Tick-Borne Illness: A Diagnostic Approach for the Urgent Care Clinician (Infectious Disease CME and Pharmacology CME) -
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Publication Date: June 2023 (Volume 2, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 06/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease and 1 Pharmacology CME credits, subject to your state and institutional requirements.

Authors

Christopher Chao, MD

Physician, Urgent Care, WakeMed Health and Hospitals, Raleigh, NC; President, College of Urgent Care Medicine

Kristopher W. Decker, MS, PA-C

Certified Physician Assistant, Urgent Care, WakeMed Health and Hospitals, Raleigh, NC

Peer Reviewer

Margaret Carman, DNP, RN, ACNP-BC, ENP-BC, FAEN

Associate Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC; Emergency/Acute Care Nurse Practitioner, Martha's Vineyard Hospital, Oak Bluffs, MA

Benjamin Silverberg, MD, MSc, FAAFP, FCUCM

Associate Professor, Department of Emergency Medicine; Medical Director, Division of Physician Assistant Studies, Department of Human Performance, West Virginia University, Morgantown, WV

Charting & Coding Author

Bradley Laymon, PA-C, CPC, CEMC

Certified Physician Assistant, Winston-Salem, NC

Abstract

Tick-borne illnesses, including Lyme disease and Rocky Mountain spotted fever, are becoming increasingly common in the United States. Presentations of various tick-borne illnesses are sometimes nonspecific, but timely and effective diagnosis are critical for optimal outcomes. Urgent care clinicians play an important role in identifying and treating tick-borne illnesses. This issue discusses the diagnosis of the tick-borne illnesses most commonly seen in urgent care settings in the United States, including the key clinical findings of the history and physical examination, and diagnostic testing options. Tick removal technique, indications for prophylactic treatment, and treatment recommendations for specific tick-borne illnesses are also reviewed.

Case Presentations

CASE 1

A 24-year-old man presents to urgent care for a rash...

The patient reports an “unusual rash” on his right lower leg that started 3 days ago, but the rash has gradually enlarged each day. He does not report or recall a tick bite.
He reports fatigue and malaise but is afebrile and otherwise asymptomatic.
He notes that, until last week, he was working as a camp counselor at a summer camp in the Catskill Mountains in New York state.
On examination, there is a well-demarcated erythematous patch in a “bull’s-eye” pattern measuring 8 cm in diameter on his right lower leg.
You recognize his rash as erythema migrans, and consider whether Lyme disease testing is necessary in this patient…

CASE 2

A 54-year-old woman presents to an urgent care center for an embedded tick on her abdomen...

The patient says she noticed a bump this morning while taking a shower 2 hours prior to arrival and, upon closer inspection, found an embedded tick.
There is slight erythema around the bite site, but she is otherwise asymptomatic.
In addition to prompt tick removal, you wonder if any testing or antibiotic therapy will be needed...

CASE 3

A 27-year-old woman presents to urgent care for follow-up care after an upper respiratory illness...

The patient states that 2 weeks ago, she had a febrile upper respiratory illness. At another urgent care center, she was tested for Rocky Mountain spotted fever and given a prescription for doxycycline. She says she never started the medication because her symptoms quickly resolved.
Yesterday she was notified by phone that her “tick test was positive” and that she should seek medical attention immediately.
You consider whether this patient should start antibiotic treatment at this point, given that she is now asymptomatic, or if additional testing is needed...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.