小结
定义
病史和体格检查
关键诊断因素
- history of tick bite
其他诊断因素
- constitutional symptoms
- pyrexia
- bradycardia
- jaundice
- hepatosplenomegaly
- petechiae, splinter hemorrhages, or ecchymoses
- dark urine
- conjunctival injection
- cough
- sore throat
- photophobia
危险因素
- residence in or travel to an endemic region
- exposure to Ixodes scapularis ticks
- asplenia
- immunosuppression
- blood transfusion
- age >50 years
- Lyme disease
- human granulocytic anaplasmosis
- maternal infection during pregnancy
诊断性检查
首要检查
- peripheral blood smear (Giemsa or Wright stained)
- polymerase chain reaction (PCR) for babesial DNA
- CBC
- LFTs
- serum creatinine and blood urea nitrogen (BUN)
- urinalysis
- enzyme-linked immunosorbent assay (ELISA) and/or immunofluorescence assay for Lyme disease
- polymerase chain reaction (PCR) and/or immunofluorescence assay or buffy coat smear for human granulocytic anaplasmosis (HGA)
需考虑的检查
- indirect immunofluorescence antibody assay for Babesia microti
- IgG/IgM immunoblot for Lyme disease
- HIV serology
- serum LDH
治疗流程
asymptomatic documented infection
mild to moderate disease
acute severe disease
recurrent or refractory disease
撰稿人
作者
Sarah Hochman, MD
Assistant Professor
Department of Medicine
Division of Infectious Diseases and Immunology
New York University School of Medicine
New York, NY
利益声明
SH declares that she has no competing interests.
Louis M. Weiss, MD, MPH
Professor, Department of Pathology
Professor, Department of Medicine (Infectious Diseases)
Albert Einstein College of Medicine
Bronx, NY
利益声明
LMW has received grant funding from the National Institutes of Health for research on Toxoplasma gondii and microsporidiosis. LMW receives training grants for infectious diseases at the Albert Einstein College of Medicine, and serves on the board of the Humane Society of Westchester.
同行评议者
Cheston B. Cunha, MD
Associate Professor of Medicine
Warren Alpert Medical School of Brown University
Medical Director of the Antimicrobial Stewardship Programs
Rhodes Island Hospital and Miriam Hospital
Providence, RI
利益声明
CBC declares that he has no competing interests.
Jeremy Gray, BSc, MSc, PhD
Professor
Department of Environmental Resource Management
University College Dublin
Belfield
Dublin
Republic of Ireland
利益声明
JG declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers, sixth edition. Aug 2022 [internet publication].全文
Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis. Clin Infect Dis. 2021 Jan 27;72(2):e49-64.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Lyme disease
- Human granulocytic anaplasmosis
- Rocky Mountain spotted fever
更多 鉴别诊断指南
- Tickborne diseases of the United States: a reference manual for health care providers
- Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis
更多 指南
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