Pearls on some of the less common Tick Borne Illnesses

  • Erlichiosis: presents with flu-like syndrome including GI symptoms; fever present in most cases: 10-30% of adults develop a maculopapular rash that can involve the palms/soles; rash is more common in pediatrics; leukopenia, thrombocytopenia and transaminitis are common lab findings; complications include renal failure, respiratory failure, enceophalitis, DIC; peripheral smear shows "mulberry-like" clusters (morulae) in leukocytes; treat with doxycycline in most cases


  • Anaplasmosis: symptoms similar to erlichiosis and influenza; rash is rare; can find leukocytopenia, thrombocytopenia and elvation of hepatic enzymes; can get pulmonary infiltrates (especially in children); treat with doxycycline


  • Babesiosis: most cases occur in northeastern US; causes a "malaria-like hemolytic anemia"; "dark urine;" can see marked thrombocytopenia, DIC, hemolytic anemia, jaundice, renal insufficiency and ARDS; risk factors for severe disease = asplenia, old age, impaired function; blood smear with Maltese cross appearances; severe disease trated with clindamycin + quinine and exchange transfusiosn in the extremely ill


  • Tickborne Relapsing Fever: rarely found east of Texas; classic risk factor = sleeping in rustic mice-infested structures in the wilderness of the western US; headache and myalgia in over 90% of cases; can see a rash first; characteristically, get 3-day long febrile episodes interspersed with 7-day long afebrile periods; fevers = high; diagnosis with spirochetes or smear or darkfield micropsy; can see leukocytosis and thrombocytopenia; treat with tetracycline or erythromycin


  • Colorado Tick Fever: endemic to western mountain regions at elevations between 4000 and 10,000 ft; rash in minority of patients; biphasic or "saddleback" fever; supportive treatment only


  • Tularemia: contracted through tick/fly bites, by inhalation or through open wounds while in contact with an infected zonotic host; can present in ulceroglandular (most common), glandular, typhoidal (highest morbidity; known for ), pneumonic, oculoglandular and oropharyngeal forms!;