tics, 559 Tinea capitis, 851, 852 Tinea corporis, 490, 852, 853 Tinea cruris, 853 Tinea pedis, 853, 854 Tinea versicolor, 853, 854 Tiptoe walking, 471, 472 T-lymphocytes, 384\u2013385 Tobacco, alcohol, and substance use, 29 Tobacco use by adolescents, 87 Toddler fracture, 479"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1255",
   "text": "## \u00bb **Prevention & Treatment** Prevention involves avoiding endemic areas and using conventional means to avoid tick bite. Therapy is supportive. Do not use analgesics that modify platelet function. Choi E, Piyzocha NJ, Mauver DM: Tick-borne illnesses. Curr ~~Sports Med Rep 2016;15:98 [PMID: 26963018].~~ **1222** **CHAPTER 40** ## \u00ba **OTHER MAJOR VIRAL CHILDHOOD EXANTHEMS** See section Infections due to Herpesviruses for a discussion of varicella and roseola, the two other major childhood exanthems. ## **ERYTHEMA INFECTIOSUM** ## ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Fever and rash with \u201cslapped-cheek\u201d appearance, followed by a symmetrical, full-body maculopapular rash. - \u00bb Arthritis in older children. - \u00bb Profound anemia in patients with impaired erythrocyte production. - \u00bb Nonimmune hydrops fetalis following infection of pregnant women. ## \u00bb **General Considerations**"
  },
  {
   "source": "Cover, p. 8609",
   "text": "Children bitten by ticks can have a variety of presentations. Although rare, acute ascending paralysis is one such presentation mediated by neurotoxin in tick saliva. An acute ascending paralysis is often misdiagnosed as Guillain-Barr\u00e9 syndrome or botulinum ingestion. Patients present with generalized acute weakness and ataxia and may have paresthesias. Their weakness is progressive and can lead to respiratory failure. A number of tick species are implicated in causing paralysis. In the United States, the Rocky Mountain wood tick ( _Dermacentor andersoni_ ) and the American dog tick ( _Dermacentor variabilis_ ) are often the cause of tick paralysis in the northwest and southeast, respectively. The mechanism of action of neurotoxins is varied, but the _Ixodes holocyclus_ tick, found in Australia, is thought to interfere with release of acetylcholine at the NMJ. Examination reveals a flaccid ascending generalized weakness with bulbar involvement (ptosis, facial weakness) and hyporeflexia. Careful and prompt"
  }
 ]
}