Lyme Disease

“The most common tickborne infection in the United States!”

What is Lyme Disease?Lyme disease is caused by the bacterium

Borrelia burgdorferi and is transmitted to humans by the bite of infected ticks. *Normally lives in mice, squirrels and other small animals

• Blacklegged (deer) ticks• Lone star ticks• American dog ticks

A Tick’s Lifecycle

Statistics• Incidence of Lyme has been increasing

since 1991 • 23,305 cases of Lyme were reported in the

US in 2005 • Ten endemic states are Connecticut,

Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin (Helen E. Kest, 2008).

• Cases are present in Washington in 2007= 12 cases

Information from Helen E. Kest, 2008 & CDC

Reported Cases of Lyme Disease by Year, United

States, 1992-2007

Graph from CDC

Reported Cases of Lyme Disease by Month of Illness Onset in United States, 1992-2004

Graph from CDC

Reported Cases of Lyme Disease in United States,

2007

Graph from CDC

Why Does This Apply to You?

Signs and Symptoms

-Rash bull’s eye (70-80% of people bitten) occurs 3-30 days-General S&S: fatigue, chills, fever, HA, and muscle/joint aches (Bell’s palsy loss of facial muscles)-60% of untreated patients will have bouts of arthritis -5% of untreated patients will have neurological issues

Signs and SymptomsStage

(Incubation period)

Symptoms Laboratory Studies

Tick bite -None: may develop erythematous rash around area of bite

-None indicated

Early localizeddisease (ELD)(7 to 30 days)

-Erythema migrans (EM): rapidly expanding single annular rash that may be associated with fever, myalgia, headache, or malaise

-None indicated. If done, the 2-step approach should be used

Early disseminateddisease (EDD)(3 to 10 weeks)

-Secondary erythema migrans: new smaller lesions that develop days to weeks after primary EM rash. May be associated with other symptoms such as fever, headache, neck pain, malaise, conjunctivitis, and lymphadenopathies-Focal neurological findings: cranial nerve palsies (seventh nerve palsy more common in children)-Uncommon manifestations: carditis (various degrees of heart block), aseptic meningitis

-2-step approach:1) Perform IFA or EIA If positive/equivocal, do step 22) Western Blot (WB) IgG Positive/equivocal IFA or EIA followed by positive WB IgG may be used as adjunct to clinical diagnosis

Late disease(2 to 12 months)

-Lyme arthritis (most common manifestation): pain, swelling and effusion-Rare manifestations of pediatric Lyme disease: chronic demyelinating encephalitis, polyneuritis, and memory problems

-2-step approach: See EDD CSF testing may be done in collaboration with infectious disease expert

(Contemporary Pediatrics,2008)

Diagnostic TestsThe First Step:

- ELISA or IFA test. These tests are designed to be very "sensitive," meaning that almost everyone with Lyme disease, and some people who don't have Lyme disease, will test positive.  If the ELISA or IFA is negative, it is highly unlikely that the person has Lyme disease, and no further testing is recommended.  If the ELISA or IFA is positive or indeterminate (sometimes called "equivocal"), a second step should be performed to confirm the results.

The Second Step: - Western blot test. Used appropriately, this test is designed to be "specific," meaning that it will usually be positive only if a person has been truly infected. If the Western blot is negative, it suggests that the first test was a false positive, which can occur for several reasons. 

1."IgM" 2."IgG"

Patients who are positive by IgM but not IgG should have the test repeated a few weeks later if they remain ill. If they are still positive only by IgM and have been ill longer than one month, this is likely a false positive.

TreatmentPreferred Oral Regimens:-Amoxicillin 500mg 3x/day-Doxycyline 100mg 2x/day-Cefuroxime 500mg 2x/dayPreferred IV Regimens:-Cefotaxime 2g every 8 hours -Penicillin G 18-24 million units every 4 hours(Health Reference Center Academic)

What if I’m being treated late? What if this regimen doesn’t work?

Controversy of Chronic LymeWhat did you think of the documentary?

www.jeffblaylock.com, picasaweb.google.com, www.baproducts.com PREVENTION

The Key is Prevention!When going out…– Wear light colored clothes– Wear long pants, long sleeve shirts, tuck pants and shirts into

socks, close toe shoes – Apply insect repellent with 20-30% DEET on exposed skin and

clothing to prevent tick bites.– Permethrin is another type of repellent. Kills ticks on contact!

Application to pants, socks and shoes typically stays effective through several washes.

– Take extra precautions in May, June and July when ticks that transmit Lyme Disease are most active

– Avoid bushy areas with high grass – Stay on the trail & avoid contact with overgrown grass, brush,

and leaf litter

When coming inside…– Wash clothes in hot water and dry using high heat – Inspect skin when you come indoors– Call Doctor and get treatment promptly if develop a rashInformation from CDC & Consumer Report on Health

Do you know how to remove a tick?

References:American Lyme Disease Foundation, Inc. (2006). Lyme disease. Retrieved, October 9, 2008, ALDF: Research, Education, Prevention. Website: http://www.aldf.com/lyme.shtmlConsumer Reports (2008). Lyme disease: what really works. Consumer Health,8. 3.Kest, H.E. and Pineda, C. (2008). Lyme Disease: prevention, diagnosis and management. Contemporary Pediatrics, 25(6). 58-62. Lewis S. L., Heitkemper M.L., Dirksen S.R., O’Brien P.G., & Bucher L., (2007). Medical-

Surgical Nursing: Assessment and management of clinical problems. Lyme Disease. (pp.1714). Missouri: Mosby, Inc.

Lyme Disease Foundation, Inc. Where did Lyme disease come from? Is it new? Retrieved October 9, 2008, from Lyme Disease Foundation, Inc Website: http://www.lyme.org/othersdis/ld_history.html.McGovern, B.M., (2008). Microbiology and epidemiology of Lyme disease. Retrieved

October 23, 2008, from UpToDate database.Sherman, Carl. (2008, June). New guidelines issued for Lyme disease: for the first time

since 2000, the Infections Diseases Society of America has revised its recommendations for managing and preventing the infection. (FEATURE). Clinical Advisor 11.6, 63(3). Retrieved October 9, 2008 from Health Reference Center Academic database.