Lyme Disease

1. An introduction on the disease and it’s history, symptoms, prevention, diagnosis, transmission, and treatment Lyme Disease www.abdn.ac.uk www.faqs.org Magnification of the mouthparts of an eastern deer tick (Ixodes dammini) Magnification of the full body of an eastern deer tick (Ixodes dammini)

2. The Definition of Lyme Disease Lyme Disease- An acute inflammatory disease caused by a tick-borne spirochete bacteria, Borrelia Burgdorferi, characterized by recurrent episodes of joint swelling, fever, rashes, and cardiac and nervous system complications. Transmitted by ticks, Lyme Disease is usually characterized initially by a rash followed by flu-like symptoms including fever, joint pain, and headaches. If left untreated, the disease can result in chronic arthritis and nerve and heart dysfunction. www.allaboutarthritis.com/image/stock_image/lyme_disease_mmg.jpg

3. What is Lyme Disease? Lyme Disease is one of the newest and now most prevalent diseases in North America and certain parts of Europe. Infection of Lyme Disease occurs when a tick infected by Borrelia Burgdorferi, the bacteria responsible for creating the disease, bites a human host. Lyme Disease is able to strike people in all provinces and states throughout North America, except for Antarctica. Lyme Disease does have the potential to cause permanent damage and death. The tick most commonly responsible for transmitting Lyme Disease is the deer tick. www.wadsworth.org/databank/hirez/hechemy2.gif Lyme Disease bacteria, Borrelia Burgdorferi

4. History of Lyme Disease When Lyme Disease first began affecting children in Lyme, Connecticut, USA, in 1975, scientists first suspected an environmental pollutant, yet some children remembered being bitten while in small wooden areas. Researchers from Yale University confirmed the disease to be linked to a strikingly familiar case of breakouts in Europe in the early 1900s. A committed scientist from this university, named Dr. Willy Burgdorfer spent the next few years researching the disease. He discovered a corkscrew shaped bacterium in human blood, spinal fluid, and skin, and the bacteria was named Borrelia burgdorferi, after him. http://www.medscape.com/pi/editorial/conferences/2000/183/art-burg-fig07.hpeg

5. Things You Should Know About Lyme Disease -The tick’s bite is painless to humans, and in fact most people do not even know they have been bitten -In order for infection to occur, the tick must be attached for 5 to 7 days. -Up to 12% of untreated cases result in death -If people allow their dogs and cats to sleep in their beds with them, there is a chance that a tick carrying the Lyme Disease bacteria could migrate from the pet to the owner -There are over 100 types of Borrelia burgdorferi strains (a further division beyond the species) -There are 2 other Lyme Disease causing species besides Borrelia burgdorferi (Borrelia afzelii and Borrelia garinii) -Borrelia Burgdorferi is the longest and narrowest spirilium of all spirilla bacteria, at about 20 to 30 micrometres in length, and 0.2 to 0.3 micrometres wide

6. Know The Facts About Deer Ticks www.pbrc.hawaii.edu http://news.bbc.co.uk/nol/shared/spl/hi/health/03/travel_health/diseases/img/lyme.jpg Ticks transmit infection throughout several days of feeding, which involves inserting their mouths into skin covered by excessive amounts of hair, such as the armpits, scalp, and groin. Contrary to popular belief, ticks can neither fly nor jump: they grab on to potential hosts with their front legs. The ticks that transmit Lyme Disease include Ixodes dammini, in eastern areas of North America, Ixodes pacificus, in western areas of North America, and Ixodes ricinus, in Europe. Ticks are not much larger than sesame seeds, measuring only 1 to 4 millimeters in length. Ticks are often mistaken for freckles or specks of dirt.

