| A |
DrVirgo, peter90036, lq2006, CocaCola, khiladi, Korotkoff, kpmle2, Drtweetie, aspire, Justice, inkspot, miha152 |
12 |
75% |
| B |
nyimalay |
1 |
6% |
| C |
|
0 |
0% |
| D |
|
0 |
0% |
| E |
, Thunderball65, fd |
3 |
19% |
| Author | 13 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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A 19-year-old woman from Indianapolis comes to the emergency department of a New Jersey hospital with a tick on her right arm. She first noted the tick 9 hours ago. The patient was on a 2-week college industrial-ecologic field trip, during which time she toured a factory or a nature habitat each day and returned to the hotel each evening. She showered daily. She is healthy and takes no medications.
The emergency department physician identified the tick as an Ixodes scapularis nymph that was not engorged. After removing the tick, there was no evidence of redness or inflammation at the site of the bite, although the tick had definitely been attached. No residual tick parts were left in the skin. Which of the following is the most appropriate management at this time?
A. Observation
B. Amoxicillin, 500 mg orally three times daily for 10 days
C. Azithromycin, 1 g orally daily for 10 days
D. Cefuroxime-axetil, 500mg orally twice daily for 10 days
E. Doxycycline, 200 mg orally once daily
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| DrVirgo
Forum Hero
Topics: 1046
Posts: 3,352
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Asymptomatic tick bite = observe
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| peter90036
Forum Elite
Topics: 28
Posts: 315
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yup, my lyme notes:
Serology(+) w/o clinical= NO tx
No EM rash NO tx
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| CocaCola
Forum Guru
Topics: 35
Posts: 908
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???
tempted to say observation... although she was outdoors daily the tick was only attached 9 hours and wasn't engorged (thinking this means it didn't feed from her so could not transmit the disease)...
although in the real world there is no way i am determining whether this tick fed from her or not - so i would give doxycyline
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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| Markus2009
Forum Senior
Topics: 9
Posts: 189
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Same concept here, tick bite prophylaxis--------->E
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| Thunderball65
Forum Newbie
Topics: 3
Posts: 34
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i agree treat.
if you change the patient to a 22 week pregnant female. then what would you do?
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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Thunderball65 wrote:
i agree treat.
if you change the patient to a 22 week pregnant female. then what would you do?
I will answer your qns after we close this poll, in 2 days...
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| DrVirgo
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Thunderball65 wrote:
i agree treat.
if you change the patient to a 22 week pregnant female. then what would you do?
I'd also like to know if the management is the same in a child.
Thanks J.
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| CocaCola
Forum Guru
Topics: 35
Posts: 908
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i threw my hat in for observation...
but in the real world i would treat - in a child i would use a macrolide like erythromycin instead of doxycycline
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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DrVirgo wrote:Thunderball65 wrote:
i agree treat.
if you change the patient to a 22 week pregnant female. then what would you do?
I'd also like to know if the management is the same in a child. Thanks J.
Sure...
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| aspire
Forum Senior
Topics: 24
Posts: 158
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A-Observe.
Routine use of prophylactic antibiotics after a tick bite is not recommended.-Quote.
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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The correct answer is A
It is tempting to consider any tick bite as a cause for intervention, since development of various tick-borne illnesses is possible. However, three key factors should be considered before initiating prophylaxis or early treatment following a tick bite: species of the tick, geographic location of acquisition, and duration of attachment. In this case, there was no uncertainty about the species of tick, since an experienced observer determined that it was a deer tick 4xodes scapularis, formerly called Ixodes dammini). New Jersey is a state with a high incidence of Lyme disease and a low to medium incidence of babesiosis and ehrlichiosis. However, in both humans and animals, the minimal time of tick attachment for transmission of Borrelia burgdorferi infection is 24 hours (and most likely 48 hours or more). By this time, the tick is usually engorged and is much easier to see. Ticks on parts of the body that are difficult for the patient to see are more likely to go unnoticed than are ticks on the arm.
Although all the oral regimens listed are fairly safe, they offer little advantage over observation, since this patient has an infinitesimally small risk of developing Lyme disease. When treatment is indicated, amoxicillin is a suitable agent and is the drug of choice for treating erythema migrans in children. Azithromycin is a less suitable alternative and has a higher failure rate than amoxicillin, doxycycline, or a cephalosporin. Many oral and parenteral cephalosporins are effective for the treatment of Lyme disease. If the duration of tick attachment is significant and exposure occurred in a highly endemic area, evidence shows that a single dose of doxycycline is effective in preventing most cases of Lyme disease. However, the high dose needed (200 mg) may provoke nausea.
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