During early, disseminated Lyme disease, multiple lesions may appear as erythema multiforme or urticaria. The aseptic meningitis is similar to viral meningitis, and the seventh nerve palsy is indistinguishable from herpetic or idiopathic Bell palsy. Lyme carditis is similar to viral myocarditis. Monarticular or pauciarticular arthritis of late Lyme disease may mimic suppurative arthritis, juvenile idiopathic arthritis, or rheumatic fever (see Chapter 89). The differential diagnosis of neuroborreliosis includes degenerative neurologic illness, encephalitis, and depression.
Early localized disease and early disseminated disease, including facial nerve palsy (or other cranial nerve palsy) and carditis with first-degree or second-degree heart block, is treated with doxycycline or amoxicillin for 14 to 21 days. Early disease with carditis with third-degree heart block or meningitis and
Cat-scratch disease Bartonella henselae Cats, dogs Bites and scratches United States
Erysipeloid Erysipelothrix rhusiopathiae Sheep, swine, turkeys, Direct contact Worldwide ducks, fish
Wound infection Mycobacterium marinum, Fish, aquarium Direct contact, scratches Worldwide Mycobacterium fortuitum, Mycobacterium kansasii
Leptospirosis Leptospira interrogans Dogs, rodents, livestock Direct contact, contact Worldwide with water or soil contaminated by urine of infected animals
Relapsing fever Borrelia Rodents, fleas Louse bite, flea bite, Western and southern transplacental transmission United States
Southern tick-associated Borrelia lonestari Deer, rodents Tick bite (I. scapularis) Southeastern and rash illness south-central U.S.
African tick-bite fever Rickettsia africae Cattle, goats (?) Tick bite Sub-Saharan Africa, Caribbean
Rickettsialpox Rickettsia akari Mice Mite bite North America, Russia, Ukraine, Adriatic region, Korea, South Africa
Murine typhus–like illness Rickettsia felis Opossums, cats, dogs Flea bite Western hemisphere, Europe
Epidemic typhus Rickettsia prowazekii Humans Louse feces Africa, South America, Central America, Mexico, Asia
Flying squirrel (sylvatic) R. prowazekii Flying squirrels Lice or fleas of flying United States typhus
Scrub typhus Orientia tsutsugamushi Rodents (?) Chigger bite Southern Asia, Japan, Indonesia, Australia, Korea, Asiatic Russia, India, China
Human Ehrlichia chaffeensis Deer, dogs Tick bite (Amblyomma United States, Europe, monocytic ehrlichiosis
Anaplasmosis (human Anaplasma Rodents, deer, Tick bite (I. scapularis) United States, Europe granulocytic ehrlichiosis) phagocytophilum ruminants
Sennetsu ehrlichiosis Neorickettsia sennetsu Unknown Ingestion of helminth-Japan, Malaysia contaminated fish (?)
Table 122-1 Major Zoonotic and Vector-Borne Infections*—cont’d DISEASE CAUSATIVE AGENT COMMON ANIMAL RESERVOIRS VECTORS/MODES OF TRANSMISSION GEOGRAPHIC DISTRIBUTION Hantavirus cardiopulmonary syndrome Hantavirus Rodents, mice, cats Aerosol inhalation Southwestern United States
Lymphocytic Lymphocytic Rodents, hamsters, mice Aerosol inhalation, direct Worldwide choriomeningitis choriomeningitis virus contact, bite
Rabies Rabies virus Dogs, skunks, bats, Bites and scratches Worldwide raccoons, foxes, cats