Transcript Lyme Disease, The fastest Growing Infectious Disease in the Nation

Focusing our Sites on the Bull’s Eye:
Lyme Disease, The fastest Growing Infectious
Disease in the Nation
Denise Abernethy, MSN, RN, CEN
Emergency Nurses Association, Horizons 2016
Under Our Skin trailer
https://www.youtube.com/watch?v=sxWgS0XLVqw
History of Lyme Disease
•Unusual outbreak of juvenile rheumatoid
arthritis
•First recognized in 1975 in US juvenile
arthritis(1981 researchers identified cause)
•Lyme Connecticut
•Most common vector-borne disease in the
US
Photo courtesy: CDC.gov
CDC Statistics
•30,000 cases of Lyme disease reported each
year in the United States
•Lyme disease cases are concentrated in the
Northeast and upper Midwest, with 14 states
accounting for over 96% of cases reported to
CDC.
•Most common age of reported cases, 5-7 yr.
old boys
(retrieved from http://www.CDC.gov/lyme, 2016)
Reported cases of Lyme disease by state, 2010-2014
State
2010
2011
2012
2013
2014
Confirmed
2014
2014
Probable Incidence*
Connecticut
1964
2004
1653
2111
1719
641
47.8
Maine
559
801
885
1127
1169
232
87.9
2380
1801
3396
3816
3646
1658
54.1
830
887
1002
1324
622
102
46.9
Pennsylvania
3298
4739
4146
4981
6470
1017
50.6
Vermont
271
476
386
674
442
157
70.5
22,561
24,364
22,014
27,203
25,359
8102
7.9
Massachusett
s
New
Hampshire
U.S. TOTAL
†confirmed cases presented for all years except most recent
*confirmed cases per 100,000 population
Adapted from Lyme Disease (2016) Retrieved from http://www.cdc.gov/lyme/
Cause
•Spirochete Corkscrew shaped bacterium,
Borrelia burgdorferi
•Mice, birds, chipmunks, small mammals are
natural reservoirs for bacterium
•Deer are not competent hosts but are
important in the lifecycle of vector tick
•Bite of infected blacklegged tick (deer tick)
Blacklegged deer tick
(Ixodes scapularis)
Early Localized Disease
•Erythema migrans (EM) rash -fewer than 50%
recall having rash (Shapiro, 2014)
•May be warm to touch
•Rarely painful or pruritic
•Typically expands slowly over 3 to 30 days,
often with a central clearing resulting in a
target or Bull’s eye appearance
Early Localized Disease
•Flulike signs and symptoms(during off
months)
•Fever, chills, Headache, fatigue, anorexia
•Muscle, joint aches
•Swollen lymph nodes
Diagnosis
•Possible exposure
•Signs and symptoms
•ELISA test- if negative, no further testing
•Western blot test(+ in 20-40% of EM
patients)
Blood test- testing for antibodies to the
bacteria (borrelia burgdorferi)
•Co-infection testing for other bacteria found
in ticks
Transmission
•Infected Tick attaches to human body (often
hard to see areas; belt line, axilla, inguinal
area, popliteal fossa, scalp (Shapiro, 2014)
•Usually must attach for 24-36 hours to
transmit
•Bacteria multiply at site of bite
•3-32 days after bite, bacteria migrate from
the site to surrounding skin
• spread through lymphatic system to organs
www.jlgh.org
Early Disseminated Disease
•Days to weeks following infection
•Multiple EM lesions may occur
•Acute neurologic or cardiac involvement
•Bells palsy (cranial nerve VII)
•Lymphocytic meningitis
•Radiculopathy
meningoradiculitis
•Neuroborreliosis
http://www.hopkinsrheumatology.org/specialty-clinics/lymedisease-clinical-research-center/what-to-do-after-a-tick-bite/
Neuroborreliosis
•one or more meninges or nerves inflamed
•10-15% of infected patients
•Sub-acute or chronic infection of peripheral
or central nervous system
•Lyme encephalopathy-cognitive and memory difficulties
- fatigue, malaise
Early Disseminated Disease
Cardiac involvement/Carditis (up to 7
mo. Later)
•Various degrees of AV block
•Myopericarditis- can cause dizziness.
Palpitations, shortness of breath,
syncope
•Complete heartblock
•Most common in 15-45 yr. olds
Treatment of Carditis
•IV Antibiotics
•Admit if PR > 30 msec in 1st degree block
or if 2nd or 3 degree block
•Temporary pacer
Late Lyme Disease
Months to a few years following infection
•Intermittent or persistent arthritis
•Neurologic disorders
polyneuropathy (CDC,2016)
Memory, sleep disturbances
Numbness
Nerve paralysis
Pain
Post Treatment Lyme Disease
Syndrome
•Not uncommon for patients treated
with 2-4 wks of antibiotics to have
lingering fatigue, muscle or joint aches
for 6 months or more
•Unknown cause (? Residual damage to
tissue or immune system)
Treatment
Antibiotics
• Doxycycline for non-pregnant or nonlactating adults and children >8 yr. old
•Amoxicillin
•IV ceftriaxone (if neurologic symptoms)
•May need second course (additional 3-4
wks)
Prevention
•Avoid wooded or high grass areas with leaf
litter and edge of yard near woods
•Walk in center of trails
•Cover arms and legs with light colored
clothing, tuck pant leg into socks
•Use insect repellents- 20% or more DEET
•Clothing, tents etc can be treated with
permethrin (kills ticks on contact) not for skin
Landscape to create a tick free zone
Check for Ticks!
