Lyme Disease “The most common tickborne infection in the United States!” 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 A Tick’s Lifecycle Statistics • Incidence of Lyme has been increasing since 1991 • 23,305 cases of Lyme were reported in the US in 2005 • Ten endemic states are Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin (Helen E. Kest, 2008). • Cases are present in Washington in 2007= 12 cases Information from Helen E. Kest, 2008 & CDC Reported Cases of Lyme Disease by Year, United States, 1992-2007 Graph from CDC Reported Cases of Lyme Disease by Month of Illness Onset in United States, 1992-2004 Graph from CDC Reported Cases of Lyme Disease in United States, 2007 Graph from CDC Why Does This Apply to You? Signs and Symptoms -Rash bull’s eye (70- 80% of people bitten) occurs 3-30 days -General S&S: fatigue, chills, fever, HA, and muscle/joint aches (Bell’s palsy loss of facial muscles) -60% of untreated patients will have bouts of arthritis -5% of untreated patients will have neurological issues Signs and Symptoms Stage Symptoms Laboratory Studies (Incubation period) Tick bite -None: may develop erythematous rash -None indicated around area of bite Early localized -Erythema migrans (EM): rapidly expanding -None indicated. If done, the 2- disease (ELD) single annular rash that may be associated step approach should be used (7 to 30 days) with fever, myalgia, headache, or malaise Early -Secondary erythema migrans: new smaller -2-step approach: disseminated lesions that develop days to weeks after 1) Perform IFA or EIA If disease (EDD) primary EM rash. May be associated with positive/equivocal, do step 2 (3 to 10 weeks) other symptoms such as fever, headache, 2) Western Blot (WB) IgG neck pain, malaise, conjunctivitis, and Positive/equivocal IFA or EIA lymphadenopathies followed by positive WB IgG -Focal neurological findings: cranial nerve may be used as adjunct to palsies (seventh nerve palsy more common clinical diagnosis in children) -Uncommon manifestations: carditis (various degrees of heart block), aseptic meningitis Late disease -Lyme arthritis (most common -2-step approach: See EDD CSF (2 to 12 manifestation): pain, swelling and effusion testing may be done in (Contemporary Pediatrics,2008) months) -Rare manifestations of pediatric Lyme collaboration with infectious Diagnostic Tests The First Step: - ELISAor IFA test. These tests are designed to be very "sensitive," meaning that almost everyone with Lyme disease, and some people who don't have Lyme disease, will test positive. If the ELISA or IFA is negative, it is highly unlikely that the person has Lyme disease, and no further testing is recommended. If the ELISA or IFA is positive or indeterminate (sometimes called "equivocal"), a second step should be performed to confirm the results. The Second Step: - Western blot test. Used appropriately, this test is designed to be "specific," meaning that it will usually be positive only if a person has been truly infected. If the Western blot is negative, it suggests that the first test was a false positive, which can occur for several reasons. 1."IgM" 2."IgG" Patients who are positive by IgM but not IgG should have the test repeated a few weeks later if they remain ill. If they are still positive only by IgM and have been ill longer than one month, this is likely a false positive. Treatment Preferred Oral Regimens: -Amoxicillin 500mg 3x/day -Doxycyline 100mg 2x/day -Cefuroxime 500mg 2x/day Preferred IV Regimens: -Cefotaxime 2g every 8 hours -Penicillin G 18-24 million units every 4 hours (Health Reference Center Academic) What if I’m being treated late? What if this regimen doesn’t work? Controversy of Chronic Lyme What did you think of the documentary? www.jeffblaylock.com, picasaweb.google.com, www.baproducts.com PREVENTION The Key is Prevention! When going out… – Wear light colored clothes – Wear long pants, long sleeve shirts, tuck pants and shirts into socks, close toe shoes – Apply insect repellent with 20-30% DEET on exposed skin and clothing to prevent tick bites. – Permethrin is another type of repellent. Kills ticks on contact! Application to pants, socks and shoes typically stays effective through several washes. – Take extra precautions in May, June and July when ticks that transmit Lyme Disease are most active – Avoid bushy areas with high grass – Stay on the trail & avoid contact with overgrown grass, brush, and leaf litter When coming inside… – Wash clothes in hot water and dry using high heat – Inspect skin when you come indoors – Call Doctor and get treatment promptly if develop a rash Information from CDC & Consumer Report on Health Do you know how to remove a tick? References: American Lyme Disease Foundation, Inc. (2006). Lyme disease. Retrieved, October 9, 2008, ALDF: Research, Education, Prevention. Website: http://www.aldf.com/lyme.shtml Consumer Reports (2008). Lyme disease: what really works. Consumer Health,8. 3. Kest, H.E. and Pineda, C. (2008). Lyme Disease: prevention, diagnosis and management. Contemporary Pediatrics, 25(6). 58-62. Lewis S. L., Heitkemper M.L., Dirksen S.R., O’Brien P.G., & Bucher L., (2007). Medical- Surgical Nursing: Assessment and management of clinical problems. Lyme Disease. (pp.1714). Missouri: Mosby, Inc. Lyme Disease Foundation, Inc. Where did Lyme disease come from? Is it new? Retrieved October 9, 2008, from Lyme Disease Foundation, Inc Website: http://www.lyme.org/othersdis/ld_history.html. McGovern, B.M., (2008). Microbiology and epidemiology of Lyme disease. Retrieved October 23, 2008, from UpToDate database. Sherman, Carl. (2008, June). New guidelines issued for Lyme disease: for the first time since 2000, the Infections Diseases Society of America has revised its recommendations for managing and preventing the infection. (FEATURE). Clinical Advisor 11.6, 63(3). Retrieved October 9, 2008 from Health Reference Center Academic database.