Tick-Borne Illnesses: Identification and Management in the Emergency Department

Tick-Borne Illnesses: Identification and Management in the Emergency Department -

Tick-Borne Illnesses: Identification and Management in the Emergency Department
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Publication Date: September 2018 (Volume 15, Number 9)

No CME for this activity


Jennifer Bellis, MD, MPH
Instructor, Department of Pediatrics, Section of Emergency Medicine, University of Colorado, Aurora, CO
Ee Tay, MD
Clinical Assistant Professor, Ronald O. Perelman Department of Emergency Medicine, Clinical Site Chief, Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
Peer Reviewers
Michael Gottlieb, MD, RDMS
Director of Emergency Ultrasound, Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
Lise Nigrovic, MD, MPH
Associate Professor of Pediatrics and Emergency Medicine, Harvard Medical School, Boston Children’s Hospital, Boston, MA

Tick-borne illnesses are increasing in prevalence and geographic reach. Because the presentation of these illnesses is sometimes nonspecific, they can often be misdiagnosed, especially in the early stages of illness. A detailed history with questions involving recent activities and travel and a thorough physical examination will help narrow the diagnosis. While some illnesses can be diagnosed on clinical findings alone, others require confirmatory testing, which may take days to weeks to result. This issue reviews the emergency department presentation of 9 common tick-borne illnesses and evidence-based recommendations for identification, testing, and treatment.

Excerpt From This Issue

A 10-year-old girl presents to the ED with left knee swelling and pain. She has been able to walk, but the swelling and pain have become worse over the last 3 to 4 days. The girl says she has not had a fever or chills, and there is no known trauma. The girl’s mother states that her daughter spent 3 weeks at summer camp in Connecticut a few months ago, but otherwise has not traveled recently. On examination, the girl’s knee is swollen, but without erythema or warmth. The girl is able to bear weight, but she is unable to fully flex her knee. X-rays of her knee are significant only for a joint effusion. Should you perform an arthrocentesis of the girl's knee? What lab work would help in making the diagnosis? What are the best treatment options for this patient?

A 5-year-old girl with no past medical history presents to your ED. Her mother noticed that the girl was having difficulty walking today, so she brought her in. She states that her daughter has been complaining that she's tired, and has been saying that her legs feel "weird"after playing in the park yesterday. The mother also mentions that they have a new dog that likes to run in the woods behind their house. On examination, the girl is afebrile with a normal heart rate and respiratory rate. The examination is significant for 3/5 strength in her legs bilaterally, with normal sensation. The girl has had no fever, cough, or congestion. As you consider the possible diagnoses, you begin to wonder whether a lumbar puncture or head imaging is necessary...



Product Reviews

This article was very informative discussing meat allergy after a tick bite. I was unfamiliar with this and will certainly be part of my questioning the patient comes in with middle of the night with anaphylaxis
Dr. Bellis and Dr. Tay - 04/04/2019
Well organized review of this topic. The table for the recommended treatment regimens is wonderful.
Dr. Bellis and Dr. Tay - 04/01/2019
Better understanding about clinical presentation, laboratory results and treatment will improve my patient care in general.
Dr. Bellis and Dr. Tay - 03/29/2019
I’m now aware that doxycycline can be used in all age groups except of course if there is a true allergy to doxycycline.
Dr. Bellis and Dr. Tay - 03/22/2019
A great review of the topic...will uses the material for reference!
Dr. Bellis and Dr. Tay - 03/21/2019
Good review of testing, treatment and new Doxycycline for all ages.
Dr. Bellis and Dr. Tay - 03/19/2019
I now have more awareness of other, less common tick-borne illnesses and a better understanding of how to treat each tick-borne illness.
Dr. Bellis and Dr. Tay - 03/16/2019
As someone practicing in relatively tick-free Miami, this was a great review.
Dr. Bellis and Dr. Tay - 03/13/2019
I will consider tick born illness when examining a child or adult with neurological symptoms and a rash who has recently been outdoors.
Dr. Bellis and Dr. Tay - 03/08/2019
I now feel better equipped to detect patients at risk for tick-borne illnesses.
Dr. Bellis and Dr. Tay - 03/06/2019
I will consider tick-borne illness in summer febrile illness with vague symptoms.
Dr. Bellis and Dr. Tay - 03/04/2019
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