7. Reservoir Hosts Wildlife such as raccoons, chipmunks, mice, rabbits, fox, deer, and wolves are all known as reservoir hosts (places where bacteria such as Borrelia burgdorferi live and reproduce). Lyme Disease does not often effect these animals even if they are bitten, yet some animals are affected. Deer are the most common reservoir hosts to ticks, which is why the ticks that transmit Lyme Disease are called deer ticks. http://www.fcps.k12.va.us/StratfordLandingES/Ecology/Mammals/White-tailed%20Deer/deer.jpg http://www.canr.uconn.edu/ansci/faculty/photos/lcf/red_fox_(juvenile).jpg http://homepage.mac.com/wildlifeweb/mammal/wolf/seattle/wolf27.jpg http://www.lib.uchicago.edu/~dean/chipmunk.jpg

8. Symptoms of Lyme Disease Lyme Disease bacterium can infect more than one part of the body, producing many different symptoms at many different times. Lyme Disease sufferers go through 3 stages of distinct symptoms: The first stage of Lyme Disease infection is called early Lyme Disease. Symptoms at this stage include fatigue, chills, headaches, fever, sore throat, dry cough, nausea, and mild muscle and joint pain. A red rash called erythema migrans, or EM, also appears at this stage, which can reach up to 12 inches in size. This stage is where flu like symptoms are mimicked, making Lyme Disease difficult to diagnose. Close up Image of erythema migrans http://www.aldf.com/images/img-tickonfinger.jpg

9. Symptoms of Lyme Disease (cont’d) The second stage of Lyme Disease infection is called early disseminated Lyme Disease. At this stage, the infection of bacteria has begun to spread throughout the entire body, interrupting many bodily functions. Symptoms at this stage include severe migraines, fever, stiff neck, muscle paralysis, numbness and pain. The third stage of infection is called late, or chronic, Lyme Disease. This stage can occur anywhere from 2 weeks to 3 years after the initial infection. Symptoms at this stage include arthritis, swelling of the brain, neurological complications, memory loss, tingling of the hands and feet, shooting pains in many parts of the body, dizziness due to an abnormal heartbeat, and muscle pain.

10. Transmission of Lyme Disease Person to Person- Lyme Disease has never been transmitted from one person to another, and so scientists believe that it never can happen. A person is unable to get Lyme Disease from touching, kissing or having sex with an infected person. During Pregnancy and while Breastfeeding- There has never been a report of infection through breast milk. Lyme Disease acquired through pregnancy often leads to infection of the placenta, and to the possible death of the fetus, if not treated with antibiotics. Food Transmission- You will not get Lyme Disease from eating deer or squirrel meat, but you should always make sure that your meat is cooked thoroughly to protect against other diseases. Note that hunting deer, rabbits, and wolves brings you in close contact with infected ticks. http://www.stumps.org/mann/Dan%20%20Jody%20Hugging.JPG http://user.cs.tu-berlin.de/~bertramp/www/Eating%20with%20the%20Chinese2.jpg

11. Transmission of Lyme Disease (cont’d) Through Blood Donation- There have never been any cases of Lyme Disease being passed on to other people through blood transfusions, yet scientists have been studying Lyme Disease and have found that Lyme Disease bacteria are able to live in packaged blood that is being stored for donation Pets to Persons- Although dogs and cats can get Lyme Disease, they are highly unlikely to transmit the disease directly to their owners. All owners should take the proper precautions to protect their pets against Lyme Disease. Picture of a dog with Lyme Disease http://www.lyme.org/img/gallery/dog-masters.jpg

12. Treatment For People With Lyme Disease Treatment for people with Lyme Disease are as followed: Tetracycline, 250-500 mg four times daily for 10 to 21 days Doxycycline, 50-100 mg twice daily for 10 to 21 days Phenoxymethyl penicillin, 250-500 mg four times daily for 10 to 21 days Amoxicillin, 250-500 mg four times daily for 10 to 21 days Azithtomycin, one 250 mg capsule twice daily for two weeks For patients in the later stages of Lyme Disease infection, antibiotic treatment AND hospitalization is the best and often only option.

