SHM Converge Scientific Abstract ePoster Gallery-Ticked Off: Early Consideration of a Tick-Borne Illness

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This case report highlights the importance of early recognition of tick-borne illness in septic patients, especially in endemic regions. A 44-year-old woman from Delaware presented with fever, lethargy, and hypotension, along with pancytopenia, neutropenia, thrombocytopenia, and elevated liver enzymes. Initial workup for common septic sources was negative, including blood cultures, urinalysis, respiratory and GI testing, and CT imaging. She was treated empirically with broad-spectrum antibiotics without improvement.<br /><br />Only after 48 hours, when she was asked about possible tick exposure, did she report a recent tick bite. Doxycycline was then added, and within 48 hours she had complete clinical and laboratory recovery. Subsequent tick-borne testing was positive for Ehrlichia chaffeensis DNA by PCR and Babesia duncani WA1 IgG at 1:256, indicating a coinfection.<br /><br />The authors emphasize several key points: tick-borne diseases can present like severe sepsis; thorough exposure history is essential; and early empiric doxycycline may significantly improve outcomes, reducing ICU admission, ARDS, multiorgan failure, and mechanical ventilation in suspected cases. They also note that while standard Babesiosis treatment is usually quinine or atovaquone-based combinations, this patient improved despite receiving doxycycline alone, raising the question of whether Babesia duncani was incidental or potentially responsive to doxycycline. However, evidence remains limited, and more research is needed before recommending doxycycline monotherapy for Babesia duncani.

Asset Subtitle

Taimur Bayar-Masood

Meta Tag

Author List Lawrence Ward, Mohammed O. Choudary, Muhammad Syed, Shefali Waghray, Taimur Bayar-Masood

Category Clinical Vignettes

Concept Tick-Borne Disease

Concept Sepsis

Concept Ehrlichiosis

Concept Babesiosis

Concept Tick Exposure

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Taimur Bayar-Masood

Track Adult

Keywords

tick-borne illness

sepsis

Ehrlichia chaffeensis

Babesia duncani

doxycycline

coinfection

pancytopenia

thrombocytopenia

Delaware

tick bite

Tick-Borne Disease

Sepsis

Ehrlichiosis

Babesiosis

Tick Exposure