Publication Date: September 2018 (Volume 15, Number 9)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 9/1/2021
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME and 1.5 Pharmacology CME credits, subject to your state and institutional approval.
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.
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...