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 mouth-

part 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. New Jersey = 33982. Wisconsin = 24083. Connecticut = 20044. Minnesota = 11855. 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 fromhttp://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.html