tick safety and lyme disease msn
TRANSCRIPT
Tick Safety and
Lyme Disease
Virginia Anne Mears, BSN, RN
University of Phoenix
Disclosures
Master of Science, Nursing (MSN) from University of Phoenix
Member of California Lyme Disease Association (CALDA)
Member of International Lyme and Associated Diseases Society (ILADS)
Owner of Mears’ Infusion Services and Lyme Education, which offers nursing services to Lyme patients who have no insurance coverage for infusion therapy
What is Lyme Disease?
Bacterial infection spread by ticks
Disease named in 1975
Named after Lyme, CT
Evidence it has been around for at least 100 years
Bacteria identified in 1982(Cowden et al, 2003)
Incidence of Lyme disease has been increasing
Who is at Risk?
Outdoor workers
Campers
Hikers
Hunters
Fishermen
Country dwellers
City dwellers
Children
Gardeners Tick on fingernail
Why is Lyme Disease
Important?
When Lyme disease is not treated adequately, it can cause:
Severe fatigue
Severe pain
Trouble thinking
Heart problems
Muscle weakness
Burning or tingling(Savely, 2007)
What is the Risk?
Estimated tick infection rate –5% or less
Potential tick infection rate –31 to 47%
Kangaroo rat infection rate –95%
Wood rat infection rate – 95%
Gray squirrel infection rate –80%
(Lane, Mun, Eisen & Eisen, 2005)
Tick-bite Risk for
California
Imperial County –
6%
San Francisco area –
36%
Northern California –
79%(Lane et al, 1999)
What is your risk?
Population of San Bernardino County ~
2,000,000
Tick-bite rate 30% over 2 years (Lane et al, 1999)
300,000 people bitten each year in San Bernardino
County
If tick infection rate in San Bernardino is:
3% then 9,000 people exposed (Lanzendorfer, 2007)
15% then 45,000 people exposed (Hecht & Hecht, 2004)
30% then 90,000 people exposed
Time Factors
Tick attachment
Research
24 hours to transmit Lyme
disease (Wormser et al, 2006)
Anecdotal reports
Less than 2 hours to
transmit Lyme disease (Jones, 2007)
Can all Ticks Carry Lyme
Disease?
Ixodes Scapularis (Deer Tick)
Ixodes Pacificus (Western Black-legged Tick)
Dermacenter Andersoni(Wood Tick)
Amblyomma americanum(Lone Star Tick)
Mouthparts of tick.
Tick Life Cycle
Egg
Larvae Feeds on small animals,
Gets infected
Nymph Feeds on small or large
animals
Transmits infection
Adult Same as nymph
(Lyme Disease Association, 2004)
Tick Habitat
Forest
Grasses
Brush
What About Repellents?
DEET on exposed skin surfaces
Permethrin on clothing only
Requires special handling to apply
Can buy Permethrin-treated clothes
(Lyme Disease Association, 2004)
Do Types of Clothes
Matter?
Light colored clothes
Easier to see ticks
Long sleeves
Long pants
Shirt tucked into pants
Pants tucked into socks
Closed shoes
Hat with 2 inch brim
(American Lyme Disease Foundation, 2002)
What Activities are Most
Dangerous?
Sitting on a log
Leaning against a tree
Gathering firewood
Walking through tall grass
Kicking up leaf litter (Lane, Steinlein, & Mun,
2004)
Outdoor Activities
Use tick repellent
Stay on prepared trails
Avoid grasses
Avoid bushes
Use a barrier when
sitting
Dress appropriately
After Tick Exposure
Do tick check
Put clothes in hot dryer for 1 hour
Watch for tick attachment over next 2-3 days
Watch for changes in health for next 30 days
Seek medical attention at first sign of illness
after tick exposure (Stricker, Lautin, & Burrescano, 2005)
What is a Tick Check?
Checking all parts of body for ticks
Hair
Under arms
Back and neck
Legs
Groin(American Lyme Disease Foundation, 2002)
Tick check
So I found a Tick, Now
What?
Use fine tweezers or a tick-remover Don’t smother
Don’t burn
Don’t smash
Don’t irritate in any way
Save tick for testing
Seek medical treatment for prophylaxis
(U.S. Food and Drug Administration, 1999)How to remove a tick.