13. Diagnosing The Disease Lyme Disease is diagnosed based on symptoms, history of tick exposure, and physical findings such as arthritis, red rashes, and facial paralysis. The CDC (Center for Disease Control and Prevention) recommends using the two-step process when testing for Lyme Disease: -The First step is by using the ELISA test. This test is termed “sensitive”, meaning that almost everyone with Lyme Disease, and even some people who don’t have Lyme Disease will test positive. -The second step is by using the WESTERN BLOT TEST. This test will rule out people who don’t really have Lyme Disease. This test is termed “specific”, meaning that it will only test positive if a person truly has Lyme Disease.

14. Preventing Lyme Disease In order to prevent people from being infected with Lyme Disease, we must either control the number of deers in certain areas, or control the way we protect ourselves when outdoors Tick prevention involves regular clearing of tall bushes, controlling deer populations, and regularly checking domestic animals. DEET is also effective, as well as tucking pants into shoes and shirts into pants After outdoor activities, all clothing should be washed and dried at high temperatures to remove any ticks that may be in the fabric If ticks are ever found in or around your house and suspected of Borrelia burgdorferi infection, they should be put in a container and given to local health department officials

15. How To Safely Remove a Tick To safely remove a tick that has inserted itself into the skin, follow these 3 simple instructions: 1) Using a pair of tweezers, grab the tick at the closest part of the body that has been inserted into the skin 2) Lift the tick straight upwards 3) Using this method should remove the tick and it’s mouthparts, but if any mouthparts are left in the skin, be sure to remove them afterwards as well. WHEN REMOVING A TICK: -Don’t use your fingers (you could easily crush the tick) -Don’t use a burning match or cigarette -Don’t use poison or cleaning fluid http://www.lymediseaseaction.org.uk/images/lda/removal.gif http://www.aldf.com/images/img-tickonfinger.jpg

16. The Future Outlook of Lyme Disease • Two new vaccines are recently being invented and should be fully functional within the next year: • LYMErix- being produced by Smith Kline Beecham • ImuLyme- being produced by Pasteur Merieux Company • FUTURE CONSIDERATIONS FOR THE CURRENT VACCINE: • - determination of safety for children under age 15 and adults over age 70 • - research for the correct recommended dosage • development of Lyme disease education programs for patients and care givers • - Development of cost effective vaccination programs (currently very expensive) • Improved accuracy in determining the distribution of Lyme Disease infection

17. The Future Outlook of Lyme Disease (cont’d) FUTURE CONSIDERATIONS FOR NEW VACCINES: Future efforts for the development of more effective vaccines may include a vaccine that would target more than one antigen. The Lyme Disease Foundation (LDF) is currently selling stuffed bears called “Lyme Disease Bears” and all proceeds go toward Lyme Disease research. For more information on Lyme Disease Bears, or to purchase one of your own and contribute to this worthy cause, visit www.headcovers.com http://www.viewfrommywindow.net/archives/lyme%20disease%20bear.bmp

18. References American College of Physicians. (2006). Lyme disease: a patient’s guide. Retrieved October 19,2006 on the World Wide Web: <http://www.acponline.org/lyme/patient/diagnosis.htm> Carter, J. (1989). The new good housekeeping family health and medical guide. New York: The Hearst Corporation Engel, J. (2005) The complete canadian health guide. Toronto: Key Porter Books Limited. Lyme Disease. (2002). In Magill’s Medical Guide (Vol 2, pp. 1400-1402). Hackensack: Salem Press Inc. Lyme disease diagnosis. (2005). Retreived October 16,2006 on the World Wide Web: <http://www.cdc.gov/ncidod/dvbid/lyme/ld_humandisease_diagnosis.htm> Lyme disease symptoms. (2005). Retreived September 21, 2006 on the World Wide Web: <http://www.cdc.gov/ncidod/dvbid/lyme/ld_humandisease_symptoms.htm> Lyme disease transmission. (2005). Retreived September 21, 2006 on the World Wide Web: <http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm> Yannielli, L. (2004). Lyme disease. Philadelphia: Chelsea House Publishers.