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Lyme disease Borrelia

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Lyme disease Borrelia

Text of Lyme disease Borrelia


2. DISEASE HISTORY In the early 1900s, manifestation first reported in Europe associated it with tick bites In 1975, outbreak in Lyme, Connecticut Believed to be juvenile rheumatoid arthritis In 1982, spirochetes were identified in the midgut of theblack-legged tick (Ixodes scapularis) and named Borreliaburgdorferi. In 1984, Borrelia burgdorferi was isolated from the blood ofpatients with EM and from the rash lesion itself. Determined etiologic agent Today, it is the most common tick-borne infection in the U.S. more than 16,000 infections each year. 3. BORRELIA IS A SPIROCHETE Group or bacteria with ahighly characteristicappearance Helical, slender,relatively long cells One of the species ofborrelia cause lymedisease in humanDR.T.V.RAO MD3 4. BORRELIA AND AMDE BORREL. Borrelia is a genus ofbacteria of the spirochetephylum. It causesborreliosis, a zoonotic,vector-borne diseasetransmitted primarily byticks and some by lice,depending on the species.There are 36 knownspecies of Borrelia. Thegenus was named afterthe French biologistAmde Borrel.DR.T.V.RAO MD 4 5. TAXONOMYSuper kingdom: BacteriaPhylum: spirochaetesOrder:spirochaetalesFamily: spirochaelaceaeGenus:BorreliaSpecies:borrelia burgdorferiDR.T.V.RAO MD 5 6. CAUSATIVE AGENT Borrelia burgdorferi sensu stricto Spirochete: slender helicalshaped bacteria Gram negative Motile Extracellular pathogen Aerobic or microaerophilic 7. POPULATION AT RISK Most Burgdorferi infectionsresult from residentialexposure to infected ticksduring propertymaintenance, recreation,and leisure activity The person who engage inoutdoor occupations Forestry landscapingDR.T.V.RAO MD7 8. LYME DISEASE Lyme disease is caused by bacteria called Borreliaburgdorferi (B. burgdorferi). Blacklegged ticks carrythese bacteria. The ticks pick up the bacteria when theybite mice or deer that are infected with Lyme disease.You can get the disease if you are bitten by an infectedtick.Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975DR.T.V.RAO MD8 9. WHAT IS LYME DISEASE Lyme disease (named after thetown of Lyme, Connecticut,where a number of cases wereidentified in 1975) is a seriouslycomplex multi-systeminflammatory disease that istriggered by the bacteriallipoproteins (BLPs) produced byspiral-shaped bacteria calledBorrelia burgdorferi, also calledBb. Bb are difficult to isolate,grow, and study in the laboratory.DR.T.V.RAO MD9 10. EPIDEMIOLOGY Caused by spirochete Borrelia burgdorferi Transmitted by Ixodes ticks Nymph-stage ticks feed on humans May through July -transmit spirochete Endemic areas Northeastern coastal states Wisconsin & Minnesota Coast of Oregon & northern California 11. DISTRIBUTION Mostlylocalized tostates in thenortheastern,mid-Atlantic,and north-centralregions, and toseveral innorthwesternCalifornia DR.T.V.RAO MD 11 12. METHODS OF TRANSMISSION Vector-borne disease Vector is deer or black-legged tick (Ixodesscapularis) or by the western black-legged tick(Ixodes pacificus) on the Pacific Coast. Transmits B. burgdorferi while feeding on anuninfected host the spirochetes are present in the midgut and migrate during blood feeding to the salivary glands, from which they are transmitted to the host via saliva. B. burgdorferi cannot penetrate intact skin DR.T.V.RAO MD 12 13. LARVA, NYMPH, AND ADULT FEMALE AND MALE IXODESDAMMINI TICKS THEY ARE SMALLER THAN WE THINKDR.T.V.RAO MD 13 14. TICKS LIFE CYCLEDR.T.V.RAO MD14 15. WHAT IS LYME DISEASE?Lyme disease is caused by the bacteriumBorrelia burgdorferi and is transmitted tohumans by the bite of infected ticks.*Normally lives in mice, squirrels and othersmall animals Blacklegged (deer) ticks Lone star ticks American dog ticks 16. HOW THE INFECTION IS INITIATED When an infected lousefeeds on an uninfectedhuman, the organism gainsaccess when the victimcrushes the louse orscratches the area wherethe louse is feeding. B.recurrentis infects theperson via mucousmembranes and theninvades the bloodstream.DR.T.V.RAO MD16 17. SYMPTOMS The early symptoms aremild and easily overlook. The first symptom is usuallyan expanding rash. Called erythema migrans. Appear as a solid redexpanding rash or blotch,OR a central spotsurrounded by clear skinthat in ringed by anexpanding red rash lookslike bulls eye.DR.T.V.RAO MD17 18. COMMON PRESENTING SYMPTOMS IN LYMEDISEASE