Early Symptoms
Rash
Fever
Muscle or joint pain
Fatigue
May appear in 1 – 30 days
May go away without treatment
Infection can and will persist
without treatment (Savely, 2007)
Late Symptoms
Fatigue
Numbness or
burning sensation
Pain
Paralysis, especially
of face
Muscle twitching
Memory problems
Learning problems
Swelling of joints
Trouble
concentrating
Word finding
problems
Mood changes(Savely, 2007)
Lyme can mimic
Alzheimer’s disease (MacDonald, 2006)
Parkinson’s disease (Cassarino, Quezado, Ghatak, & Duray, 2003)
Multiple sclerosis (Karusis, Weiner & Abramsky, 1999), (Nicolson, 2007)
ALS (Lou Gehrig’s disease) (Waisbran, Cashman, Schnell, & Johnson, 1987),
(Nicolson, 2007)
Autism (Duncan, 2007), (Bransfield, Wulfman, Harvey, & Usman, In Press), (Nicolson,
2007)
Chronic fatigue/fibromyalgia (Nicolson, 2007)
Over 300 other diseases (Cowden et al, 2003)
Testing
ELISA
Initial screening test
65% sensitivity (Savely, 2007)
Western Blot
Confirmation test
55% to 75% sensitivity (Stricker,
Lautin, & Burrescano, 2005)
PCR (Cleveland Clinic Reference Laboratory, 2003)
Culture (Stricker, Lautin, & Burrescano, 2005)
Two Standards of Care
Infectious Disease Society of America
(IDSA) (Savely, 2007)
International Lyme and Associated
Diseases Society (ILADS) (Savely, 2007)
Patients should be able to choose which
standard of care (Johnson, 2005)
Infectious Disease Society
of America
Requires EM Rash
Positive ELISA
Positive Western Blot
Antibiotic treatment 14-28 days
Post-Lyme Syndrome
Don’t look for other infections(Wormser et al, 2006)
International Lyme and
Associated Diseases Society
Clinical diagnosis
Testing to confirm diagnosis
Antibiotic therapy until symptoms resolve
Look for co-infections
Use of supplements(Cameron et al, 2004)
Other Tick-Borne
Infections
Bartonella (not the same as Cat-Scratch disease)
Babesia
Ehrlichia
Anaplasma
Rocky Mountain Spotted Fever
Southern Tick Associated Rash Illness(Savely, 2007)
Conclusion
Lyme disease is present in San Bernardino County
Practicing tick safety can reduce the risk
Avoid risky behaviors
Take precautions
Know how to remove attached ticks safely
Know symptoms if victim of tick bite
Know treatment options
Lyme Support Group
All welcome: physicians, nurses,
patients, families, friends.
Second Sunday of even months
Seventh Day Adventist Church
880 W. Laurel St. Junior room
Colton, CA
2 PM to 4 PM
References
American Lyme Disease Foundation, (2002). Retrieved March 24, 2005 from http://www.aldf.com/
Bransfield, R.C. Wulfman, J.S. Harvey, W.T. & Usman, A.I. (in Press). The association between tick-borne infections, Lyme borreliosis and autism spectrum disorders. Medical Hypotheses.
Cameron, D. Gaito, A. Harris, N. Bach, G. Bellovin, S. Bock, K. et al. (2004). Evidence-based guidelines for the management of Lyme disease. Expert Review of Anti-infective Therapy. 2(1).
Cassarino, D.S. Quezado, M.M. Ghatak, N.R. & Duray, P.H. (2003, September). Lyme – associated Parkinsonism: A neuropathologic case study and review of literature. Archives of Pathology and Laboratory Medicine. 127. Retrieved on October 27, 2007, from EBSCOhost database.
Cleveland Clinic Reference Laboratory. (2003, August). Technical update. Retrieved April 13, 2004 from http://referencelab.clevelandclinic.org/images/August2003-Dir.PDF
References
Cowden, W.L., Romero, L., Vandergriff, J., Moayad, H., Ivanova, S., Whitaker, J.A., (2003, October). NutraNews: New thinking, new discoveries in nutraceutical research. Retrieved March 19, 2004 from http://www.samento.com.ec/nutranews/index.html
Duncan, T. (2007, June 23). Autism, an informal survey. Presentation at the Lyme Induced Autism conference in Irvine, CA.
Eisen, R. J., Lane, R. S., Fritz, C. L., & Eisen, L. (2006). Spatial patterns of Lyme disease risk in California based on disease incidence data and modeling of vector-tick exposure. American Journal of Tropical Medicine and Hygiene. 75(4)669-676.
Fort Dodge Animal Health, (2007). US Canine Lyme Map. Retrieved on November 6, 2007, from http://goodnewsforpets.com/newsroom/fort_dodge/lymevax/images/uscaninelymemap.jpg
References
Fritz, C. L,. Kjemtrup, A. M., Conrad, P. A., Flores, G. R., Campbell, G. L., Schriefer, M. E., et al (1997). Seroepidemiology of emerging tickborne infectious diseases in a northern California community. The Journal of Infectious Diseases. 175. 1432-1439.
