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.