Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, CA, USA.
Am Fam Physician. 2020 May 1;101(9):530-540.
Tickborne diseases that affect patients in the United States include Lyme disease, Rocky Mountain spotted fever (RMSF), ehrlichiosis, anaplasmosis, babesiosis, tularemia, Colorado tick fever, and tickborne relapsing fever. Tickborne diseases are increasing in incidence and should be suspected in patients presenting with flulike symptoms during the spring and summer months. Prompt diagnosis and treatment can prevent complications and death. Location of exposure, identification of the specific tick vector, and evaluation of rash, if present, help identify the specific disease. Lyme disease presents with an erythema migrans rash in 70% to 80% of patients, and treatment may be initiated based on this finding alone. RMSF presents with a macular rash starting on the wrists, forearms, and ankles that becomes petechial. RMSF has a higher rate of mortality than other tickborne diseases; therefore, empiric treatment with doxycycline is recommended for all patients, including pregnant women and children, when high clinical suspicion is present. Testing patient-retrieved ticks for infections is not recommended. Counseling patients on the use of protective clothing and tick repellents during outdoor activities can help minimize the risk of infection. Prophylactic treatment after tick exposure in patients without symptoms is generally not recommended but may be considered within 72 hours of tick removal in specific patients at high risk of Lyme disease.
在美国影响患者的蜱传疾病包括莱姆病、落基山斑点热（RMSF）、埃立克体病、无形体病、巴贝斯虫病、兔热病、科罗拉多蜱热和蜱传回归热。蜱传疾病的发病率正在增加，在春季和夏季出现流感样症状的患者应怀疑患有此类疾病。及时诊断和治疗可以预防并发症和死亡。暴露地点、特定蜱虫媒介的识别以及皮疹的评估（如果存在）有助于确定具体疾病。莱姆病在 70%至 80%的患者中出现游走性红斑皮疹，仅根据这一发现即可开始治疗。RMSF 表现为始于手腕、前臂和脚踝的斑疹，随后变为瘀点。RMSF 的死亡率高于其他蜱传疾病；因此，当高度怀疑临床时，建议对所有患者（包括孕妇和儿童）进行经验性多西环素治疗。不建议对患者采集的蜱虫进行感染检测。在户外活动时，建议患者使用防护服和驱虫剂，以最大程度降低感染风险。在无明显症状的患者中，一般不建议在接触蜱虫后进行预防性治疗，但在高风险莱姆病患者中，在蜱虫去除后 72 小时内可以考虑进行预防性治疗。