Hecht, B.K. & Hecht, F. (2007, May 29). Where ticks come from. eMedicine Health. Retrieved on October 27, 2007, from http://www.emedicinehealth.com/script/main/art.asp?articlekey=31952
Ixodes pacificus image, retrieved on November 5, 2007, from www.doh.wa.gov
Johnson, L. (2005). Lyme disease: Two standards of care. Retrieved on November 1, 2005, from http://ilads.org/insurance.html
Jones, C.R. (2007, June 23). Treating Lyme disease in the pediatric patient. Presentation at Lyme Induced Autism Conference in Irvin, CA.
References
Kangaroo rat image, retrieved on November 5, 2007, fromhttp://fwp.mt.gov/fieldguide/mediaDisplay.aspx?id=6112&elcode=AMAFD03010
Karusis, D. Weiner, H.L. & Abramsky, O. (1999). Multiple Sclerosis vs. Lyme disease: A case presentation to a discussant and a review of the literature. Multiple Sclerosis. 5. 395-402. Retrieved on October 27, 2007, from EBSCOhost database.
Lane, R. S., Moss, R. B., Hsu, Y. P., Wei, T., Mesirow, M. L., and Kuo, M. M., (1999). Anti-arthropod saliva antibodies among residents of a community at high risk for Lyme disease in California. The American Society of Tropical Medicine and Hygiene. 61 (5) 850-859.
Lane, R.S. Mun, J. Eisen, R.J. & Eisen, L. (2005). Western gray squirrel (Rodentia: Sciuridae): A primary reservoir host of Borrelia burgdorferi in Californian oak woodlands? Journal of Medical Entomology. 42(3)388-396.
References
Lane, R.S. Steinlein, D.B. & Mun, J. (2004). Human behaviors elevating exposure to Ixodes Pacificus (Acari: Ixodidea) nymphs and their associated bacterial zoonotic agents in a hardwood forest. Journal of Medical Entomology. 41(2)239-248.
Lanzendorfer, J. (2007, June 21-27). Tick talk. North Bay Bohemian. http://www.bohemian.com/bohemian/06.21.06/lyme-disease-0625.html
Lyme Disease Association, (2004). Retrieved March 24, 2005 from http://www.lymediseaseassociation.org/Pictures.html
Lyme disease case map, retrieved on November 5, 2007, from http://lymediseaseassociation.org/Maps/usa_total.jpg
MacDonald, A. (2006). Transfection"junk" DNA: A link to the pathogenesis of Alzheimer's Disease. Medical Hypotheses. 66. 1140-41.
Map of California (2007). Retrieved on November 24, 2007, from www.dkimages.com
References
McKenna, D. Faustini, Y. Nowakowski, J. & Wormser, G.P. (2004). Factors influencing the utilization of Lyme disease –Prevention behaviors in a high-risk population. Journal of the American Academy of Nurse Practitioners. 16(1)24-30. Retrieved on November 17, 2006 from EBSCOhost database.
Nicolson, G.L. (2007). Systemic intracellular bacterial infections (Mycoplasma, Chlamydia, Borrelia species) in neurodegenerative (MS, ALS) and behavioral disorders (ASD). Infections Disease Newsletter.
Savely, V. (2007, May). Controversy continues to fuel the “Lyme war”. The Clinical Advisor.
Stricker, R. B., Lautin, A., Burrascano, J. J., (2005). Lyme disease: Point/counterpoint. Expert Review Antiinfective Therapy. 3 (2).
Tick bite image, retrieved on November 5, 2007, from www.merckmedicus.com
References
Tick map of California, retrieved on November 5, 2007, from http://www.ventanawild.org/news/fe03/lyme.html
Tick map of the United States, retrieved on November 5, 2007, from www.cdc.gov
U.S. Food and Drug Administration, (1999, April 19). Proper removal of a tick. Retrieved May 25, 2004 from http://www.fda.gov/fdac/features/1999/lymeside.html
Waisbran, B.A. Cashman, N. Schnell, R.F. & Johnson, R. (1987). Borrelia burgdorferi antibodies and Amyotrophic Lateral Sclerosis. The Lancet. 2. 332.
Wormser, G.P. Dattwyler, R.J. Shapiro, E.D. Halperin, J.J. Steere, A.C. Klempner, M.S. et al. (2006). The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babeiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases. 43. 1089-1134.