It’s ID Week!
We have some excellent ID and sepsis articles for you guys this week. Enjoy!
Written by Kathryn Sulkowski and Ketan Patel
Spoon Feed
Due to a multitude of factors, the tick population is increasing, leading to a congruent increase in tick-borne diseases (TBD), most notably Lyme disease and babesiosis. Clinicians should keep TBD on their differential for fever with flu-like symptoms, even in traditionally non-endemic areas, as range is expanding and travel has increased.
What’s causing that fever? It’s TBD…
This is a clinical insight paper detailing the multifactorial increase in TBD, especially Lyme disease in the US. The most likely causes include a blossoming white-tailed deer population (the vector), climate change increasing the TBD season and expanding their range, as well as an increasing age of the general population leading to an increased incidence of more severe cases.
The ability to diagnose TBD has also improved. There are now a multitude of diagnostic testing assays available, including a panel assay which includes multiple tick-borne agents. While this can help guide treatment, it can also lead to unnecessary testing when clinical suspicion is already high enough to warrant treatment. Doxycycline remains the antibiotic of choice for treatment of almost all TBD (except for Babesia microti).
Almost equally important to the awareness of increasing TBD for clinical practice is the significance of patient education. Targeted education regarding TBD can substantially reduce disease burden with simple measures such as wearing protective clothing, DEET containing repellants, and removing any ticks as soon as they are spotted.
How will this change my practice?
This article serves as an excellent update and resource for reference when weighing the potential of a TBD, the proper evaluation and subsequent management when presentations arise. While I don’t practice in an endemic area, it highlights the evolving nature of this communicable disease, including wider geographic risk, particular risk to the elderly and the wide spectrum of TBDs that can occur beyond Lyme disease.
Another Spoonful
Hi, editorial note from Clay Smith… I practice in an endemic area. A critical error I often see is over-testing and waiting for testing instead of empiric treatment.
- The CDC says of ehlichiosis and Rocky Mountain spotted fever (RMSF), “Clinical suspicion of any of these diseases is sufficient to begin treatment. Delay in treatment may result in severe illness and death.” The bold print was from the CDC.
- Also, in a patient with erythema migrans, the CDC says, “For patients who present with an EM rash after being in an area where Lyme disease is common, Lyme disease should be diagnosed clinically (without diagnostic testing), as serologic tests may be negative during the first few weeks of infection before antibodies have developed.”
- This publication on TBD from the CDC is required reading. Seriously, we need to know this – download and read this PDF now.
Source
Increasing Risk for Tick-Borne Disease: What Should Clinicians Know? JAMA Intern Med. 2024 Aug 1;184(8):973-974. PMID: 38829668.
