Consider tick borne illness when:

• Influenza-like illness presentations, especially during the summer months. 
• Fever of unknown origin
• When viral meningitis is on your differential diagnosis. 

Babesiosis:

• PO: Atovaquone + Azithromycin
• IV: Clindamycin + Quinine
• Exchange transfusion indications (would need Hematology/Oncology consult): 1. Asplenia       2. Parasite Load > 10%

Lyme's Disease:

• Doxycycline for early localized or early disseminated disease
• If under 8 years old or allergy, can do Amoxicillin
• if high degree AV Block or Meningitis - IV Ceftriaxone 
• Lyme prophylaxis with 200 mg Doxy x 1 dose; Amoxicillin not effective
• Attached x 36h; based on engorgement size
• Lyme endemic area (local infection rate > 20%)
• Treatment within 72h of tick removal
• No Doxycycline contraindication 

Erhlichiosis and Anaplasmosis:

• Doxycycline regardless of age. 
• Rifampin if life-threatening allergy or pregnant

Tularemia (not always tickborne): 

• Streptomycin or Gentamycin.