Lyme Disease 2015

March 9, 2015

Daniel M. Sullivan MD FACP

Medicine Institute

What is it?

• Lyme Disease is a tick borne illness

• Bacteria is transmitted under the

skin through a tick bite.

• Borrelia Burgdorferei in the United

States

- Blacklegged ticks are the source

Blacklegged Ticks (Ixodes scapularis)

http://www.cdc.gov/lyme/transmission/blacklegged.html

Ticks need 36 hours of

attachment to transmit disease

• The ticks are often in the nymph stage

• 2 mm in size

Ixodes scapularis ticks demonstrating changes in

blood engorgement after various durations of

attachment

Gary P. Wormser et al. Clin Infect Dis. 2006;43:1089-1134

Typical Symptoms

• Fever

• Headache

• Fatigue

• Rash

Erythema Migrans

• Rash is called Erythema Migrans

• Looks like a red bulls eye with a white

center

http://www.cdc.gov/ticks/symptoms.html

If Untreated

• Spreads to Joints

• Heart

• Nervous System

Diagnosis is Based on

Symptoms

• Red expanding rash

• Fatigue, Chills, Fever

• Headache, Muscle, and Joint Aches

• Swollen Lymph Nodes

Lab Testing

• Should be done if exposed to

blacklegged ticks and have symptoms

Treatment

If diagnosed with symptoms & lab

testing…..

Most cases resolve with a few weeks of

antibiotics

Prevention

• Daily visual inspection of skin & clothes

• Use insect repellent

• Remove the tick promptly

• Reducing tick habitat

http://www2.epa.gov/insect-repellents

Prevention

1. Once the tick has been isolated

and clearly visible and free from

obstruction, place the wide part

of the notch on the skin near the

tick (hold skin taut if necessary).

2. Applying slight pressure

downward on the skin, slide the

remover forward so the small

part of the notch is framing the

tick. Continuous forward sliding

motion detaches the tick. (Do not

pry, lever or lift up - slide

forward.)

3. Clean your tick remover with

alcohol or similar disinfectant.

4. Although the spoons can be

disinfected, please use your

spoon only.

How to Remove a Tick Using a Tick Spoon Remover

Where is the Highest Risk

• Northeast and Mid-Atlantic

• Wisconsin and Minnesota

• Northern California

Reported cases of Lyme disease, United

States, 2013

Though Lyme disease cases have been reported in nearly every state, cases are reported

from the infected person’s county of residence, not they place where they were infected. http://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf

Reported Lyme disease cases in the United

States from 1990-2013

http://module.lymediseaseassociation.net/Maps/

Can the Blood Test be

Wrong?

• Often the test is negative during the

rash stage of the illness in the first few

weeks

If the Blood test is still

positive is infection still

present?

• The blood test measures antibodies

and stays positive for years.

Standard Treatment

• Early disease is treated with

doxycycline or amoxicillin

• Later disease in the nervous system

may need intravenous antibiotics

Questions

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