Lyme Disease Lyme Disease “The by pengxiang

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									    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
• 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,

Graph from CDC
Why Does This Apply to
    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
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
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.
   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.
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?,,   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
American Lyme Disease Foundation, Inc. (2006). Lyme disease. Retrieved,
         October 9, 2008, ALDF: Research, Education, Prevention. Website:
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:
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.

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