Transcript Lyme`s Disease

Lyme’s Disease
By: Jena Hendricks
History
• In early 1970’s, a mysterious group of children
rheumatoid arthritis cases occurred in Lyme,
Connecticut
• It was not until 1981 that National Institute of Allergy
and Infectious Diseases (NIAID) researchers in
Hamilton, Montana connected the deer tick to the
disease
• In November 1981, the two scientists found that a
spirochete cause both Lyme disease and erythema
migrans (EM)
• The spirochete was later named Borrelia burgdorferi in
honor of Dr. Burgdofer’s role in the discovery.
Interesting Factoid
• In 2011, 96% of Lyme Disease cases were
reported from 13 states
– Connecticut, Delaware, Maine, Maryland,
Massachusetts, Minnesota, New Hampshire, New
Jersey, New York, Pennsylvania, Vermont, Virginia and
Wisconsin.
• Lyme Disease does not occur nationwide and is
concentrated heavily in the northeast and
Midwest.
Lyme Disease case
• Who: John from Virgina
• What: John contracted Lyme disease from a tick bite,
while out in the woods with his son’s boy scout troop
• When: Occurred in July 2011
• Where: First noticed an itch on right hip, but didn’t
think much about it. Later he found out he had
contracted Lyme disease from that bit
• Why: John sought treatment from his Doctor, Dr.
Heaton (Family Practice Physician in Virginia) after
knowing something was not right; completed first (and
only) round of doxycycline medication
Website link – “One Man’s Experience”
http://www.cdc.gov/lyme/diagnosistreatment/Stories/index.html#oneman
Case of Lyme Disease - WHEN
• Timeline/Incubation:
– Wednesday
• Felt itch on hip, but shrugged off as insect bite
• Checked himself before bed, but did not notice any ticks
– Friday
• Started to not feel well, but still did not connect the two events
together
– Saturday (morning)
• Felt lethargic, tired and a little achy
• While taking a shower, John noticed a red “bullseye” rash on his
right hip
• He knew something was wrong, so decided to go to the Doctor
• Received round of medical: doxycycline
– (Following) Saturday
• Felt fantastic, back to old self again
Transmission
• Lyme disease is a bacterium
– Genus: Borrelia
– Species: burgdoferi
• Spread through a bite of an infected ticks
– Blacklegged tick (or deer tick)
• Ticks can attach to any part of the body
– Often found in hard to see areas such as; groin, armpit
and scalp
• In most cases, the tick must be attached for 36-48
hours (or more) before the Lyme Disease
bacterium can be transmitted
Tick Size
• Most transmission of Lyme disease occurs
from bites of immature ticks, called nyphms
• Harder to detect, unlike larger adult ticks
Other modes of transmission?
• There is NO evidence that Lyme disease is transmitted
from person-to-person
• There is no credible evidence that Lyme disease can be
transmitted through air, food, water or from the bites
of mosquitoes, flies fleas or lice
• Scientists have found that Lyme disease bacteria can
live in blood that is stored for donation
– Although no cases of Lyme disease have been linked to
blood transfusion
– After an individual has completed antibiotic treatment,
they can be considered as a potential blood donor
Virulence Factors
• The spirochetes have outer surface proteins
called endoflagella located in the periplasm
that allows them to remain hidden from the
host
Bacterium Characteristics
• Spiral-shaped bacteria 20 to 30 micrometers
long
• Gram-negative microaerophiles
Description of Disease
• Bacterium is injected into the skin by the bite
of an infected tick
• Tick saliva, which accompanies the spirochete
into the skin during the feeding process,
contains substances that disrupt the immune
response at the site of the bite.
• This creates a protective environment where
the spirochete can establish infection and
begin to spreads outward within the dermis
Bodies Reaction to Lyme disease
• The spirochete has been found in many
tissues, including the skin, heart, joints,
peripheral nervous system and central
nervous system
• Many of the symptoms of Lyme disease are a
consequence of the inflammatory response to
the presence of the spirochete in those
tissues.
Signs and Symptoms
• Incubation period (3-30 days post-tick bite)
– Typical first signs:
• Fatigue, chills, fever, headache, muscle and joint aches
and swollen lymph nodes
– Red, expanding rash called erythema migrans
(EM), also known as a “bullseye” rash
• ER could take up to 30 days to appear
Signs and Symptoms
• Untreated, the infection may spread from the site of the
bite to other parts of the body, producing an array of
specific symptoms that may come and go, including:
– Additional EM lesions in other areas of the body
– Bell’s Palsy (loss of muscle tone on one or both sides of the face)
– Severe headaches and neck stiffness due to meningitis
(inflammation of the spinal cord)
– Pain and swelling in the large joints (such as knees)
– Shooting pains that may interfere with sleep
– Heart palpitations and dizziness due to changes in heartbeat
**Many of these symptoms will resolve over a period time (weeks
to months), even without treatment.
Tick Removal
• Use fine-tipped tweezers to grasp the tick as close to
the skin’s surface as possible
• Pull upward with steady, even pressure
• Don’t twist or jerk the tick, this can cause the mouthpart to break off and remain in the skin
• After removing the tick, thoroughly clean the bite area
and your hands with rubbing alcohol, an iodine scrub,
or soap and water
**Avoid folklore remedies such as petroleum jelly, or
using heat to make the tick detach from the skin. Better
to remove the tick as quickly as possble.
Diagnostic Process
• Laboratory blood testing can be an important
aid in the diagnosis of Lyme disease
– Blood test measures antibodies made by white
blood cells in response to infection
– Lab tests are not recommended for patients who
do not have symptoms, typical of Lyme disease
Treatment
• Antibiotics commonly used for oral treatment
include;
– Doxycycline, amoxicillin, or cefuroxime axetil
• Approximately 10 – 20% of patients treated
for Lyme disease with a recommended 2-4
week course of antibiotics will have lingering
symptoms, such as;
– Fatigue, pain, or joint and muscle aches
Cases in United States
• Top 5 confirmed cases in the US (confirmed cases per 100,000
population)
1.
2.
3.
4.
5.
New Jersey = 3398
Wisconsin = 2408
Connecticut = 2004
Minnesota = 1185
Massachusetts = 1801
Total = 24,364
**Hawaii has had zero cases for last 9 years.
Cases in Oregon
• Confirmed cases (confirmed cases per 100,000 population)
** Oregon = 9
– The highest concentration of infected ticks in
Oregon are located from the western end of the
Columbia Gorge, near the mouth of the Deschutes
River.
Why Worry?
• Lyme disease is a real threat to families across
the U.S., especially during the months that
families play outside most frequently.
Bibliography
1. Lyme disease. (2012, JULY 26TH). Retrieved from
http://www.cdc.gov/lyme/
2. Lyme disease. (2012, OCTOBER 09). Retrieved from
http://www.niaid.nih.gov/topics/lymedisease/un
derstanding/pages/intro.aspx
3. Lyme disease. (2010, April 26). Retrieved from
http://www.aldf.com/lyme.shtml
4. Lyme disease. (2012). Retrieved from
http://ldnr.us/lyme_disease_pathophysiology.ht
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