Symptoms of early localized Lyme disease (Stage 1) begin days orweeks after infection. They are similar to the flu and may include: Body-wide itching Chills Fever General ill-feeling Headache Light-headedness or fainting Muscle pain Stiff neck There may be a "bulls eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can beDR.T.V.RAO MD large and expanding in size. quite 18 19. CLASSIC BULLS EYE RASHDR.T.V.RAO MD19 20. LESS CLASSIC LESIONSDR.T.V.RAO MD20 21. SYMPTOMS OF EARLY DISSEMINATED LYME DISEASE (STAGE 2 AND STAGE 3 ) Paralysis or weakness in the muscles of the face Muscle pain and pain or swelling in the knees and other large joints Heart problems, such as skipped heartbeats (palpitations) Symptoms of late disseminated Lyme disease (Stage 3) can occur months oryears after the initial infection. The most common symptoms are muscle andjoint pain. Other symptoms may include: Abnormal muscle movement Muscle weakness Numbness and tingling Speech problemsDR.T.V.RAO MD21 22. DISSEMINATED LYME DISEASE General Profound fatigue, headache, fever severemuscle aches/pain Brain (tingling sensations of the extremities-peripheral neuropathy, facial palsy Eyes :vision changes, retinal damage, opticatropy Skin: rash not at bite site (erythema migrans)DR.T.V.RAO MD22 23. RELAPSING FEVER Relapsing fever borreliosis often occurswith severe bacteraemia. Borreliarecurrentis is transmitted by the humanbody louse; no other animal reservoir of B.recurrentis is known. Lice that feed oninfected humans acquire the Borreliaorganisms that then multiply in the gut ofthe louse.DR.T.V.RAO MD 23 24. DIAGNOSIS There are number of blood test available Antibody test :ELISA and western blot tests.Although there is false positive and negativeresults Antigen detection tests Polymerase chain reaction: this testmultiplies the of Bb DNA to detectablemeasurable levelDR.T.V.RAO MD24 25. DIAGNOSIS Serologic data by IFA, ELISA and imunoblottingtechniques. Detect presence of IgM or IgG antibodies in patients serum against Borrelia burgdorferi Tests are insensitive the first several weeks of infection Western blot is more accurate and is used 6-12 weeks after infection to confirm results Direct Isolation Biopsies of the skin lesions may yield the organism in 50% or more of cases DR.T.V.RAO MD25 26. TREATMENT Antibiotic therapy Doxycycline and amoxicillin are used for two tofour weeks in early cases Doxycycline is also effective against humangranulocytic ehrlichiosis Cefuroxime axetil or erythromycin can be used forpatients who are allergic to penicillin or who cannottake tetracyclines. More developed cases, may require treatment withintravenous ceftriaxone or penicillin for 4 weeks ormore DR.T.V.RAO MD 26 27. PREVENTION Precautionary routineWear enclosed shoes and light-clolred clothing with a tight weaveto spot ticks easilyScan clothes and any exposed skinStay on cleared, well- traveled trailsInsect repellent containing DEET (Diethyl-meta-tolumide) in skin or clothsInspect yourself and your children carefully after been heavily bushed areaDR.T.V.RAO MD 27 28. PREVENTION Avoid tick habitats Wear appropriate barrier clothing that followpersonal protection procedures Apply insect repellent containing DEET to skin Apply permethrin to clothes Perform regular body checks for ticks Remove ticks promptly with tweezers and clean areawith antiseptic Education of the general publicDR.T.V.RAO MD 28 29. HOW TO REMOVE TICKSDR.T.V.RAO MD 29 30. PREVENTION OF LYME DISEASE Take precautions to avoid direct contact with ticks. Beextra careful during warmer months. Wheneverpossible:Avoid wooded or bushy areas, or areas with high grasses and leaf litter.. Ticks that carry Lyme disease are so small that theyare very hard to see. After returning home, remove yourclothes and thoroughly inspect all skin surface areas,including your scalp. Shower soon after coming indoorsto wash off any unseen ticks.DR.T.V.RAO MD 30 31. DR.T.V.RAO MD 31 32. CONTROL Habitat modification for ticks -Clear trees and brushChemical control of tick populations -Apply pesticides to residential properties Habitat modification for deer and rodents -Keep rodents and deer away from houses and gardens Host management-Deer feeding stations equipped with pesticideapplicators-Baited devices to kill ticks on rodentsDR.T.V.RAO MD32 33. Programme Created by Dr.T.V.Rao MD for Medical and Health CareProfessionals Email [email protected] MD 33

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