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Lyme Disease

Lyme Disease. Melissa Muston Chris Watkins. Lyme Disease (Borreliosis). A complex multi-organ disorder caused by a gram-negative spirochete bacterium called Borrelia burgdorferi

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Lyme Disease

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  1. Lyme Disease Melissa Muston Chris Watkins

  2. Lyme Disease (Borreliosis) • A complex multi-organ disorder caused by a gram-negative spirochete bacterium called Borreliaburgdorferi • Endemic in most northeastern states, with 95% of cases occurring in New York, New Jersey, Connecticut, & Pennsylvania • Signs may appear months after initial exposure and may be vague or non-specific • Diagnosis can be difficult

  3. Etiology • Caused by Borrelia burgdorferi (gram-negative spirochete bacterium) • Transmitted through the bite of a tick in the genus Ixodes (blacklegged tick) • Tick must be attached to host for minimum of 48 hours for infection to occur

  4. History

  5. History • Recognized as a separate entity in 1976 because of geographic clustering of children in Lyme, Connecticut area (Lyme arthritis) • Bacterium was discovered in 1982 by Dr. Willy Burgdorfer and other colleagues • Number of reported cases has increased steadily & it is now the most commonly reported arthropod-borne illness in the US

  6. Signalment • Affects all ages and breeds of dogs, cats, horses, cows, and goats and is a zoologic disease • Animals that spend time outdoors in tick-infested areas are at greatest risk (northeastern states)

  7. Transmission • Through the bite of a tick in the genus Ixodes (blacklegged ticks) • Zoonotic disease, but must be transmitted directly from tick bite, not from infected animal to human http://www.cdc.gov/healthypets/diseases/lyme.htm

  8. Clinical Signs • Fever • Anorexia • Lethargy • Lymphadenopathy • Episodic lameness • Presence or absence of myocardial abnormalities • Rash around site of tick bite • Nephritis (esp. in Labrador Retrievers)

  9. Clinical Signs in Dogs • Most common: Fever and Arthritis, which causes sudden lameness, pain, and swelling in one or more joints • In severe cases, infection can cause kidney failure and death (not common)

  10. Clinical Signs in Humans • Erythema migrans * ”bull’s-eye” rash around bite site * 3-30 days post tick bite • Fever • Headache • Fatigue • Bell’s (facial) palsy • Infection can spread to joints, heart, and nervous system if not treated

  11. Erythema Migrans (EM)

  12. Bell’s (facial) Palsy • Loss of muscle tone on one or both sides of the face is called facial or “Bell’s” palsy

  13. Diagnostic Tests in the Past • No test can document clinical illness resulting from Borrelia burgdorferi infection • If a dog presents with fever and joint pain, tests cannot definitively prove that Lyme disease is the cause of the clinical signs. • Clinical suspicion increases if the patient has a history of exposure to Ixodes spp ticks & responds to treatment (determinations are subjective) • B. burgdorferi can be detected in joint fluids or tissues using polymerase chain reaction or culture tests (VERY expensive and not practical in clinic) • Previous ELISA tests -antibody titers greater than 64– but cannot distinguish vaccine induced antibodies from those resulting from natural exposure

  14. Diagnostic Tests • Idexx SNAP 3Dx and SNAP 4Dx • Detected an outer membrane protein on anitbodies, called VIsE • Mapped the protein, found variable and invariable regions • Found a peptide on the sixth invariable region of the VlsE protein (known as C6) • C6 peptide is expressed when the B. burgdorferi organism infects a dog but is not contained in Lyme vaccines • Therefore, detection of antibodies w/ C6 peptide indicates infection, regardless of vaccine history

  15. Recommended Treatment • Anitibiotics- *Doxycycline *Amoxycillin *Cefuroxime • Anti-inflammatory drugs for pain and swelling *NSAIDs *Cortizone (rarely used)

  16. Prognosis • In most cases, antibiotic therapy will completely eliminate the infection • In some severe or late stage cases, antibiotic therapy may not completely eliminate the organism and some animals may be permanently infected leading to chronic cases and continued flare-ups • May have relapses

  17. Prevention • Vaccination before exposure (only in endemic areas) • Reducing exposure to ticks!! • Using tick preventive products!! • Check animal for ticks daily and remove any ticks found immediately • ****There is currently no vaccine available for humans against Lyme Disease • Avoid exposure and use tick repellent (DEET)

  18. Client Education • Possible human infection from ticks • No antibiotic is 100% effective in eliminating the organism *infected animals may have relapses of symptoms even after treatment • Vaccination of dogs already exposed is ineffective • Use tick repellents for animals traveling to infested areas

  19. Case Study

  20. References • http://www.cdc.gov/lyme • http://www.vetmed.wsu.edu/cliented/lyme.aspx • http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/reference-laboratories/quantc6-research-review.pdf • http://www.brown.edu/courses/bio_160/projects2005/lyme_disease/diagnosis.htm • http://primeinc.org/casestudies/physician/study/555/case_study_and_self-assessment_on_Lyme_disease • http://primeinc.org/casestudies/physician/study/555/case_Study_and_self-assessment_on_Lyme_disease

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