5-35
Subjective: Symptoms
Fever following tick bite, malaise, fatigue, chills, headache and possibly, jaundice.
Focused History: Do you recall being bitten by a tick? (tick bites cause babesiosis) Do you recall the size
of the tick that bit you? (transmitted by the small deer tick) How long ago were you bitten by a tick? (The
incubation period is a few days to a few weeks.)
Objective: Signs
Using Basic Tools: Fever, sometimes jaundice.
Using Advanced Tools: Lab: Giemsa or Wright stained thin or thick blood smears may confirm the presence
of Babesia inside red blood cells, and significant hemolytic anemia.
Assessment:
Differential Diagnosis - malaria, viral infections or other tick-borne infections (Rocky Mountain spotted
fever, relapsing fever) can cause similar findings.
Plan:
Treatment: Most patients with mild disease recover without treatment. Treat severe disease with
clindamycin 600 mg IV q 6 hours and quinine 650 mg po q 6 hours x 10 days.
Patient Education
General: Avoid tick bites
Activity: As tolerated
Diet: As tolerated
Medications: Occasional gastrointestinal side effects.
Prevention and Hygiene: Avoid tick bites
No Improvement/Deterioration: Return for evaluation
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve.
Zoonotic Disease Considerations
Agent: Babesia microti, B. bovis, B. divergens
Principal Animal Hosts: Cattle, wild rodents
Clinical Disease in Animals: Fever (106°F or higher), poor appetite, increased respiratory rate, muscle
tremors, anemia, jaundice, weight loss
Probable Mode of Transmission: Bite of infected Ixodes tick
Known Distribution: Worldwide, rare; Europe (B. divergens)
ID: Clonorchiasis (Chinese liver fluke)
LTC Glenn Wortmann, MC, USAIntroduction: The Chinese or oriental liver fluke, Clonorchis sinensis, is acquired by eating raw or
undercooked freshwater fish. Clonorchiasis is endemic to the Far East.
Subjective: Symptoms
Most infections are asymptomatic, but heavy worm burdens may cause right upper quadrant pain (worms block
bile and pancreatic ducts), liver enlargement, loss of appetite and fever.
Focused History: Do you have pain in your right upper abdomen? (right upper abdominal pain is typical) How
long have you been experiencing abdominal pain? (can be chronic)