LYME DISEASE

Mary Grace Stobierski, DVM, MPH, DACVPM

Michigan Dept. Community Health

Borrelia burgdorferi

Lyme Disease/ History

1908 Europe: Bannworth’s syndrome, chronic skin lesions associated with tick bites, later found to be penicillin responsive

1975 First description of Lyme arthritis - Old Lyme, CT. Cluster in children.

1983 Isolation of spirochetes from blood, CSF, and skin of patients with Lyme borreliosis

Spirochetes isolated from Ixodes sp. ticks

Willy Burgdorfer identified spirochetes as belonging to genus Borrelia

National Case DefinitionFor Epidemiologic Surveillance

A case is defined as:A person with Erythema Migrans at least 5 cm in diameter; orA person with at least one late manifestation and laboratory evidence

CDC-1997

Reported Cases of Lyme Disease, United States 1982-1999

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Human Case Reporting

P h ys ic ian

L o ca l H ea lth D e p t

S ta te H ea lth D e p t

C D C

0

20

40

60

80

100

120

140

160

180

1984 1987 1990 1993 1996 1999

Year Reported

Reported Lyme Disease Cases in Michigan

1984-2000

7 82225

76

180

148

7352

43 44

252027

181123 1991: New Case Definition

Ixodes scapularis(formerly, I. dammini)

Adult, femaleI.scapularis

Ixodes scapularis endemic vs adventitiously introduced Endemic

– All three stages abundant– Present from year to year

Introduced– Only 1 stage - usually individual adults

on deer– Not present in same location - year to

year

Peromyscus leucopus

White-footed Mouse

White-tailed deer

Early Lyme DiseaseClinical presentation

Incubation period:– 3 to 30 days after tick bite

Characteristic skin lesion:– erythema migrans (EM)

Systemic Symptoms Common:– malaise, fatigue, headaches, chills,

low-grade fever, myalgias, arthralgias

Erythema migrans, with satellite lesion

Early Lyme DiseaseNatural History

Erythema Migrans resolves within 3 to 4 weeks, even without treatment; resolves within days with antibiotics.

Minor systemic symptoms, especially fatigue.

In the absence of treatment most patients will develop other Lyme Disease manifestations.

Late Lyme Disease

CardiacNeurologicArthritisOcularDermatologic

Surveillance Definitions

Surveillance: “The collection, collation and analysis of data and the dissemination to those who need to know.”

-A.D. Langmuir

Passive Surveillance: Health provider initiates reports.

Active Surveillance: Health Department initiates reports.

Gogebic

Houghton

Keweenaw

Iron

Baraga

Marquette

Dickinson

Alger

Delta

Menominee

Schoolcraft

Luce

Mackinac Chippewa

CheboyganPresque IsleCharlevoix

Antrim Otsego MontmorencyLeelanau

BenzieGrand Traverse Kalkaska Crawford Oscoda Alcona

Manistee Wexford Ogemaw Iosco

Mason Lake Osceola ClareGladwin

Arenac

Oceana

Newaygo

Mecosta IsabellaMidland

Bay

Huron

Muskegon

Montcalm Gratiot Saginaw

TuscolaSanilac

St. ClairLapeer

ShiawasseeClintonIoniaKentOttawa

Allegan Barry Eaton Ingham Livingston Oakland

Macomb

Van Buren KalamazooCalhoun Jackson Washtenaw Wayne

Berrien Cass Hillsdale Lenawee MonroeSt. Joseph

Branch

Missaukee

Alpena

Roscommon

Emmet

Genesee

Ontonagon

Communicable Disease and Immunization Division

3

Surveillance includesat least one of the following:

1. Active surveillance for acute L.D.

2. Ecologic Investigations3. Canine seroprevalence

Michigan Counties where Surveillancehas been Conducted for Lyme Disease

1991-1998

Ecologic Field Survey

Gogebic

Houghton

Keweenaw

Iron

Baraga

Marquette

Dickinson

Alger

Delta

Menominee

Schoolcraft

Luce

Mackinac Chippewa

CheboyganPresque IsleCharlevoix

Antrim Otsego MontmorencyLeelanau

BenzieGrand Traverse Kalkaska Crawford Oscoda Alcona

Manistee Wexford Ogemaw Iosco

Mason Lake Osceola Clare Gladwin

Arenac

Oceana

Newaygo

Mecosta IsabellaMidland Bay

Huron

Muskegon

Montcalm Gratiot Saginaw

TuscolaSanilac

St. ClairLapeer

ShiawasseeClintonIoniaKentOttawa

Allegan Barry Eaton Ingham Livingston Oakland

Macomb

Van Buren Kalamazoo Calhoun Jackson Washtenaw Wayne

Berrien Cass Hillsdale Lenawee MonroeSt. Joseph

Branch

Missaukee

Alpena

Roscommon

Emmet

Genesee

Ontonagon

4

1

6

Ixodes Scapularis Michigan Submissions 1985-1996

1

1

8

3

2

1

12

241

93 1

1

1

1

2

11 3

1 1

21

2

1

Most Common Tick Submissions1985-1996

TickNo. Submitted Human Dog Other No. on:

D. variabilis

D. albipictus

A.americanum

I. cookei

I. scapularis

2554 1302 708 542

824 63 23 737

190 156 17 17

554 103 168 283

333 121 139 73