DR.T.V.RAO MD 1

Dr.T.V.Rao MD

LYME DISEASEBORRELIA

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 the black-legged tick (Ixodes scapularis) and named Borrelia burgdorferi.

• In 1984, Borrelia burgdorferi was isolated from the blood of patients 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.

DR.T.V.RAO MD 3

• Group or bacteria with a highly characteristic appearance

• Helical, slender, relatively long cells

• One of the species of “borrelia” cause lyme disease in human

BORRELIA IS A SPIROCHETE

DR.T.V.RAO MD 4

• Borrelia is a genus of bacteria of the spirochete phylum. It causes borreliosis, a zoonotic, vector-borne disease transmitted primarily by ticks and some by lice, depending on the species. There are 36 known species of Borrelia. The genus was named after the French biologist Amédée Borrel.

BORRELIA AND AMÉDÉE BORREL.

DR.T.V.RAO MD 5

TAXONOMYSuper kingdom: Bacteria

Phylum: spirochaetes

Order: spirochaetales

Family: spirochaelaceae

Genus: Borrelia

Species: borrelia burgdorferi

CAUSATIVE AGENT

• Borrelia burgdorferi sensu stricto

• Spirochete: slender helical

shaped bacteria

• Gram negative

• Motile

• Extracellular pathogen

• Aerobic or microaerophilic

DR.T.V.RAO MD 7

• Most Burgdorferi infections result from residential exposure to infected ticks during property maintenance, recreation, and leisure activity

• The person who engage in outdoor occupations

• Forestry

• landscaping

POPULATION AT RISK

DR.T.V.RAO MD 8

LYME DISEASE• Lyme disease is caused by bacteria called Borrelia

burgdorferi (B. burgdorferi). Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick.

• Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975

DR.T.V.RAO MD 9

• Lyme disease (named after the town of Lyme, Connecticut, where a number of cases were identified in 1975) is a seriously complex multi-system inflammatory disease that is triggered by the bacterial lipoproteins (BLPs) produced by spiral-shaped bacteria called Borrelia burgdorferi, also called Bb. Bb are difficult to isolate, grow, and study in the laboratory.

WHAT IS LYME DISEASE

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

DR.T.V.RAO MD 11

DISTRIBUTION• Mostly

localized to states in the northeastern, mid-Atlantic, and north-central regions, and to several counties in northwestern California

http://www.cdc.gov/ncidod/dvbid/lyme/

DR.T.V.RAO MD 12

METHODS OF TRANSMISSION• Vector-borne disease

• Vector is deer or black-legged tick (Ixodes scapularis) or by the western black-legged tick (Ixodes pacificus) on the Pacific Coast.

• Transmits B. burgdorferi while feeding on an uninfected 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 13

LARVA, NYMPH, AND ADULT FEMALE AND MALE IXODES DAMMINI TICKS

THEY ARE SMALLER THAN WE THINK

DR.T.V.RAO MD 14

TICKS LIFE CYCLE

WHAT IS LYME DISEASE?Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to

humans by the bite of infected ticks. *Normally lives in mice, squirrels and other small animals

• Blacklegged (deer) ticks• Lone star ticks• American dog ticks

DR.T.V.RAO MD 16

• When an infected louse feeds on an uninfected human, the organism gains access when the victim crushes the louse or scratches the area where the louse is feeding. B. recurrentis infects the person via mucous membranes and then invades the bloodstream.

HOW THE INFECTION IS INITIATED

DR.T.V.RAO MD 17

• The early symptoms are mild and easily overlook.

• The first symptom is usually an expanding rash.

• Called erythema migrans.

• Appear as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that in ringed by an expanding red rash looks like bull’s eye.

SYMPTOMS

DR.T.V.RAO MD 18

COMMON PRESENTING SYMPTOMS IN LYME DISEASE

• Symptoms of early localized Lyme disease (Stage 1) begin days or weeks 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 "bull's 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 be quite large and expanding in size.

DR.T.V.RAO MD 19

CLASSIC BULL’S EYE RASH

DR.T.V.RAO MD 20

LESS CLASSIC LESIONS

DR.T.V.RAO MD 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 or years after the initial infection. The most common symptoms are muscle and joint pain. Other symptoms may include:

• Abnormal muscle movement

• Muscle weakness

• Numbness and tingling

• Speech problems

DR.T.V.RAO MD 22

DISSEMINATED LYME DISEASE• General

• Profound fatigue, headache, fever severe muscle aches/pain

• Brain (tingling sensations of the extremities- peripheral neuropathy, facial palsy

• Eyes :vision changes, retinal damage, optic atropy

• Skin: rash not at bite site (erythema migrans)

DR.T.V.RAO MD 23

RELAPSING FEVER

• Relapsing fever borreliosis often occurs with severe bacteraemia. Borrelia recurrentis is transmitted by the human body louse; no other animal reservoir of B. recurrentis is known. Lice that feed on infected humans acquire the Borrelia organisms that then multiply in the gut of the louse.

DR.T.V.RAO MD 24

DIAGNOSIS

• There are number of blood test available

• Antibody test :ELISA and western blot tests.

Although there is false positive and negative results

• Antigen detection tests

• Polymerase chain reaction: this test multiplies the of Bb DNA to detectable measurable level

DR.T.V.RAO MD 25

DIAGNOSIS• Serologic data by IFA, ELISA and imunoblotting

techniques.

• Detect presence of IgM or IgG antibodies in patient’s 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 MD 26

TREATMENT• Antibiotic therapy

• Doxycycline and amoxicillin are used for two to four weeks in early cases

• Doxycycline is also effective against human granulocytic ehrlichiosis

• Cefuroxime axetil or erythromycin can be used for patients who are allergic to penicillin or who cannot take tetracycline's.

• More developed cases, may require treatment with intravenous ceftriaxone or penicillin for 4 weeks or more

DR.T.V.RAO MD 27

PREVENTION• Precautionary routineWear enclosed shoes and light-clolred clothing with a tight weave

to spot ticks easily

Scan clothes and any exposed skin

Stay on cleared, well- traveled trails

Insect repellent containing DEET (Diethyl-meta-tolumide) in skin or cloths

Inspect yourself and your children carefully after been heavily bushed area

DR.T.V.RAO MD 28

PREVENTION• Avoid tick habitats• Wear appropriate barrier clothing that follow

personal 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 area

with antiseptic• Education of the general public

DR.T.V.RAO MD 29

HOW TO REMOVE TICKS

DR.T.V.RAO MD 30

PREVENTION OF LYME DISEASE• Take precautions to avoid direct contact with ticks. Be

extra careful during warmer months. Whenever possible:

• Avoid wooded or bushy areas, or areas with high grasses and leaf litter..

• Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Shower soon after coming indoors to wash off any unseen ticks.

DR.T.V.RAO MD 31

DR.T.V.RAO MD 32

CONTROL• Habitat modification for ticks

-Clear trees and brush

•  Chemical 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 pesticide

applicators

-Baited devices to kill ticks on rodents

DR.T.V.RAO MD 33

• Programme Created by Dr.T.V.Rao MD for Medical and Health Care

Professionals

• Email• doctortvrao@gmail.com