•After being in woods or high risk area
•Nymphs are small and hard to see
(poppy seed to sesame seed)
•If removed promptly, less likely to get LD
•Wash and dry clothes at high
temperature
•Keep pets protected
Removal
•Fine tip tweezers
•Tick remover (not recommended by CDC)
•Grasp as close to skin surface as possible
•Pull upward with steady even pressure
•Twisting or jerking may break off
•Do not use vaseline, match ,nail polish etc
•Wash with 70% isopropyl alcohol, iodine
or soap and water
Tick Removal
http://www.bing.com/videos/search?q=video+of+tick+attaching&&view=detail&mid
=415EB35F93A772A4378B415EB35F93A772A4378B&rvsmid=7F006929AF54F9FBBADE
7F006929AF54F9FBBADE&fsscr=0&FORM=VDQVAP
Vaccination?
•Lyme disease is the most common tickborne illness in northern hemisphere
•Marked increase in incidence
•Long term effects documented
•Cost of care estimated between $712
million to $1.3 billion each year
(Kaaik,Luyties, 2015)
Rocky Mountain Spotted Fever
Rickettsia rickettsii
•20% mortality if untreated
•Fever, Headache, myalgia, cough, GI
symptoms, muscle pains
•Faint rash day 3 or 4 or none
•Vascular damage
•Death after day 5
www.dailymail.co.uk
STARI
•Southern tick-associated rash illness
•Rash looks like Lyme disease EM
•Similar symptoms, not linked to arthritis
or chronic disease
•Lone Star Tick bite, Amblyomma
americanum
americanum aljazeera.com
References
1.
Cook, M. (2014). Lyme borreliosis: A review of data on transmission time after tick attachment. International
Journal of General Medicine IJGM, 1. doi:10.2147/ijgm.s73791
2.
Drexler, N., MPH, Nelson, C., MD, MPH, Schiffman, E., MPH, MA. (May 25, 2016). Little bite, big disease:
Recognizing and Managing Tickborne Illnesses (webinar) in COCA call series. Retrieved from
http://emergency.cdc.gov/coca/calls/2016/callinfo_052416.asp
3.
Halperin, J. (2015). Chronic Lyme disease: Misconceptions and challenges for patient management. IDR
Infection and Drug Resistance, 119. doi:10.2147/idr.s66739
4.
Hu L. Clinical manifestations of Lyme disease in adults.
UpToDate.2013.http://www.uptodate.com/contents/clinical-manifestations-of-lyme-disease-in-adults.
5.
Kaaijk, P., & Luytjes, W. (2015). Vaccination against Lyme disease: Are we ready for it? Human Vaccines &
Immunotherapeutics, 12(3), 757-762. doi:10.1080/21645515.2015.1087628
6.
Koedel, U., Fingerle, V., & Pfister, H. (2015). Lyme neuroborreliosis—epidemiology, diagnosis and
management. Nature Reviews Neurology Nat Rev Neurol, 11(8), 446-456. doi:10.1038/nrneurol.2015.121
7.
Lantos, P. M., & Wormser, G. P. (2014). Chronic Coinfections in Patients Diagnosed with Chronic Lyme
Disease: A Systematic Review. The American Journal of Medicine, 127(11), 1105-1110.
doi:10.1016/j.amjmed.2014.05.036
8.
Lyme Disease (2016) Retrieved from http://www.cdc.gov/lyme/
9.
Marchese, N. M., BSN, & Primer, S. R., BSN. (2013). Targeting Lyme disease. Nursing, 43(5), 28-33.
doi:10.1097/01.nurse.0000429817.30469.a7
10.
Miller, A. (2013). Alternative Considerations for “Common Misconceptions About Lyme Disease”. The
American Journal of Medicine, 126(8).doi:10.1016/j.amjmed.2013.01.034
11.
Nelson, C. A., Saha, S., Kugeler, K. J., Delorey, M. J., Shankar, M. B., Hinckley, A. F., & Mead, P. S. (2015).
Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010. Emerg. Infect. Dis. Emerging
Infectious Diseases, 21(9), 1625-1631. doi:10.3201/eid2109.150417
12.
Shapiro, E. D., MD. (2014, May 1). Clinical Practice. Lyme disease. The New England Journal of Medicine,
370(18), 1724-1731. doi:10.10NEJMcp1314325
13.
What to do after a tick Bite, Lyme disease Clinical Research Center (2016) retrieved from
http://www.hopkinsrheumatology.org/specialty-clinics/lyme-disease-clinical-research-center/