FEATURE: KIMBERLY DAMATO, PA-C; DANIELLE KRUGER, PA-C, MS ED
Emerging Tickborne Illnesses: Looking Beyond Lyme Disease Although most providers are familiar with the symptoms of Lyme disease, coinfection with other tickborne illnesses is becoming more prevalent.
© JAMES GATHANY / CDC
Tickborne diseases in the United States are a significant health problem.
ickborne diseases in the United States are a significant public health problem, and in the past 50 years scientists have detected at least a dozen new such infections.With more than 30,000 cases diagnosed each year, Lyme disease is the most commonly reported vector-borne illness in the United States, and in 2015 it was the sixth most common nationally notifiable disease.1 Due to increased education and recognition, most practitioners are familiar with the symptomatic presentation of Lyme disease. In stage 1, patients usually exhibit the classic erythematous expanding annular “bulls-eye” rash known as erythema migrans, and approximately 50% experience constitutional flu-like symptoms. In stages 2 and 3, or disseminated Lyme disease, patients may present with Bell’s palsy or other cranial nerve deficits, arthritis, peripheral neuropathies, and cardiac manifestations such as transient heart block and carditis. Borrelia burgdorferi, the spirochete that causes Lyme disease, is not the only pathogen spread by the deer tick Ixodes scapularis in the northeastern United States: Babesia microti, the agent of babesiosis, and Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis (HGA; formerly human granulocytic ehrlichiosis) are asserting a presence in similar geographic regions. Coinfection with these organisms is possible. Human monocytic ehrlichiosis (HME), caused by Ehrlichia chaffeensis, is another emerging tickborne disease with similar geography to HGA. Continues on page 32
30 THE CLINICAL ADVISOR • JUNE 2019 • www.ClinicalAdvisor.com