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early treatment of tick Borne illnessesby Edwin J. Masters, MD†
and azithromycin are
generally well tolerated,
have long track records
and low incidences of
true allergy, are excreted
through the G. I. tract,
and available as generics.
illness,4,5 Lyme disease, Ehrlichia
, Ehrlichia ewingii
sensible combination of relatively safe Coxiella burnettii
(Q fever) tularemia
, acne medications to prevent serious
, Rickettsia rickettsii
etc. Tick transmission of Bartonella
very helpful. Ixodes scapularis
tick) Amblyomma americanum
star tick) and the dermacentor
a specific tick, he may not have a clear triad of the Human Granulocytic
recollection of its appearance. Many
in the northeast vectored by
Also, geography helps in deducing the Ixodes scapularis
(deer tick),and Human
tick species, but it is not absolute.
, due to Ehrlichia
, and STARI, are vectored
by the Amblyomma americanum
tick is expanding its territory into the
northeast, and has even been found in star tick) in the Midwest and south.
the state of Maine. (Keirans, Means)1, 2 Delayed diagnosis and treatment can
Human Monocytic Ehrlichiosis (HME) early diagnosis, when symptoms may
250 w July/August 2009 w 106:4 Missouri Medicine
The problem is that the tick is usually not saved
and even though the patient may have removed
a specific tick, he may not have
a clear recollection of its appearance.
evidence of recovery or 48 hours post inhibiting bacterial but not human
sensitivity and specificity. Polymerase available as generics this tends to
widely used for the treatment of acne. for many of the previously listed tick
are the rickettsial
provides therapeutic continuity in the ages.10,12-13 It has the best outcome
106:4 Missouri Medicine w July/August 2009 w 251
other antimicrobials.Intl Journ of Antimicrobial Agents
1. Keirans JE, Lacombe EH. 1998. First Records
(31) 2008 Pgs. 235-239. 10. Masters EJ, Olson OS, Weiner SJ, Paddock
of Amblyomma americanum
, Ixodes dentatus
, and Ixodes
(Ceratixodes) uriae (Acari: Ixodiae) from Maine.
CD, Rocky Mountain Spotted Fever - A Clinician’s
The Journal of Parasitology
, Vol. 84, No.3.
Dilemma. Arch Intern Med.
2. Means RG, White DJ. New distribution records
11. Olano JP, Masters EJ, Hogrefe W, Walker DH.
of Amblyomma americanum
(l) (Acari: Ixodidae
) in New
Human Monocytotropic Ehrlichiosis, Missouri.
York State. J Vector Ecol
. 1997 Dec. 22(2):133-45
Emerging Infectious Diseases, Dec., 2003;Vol. 9:
3. Kirkland KB, Wilkinson WE, Sexton DJ,
12. Centers for Disease Control and Prevention.
Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis
Consequences of delayed diagnosis of Rocky
Mountain spotted fever in children—West Virginia,
4. Masters EJ, Grigery CN, Masters RW, STARI, or
Michigan, Tennessee, and Oklahoma. May-July 2000. MMWR Morb Mortal Wkly Rep. 2000; 49:
need for tick identification or knowing Masters Disease: Lone Star Tick-Vectored Lyme-
Like Illness. Infectious Disease Clinics of North America
13. American Academy of Pediatrics. Rocky
5. Masters EJ. Lyme-Like Illness Deserves Lyme-
Like Treatment [Correspondence] or not? Clin
In: 2006 Red Book: Report of the Commission on
. 2006; 42:580-581.
6. McCants-Carr, R., Mohrman, L., Arelli,V.,
14. Holman RC, Paddock CD. Analysis of risk
Masters, E., “Cat Scratch Controversies”, Infection in
factors for fatal Rocky Mountain Spotted Fever: evidence for superiority of tetracyclines for therapy.
. May 20087. Gilbert DN, Moerllering RC, et. al. The Sanford
J Infect Dis 2001 Dec 1;184(11):1437-44. Epub
Guide to Antimicrobial Therapy 2008
, 38th edition
15. Lochary ME, Lockhart PB, Williams WT Jr.
8. Rakel, and Bope, Conn’s Current Therapy 2008
Doxycycline and staining of permanent teeth.
9. Lee J, Wormser GP, Pharmacodynamics of
Pediatr Infect Dis J. 1998;17:429-431.
doxycycline for chemoprophylaxis of Lyme disease:
preliminary findings and possible implications for
Tetracyclines and permanent teeth: the relation between dose and tooth color. Pediatrics. 1971; 47:
17. Purvis JJ, Edwards MS. Doxycycline use for rickettsial disease in pediatric patients. Pediatr Infect Dis J. Sep 2000;19(9):871-4.
18. Forti G, Benincori C., Doxycycline and the teeth. Lancet 1969;1:782.
19. Abramson JS, Givnar LB, Should Tetracycline be contraindicated for therapy of presumed Rocky Mountain spotted fever children less than 9 years of age? Pediatrics. 1990;86: 123-124.
20. Product info and Pers Comm from Pfizer Pharm.for Vibramycin and Azithromax, July 2008.
21. Freidank HM, Losch P, Vögele H, and Wiedmann-Al-Ahmad M. In Vitro Susceptibilities of Chlamydia pneumoniae Isolates from German Patients and Synergistic Activity of Antibiotic Combinations. Department of Bacteriology, Institute for Medical Microbiology and Hygiene, University of Freiburg, D-79104 Freiburg, Germany Received 23 November 1998/Returned for modification 8 March 1999/Accepted 10 May 1999. 22. Halperin JJ, Shapiro ED, et. al. Practice Parameter: Treatment of Nervous System Lyme Disease (an evidence-based review) Report oft hr Quality Standards Subcommittee of the American Academy of Neurology. American Academy of Neurology. May 2007.
23. Jaruratanasirikul S., Horttwakul R., Tantisarasart T., et.al. Distribution of azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye. J. Antimicrobial agents and chemo 1996 vol. 40, pgs.825-826.
252 w July/August 2009 w 106:4 Missouri Medicine
Int J Colorectal Dis (2000) 15:291–296DOI 10.1007/s003840000258Bidirectional supply of glutamine maintains J.D. Söderholm J. Larsson enterocyte ATP content in the in vitro Ussing J. Permert J. Lindgren M. Wirén Abstract Glutamine is the principal Accepted: 19 September 2000Published online: 9 November 2000( P <0.05), and the addition of gluta-circuit current ( P <0.05). No
Vitamin D Supplementation and Total Mortality A Meta-analysis of Randomized Controlled Trials Philippe Autier, MD; Sara Gandini, PhD Background: Ecological and observational studies sug- varied from 300 to 2000 IU. The trial size–adjusted meangest that low vitamin D status could be associated with higherdaily vitamin D dose was 528 IU. In 9 trials, there was a 1.4-mortality from