title: Diseases from North America: focus on tick-borne infections.
abstract: Tick-borne infections are seen throughout the United States, with varying geographical locations. Many of these infections are also increasingly seen in Europe. Certain ticks (eg Ixodes) can transmit more than one infection. Diagnosis, particularly in early infection, can be challenging and therefore knowledge of the distinguishing clinical features and epidemiology of these diseases is important. Testing for Lyme disease often causes confusion for patients and medical providers, as serological tests may be negative in early infection and conversely may be positive for years after infection. Newer tests, such as the C6 ELISA, may play a role in Lyme diagnosis. Additionally, the value of a simple blood film should not be underestimated for diagnosing babesiosis and anaplasmosis. In certain situations, empiric therapy may be required for tick-borne infections as severe illness with multiorgan failure can occur, particularly in older and immunocompromised hosts. This review describes the more commonly seen tick-borne infections: Lyme, babesiosis, anaplasmosis and Rocky Mountain Spotted Fever. More recently identified tick-borne infections, such as southern tick-associated rash illness and Borrelia miyamotoi, are also covered.
authors: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA rnathavi@bidmc.harvard.edu.
authors: Ruvandhi R
authors: RR
authors: Nathavitharana
authors: Harvard Medical School, Boston, MA, USA.
authors: Jennifer A
authors: JA
authors: Mitty
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D006801:Humans; D009656:North America; D017282:Tick-Borne Diseases
chemical_list: D000890:Anti-Infective Agents
keywords: Anaplasma; Babesia; Lyme; Rocky Mountain spotted fever; tick-borne
references: Clin Infect Dis. 2001 Apr 15;32(8):1117-25
references: 11283800
references: N Engl J Med. 2001 Jul 12;345(2):79-84
references: 11450675
references: Ann Intern Med. 2003 May 6;138(9):697-704
references: 12729423
references: Emerg Infect Dis. 2005 Dec;11(12):1828-34
references: 16485466
references: MMWR Recomm Rep. 2006 Mar 31;55(RR-4):1-27
references: 16572105
references: Clin Infect Dis. 2006 Nov 1;43(9):1089-134
references: 17029130
references: Clin Infect Dis. 2008 Jul 15;47(2):188-95
references: 18532885
references: Infect Dis Clin North Am. 2008 Sep;22(3):415-32, vii-viii
references: 18755382
references: Infect Dis Clin North Am. 2008 Sep;22(3):433-48, viii
references: 18755383
references: Infect Dis Clin North Am. 2008 Sep;22(3):469-88, viii-ix
references: 18755385
references: J Antimicrob Chemother. 2010 Jun;65(6):1137-44
references: 20382722
references: Am J Med. 2013 Mar;126(3):264.e1-7
references: 23321431
references: N Engl J Med. 2013 Jan 17;368(3):240-5
references: 23323900
references: N Engl J Med. 2013 Jan 17;368(3):291-3
references: 23323920
references: JAMA. 2013 Sep 18;310(11):1110
references: 24045727
references: N Engl J Med. 2014 May 1;370(18):1724-31
references: 24785207
references: Emerg Infect Dis. 2014 Jul;20(7):1183-90
references: 24960072
references: N Engl J Med. 1989 Aug 31;321(9):586-96
references: 2668764
references: Neurology. 1994 Jul;44(7):1203-7
references: 8035916
references: Lancet. 1996 Jan 6;347(8993):67-8
references: 8531586