RT Book, Section
A1 Cruz, Andrea T.
A2 Tenenbein, Milton
A2 Macias, Charles G.
A2 Sharieff, Ghazala Q.
A2 Yamamoto, Loren G.
A2 Schafermeyer, Robert
SR Print(0)
ID 1155427045
T1 Tick-Borne Infections
T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 5e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259860751
LK accesspediatrics.mhmedical.com/content.aspx?aid=1155427045
RD 2023/03/28
AB Children  may  be  at  higher  risk  for  tick-borne  infections  than  adults  due  to  outdoor  activities  and  potentially  not  noting  attached  ticks  as  readily  as  adults.The  most  common  tick-borne  infection  in  the  United  States  is  Lyme  disease,  seen  most  frequently  along  the  Atlantic  seaboard  and  the  upper  Midwest.The  most  common  symptom  of  early  localized  Lyme  disease  is  the  erythema  migrans  (EM)  (target)  rash,  which  occurs  within  the  first  2  weeks  after  the  bite,  at  which  time  the  antibody  response  is  still  negative  (making  localized  Lyme  a  clinical  diagnosis).Early  disseminated  Lyme  disease  occurs  in  approximately  15%  of  children  several  weeks  after  the  tick  bite.  The  most  common  symptom  is  multiple  EM  lesions;  other  manifestations  can  include  facial  nerve  or  other  cranial  nerve  palsies  and  lymphocytic  meningitis.  Carditis  is  rare  in  children.  Late  Lyme  disease  can  be  seen  as  a  complication  of  untreated  early-stage  Lyme.  The  most  common  symptom  is  relapsing  large  joint  arthritis;  neuropathy  and  meningoencephalitis  are  rare  in  children.The  selection,  route,  and  duration  of  antibiotic  therapy  depend  upon  the  child’s  age,  stage  of  Lyme  disease,  and  site  of  infection.  There  is  no  convincing  evidence  for  chronic  Lyme  disease,  and  courses  of  therapy  longer  than  4  weeks  are  not  supported  by  the  existing  literature.Rocky  Mountain  spotted  fever  (RMSF)  is  a  rickettsial  disease  most  common  in  the  southeastern  and  south/central  Midwest  characterized  by  fever,  headache,  and  rash.  The  rash  begins  as  a  maculopapular  rash  that  then  becomes  petechial;  it  starts  on  the  wrists/ankles  and  spreads  centrally.  Untreated  RMSF  can  lead  to  multiorgan  system  failure  and  death.  Children  suspected  of  having  RMSF  should  be  treated  empirically  with  doxycycline  without  waiting  upon  serologic  confirmation.Ehrlichiosis  is  divided  into  two  forms:  human  monocytic  ehrlichiosis  (HME)  and  human  granulocytic  anaplasmosis  (HMA).  The  two  entities  cause  very  similar  symptomatology,  of  fever,  rash,  myalgias,  and  headache,  although  HME  can  cause  more  severe  symptoms  than  HMA.  They  both  are  treated  with  doxycycline.Tularemia  can  be  spread  by  contact  with  ticks  or  rabbits  and  other  small  mammals.  A  number  of  syndromes  may  be  seen  in  patients,  including  ocular,  lymphatic,  and  pharyngeal  involvement.  The  treatment  of  choice  is  an  aminoglycoside.Babesiosis  causes  a  malaria-like  illness  in  children;  disease  severity  is  highest  in  asplenic  children.  Diagnosis  (peripheral  smear)  and  treatment  (clindamycin  +  quinine)  are  the  same  as  for  malaria.