Lyme’s Disease

1. Lyme’s Disease By: Jena Hendricks

2. History • In early 1970’s, a mysterious group of children rheumatoid arthritis cases occurred in Lyme, Connecticut • It was not until 1981 that National Institute of Allergy and Infectious Diseases (NIAID) researchers in Hamilton, Montana connected the deer tick to the disease • In November 1981, the two scientists found that a spirochete cause both Lyme disease and erythema migrans (EM) • The spirochete was later named Borreliaburgdorferi in honor of Dr. Burgdofer’s role in the discovery.

3. Interesting Factoid • In 2011, 96% of Lyme Disease cases were reported from 13 states • Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia and Wisconsin. • Lyme Disease does not occur nationwide and is concentrated heavily in the northeast and Midwest.

4. Lyme Disease case • Who: John from Virgina • What: John contracted Lyme disease from a tick bite, while out in the woods with his son’s boy scout troop • When:Occurred in July 2011 • Where: First noticed an itch on right hip, but didn’t think much about it. Later he found out he had contracted Lyme disease from that bit • Why: John sought treatment from his Doctor, Dr. Heaton (Family Practice Physician in Virginia) after knowing something was not right; completed first (and only) round of doxycycline medication Website link – “One Man’s Experience” http://www.cdc.gov/lyme/diagnosistreatment/Stories/index.html#oneman

5. Case of Lyme Disease - WHEN • Timeline/Incubation: • Wednesday • Felt itch on hip, but shrugged off as insect bite • Checked himself before bed, but did not notice any ticks • Friday • Started to not feel well, but still did not connect the two events together • Saturday (morning) • Felt lethargic, tired and a little achy • While taking a shower, John noticed a red “bullseye” rash on his right hip • He knew something was wrong, so decided to go to the Doctor • Received round of medical: doxycycline • (Following) Saturday • Felt fantastic, back to old self again

6. Transmission • Lyme disease is a bacterium • Genus:Borrelia • Species: burgdoferi • Spread through a bite of an infected ticks • Blacklegged tick (or deer tick) • Ticks can attach to any part of the body • Often found in hard to see areas such as; groin, armpit and scalp • In most cases, the tick must be attached for 36-48 hours (or more) before the Lyme Disease bacterium can be transmitted

7. Tick Size • Most transmission of Lyme disease occurs from bites of immature ticks, called nyphms • Harder to detect, unlike larger adult ticks

8. Other modes of transmission? • There is NO evidence that Lyme disease is transmitted from person-to-person • There is no credible evidence that Lyme disease can be transmitted through air, food, water or from the bites of mosquitoes, flies fleas or lice • Scientists have found that Lyme disease bacteria can live in blood that is stored for donation • Although no cases of Lyme disease have been linked to blood transfusion • After an individual has completed antibiotic treatment, they can be considered as a potential blood donor

9. Virulence Factors • The spirochetes have outer surface proteins called endoflagella located in the periplasm that allows them to remain hidden from the host

10. Bacterium Characteristics • Spiral-shaped bacteria 20 to 30 micrometers long • Gram-negative microaerophiles

11. Description of Disease • Bacterium is injected into the skin by the bite of an infected tick • Tick saliva, which accompanies the spirochete into the skin during the feeding process, contains substances that disrupt the immune response at the site of the bite. • This creates a protective environment where the spirochete can establish infection and begin to spreads outward within the dermis

12. Bodies Reaction to Lyme disease • The spirochete has been found in many tissues, including the skin, heart, joints, peripheral nervous system and central nervous system • Many of the symptoms of Lyme disease are a consequence of the inflammatory response to the presence of the spirochete in those tissues.

13. Signs and Symptoms • Incubation period (3-30 days post-tick bite) • Typical first signs: • Fatigue, chills, fever, headache, muscle and joint aches and swollen lymph nodes • Red, expanding rash called erythema migrans (EM), also known as a “bullseye” rash • ER could take up to 30 days to appear

14. Signs and Symptoms • Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including: • Additional EM lesions in other areas of the body • Bell’s Palsy (loss of muscle tone on one or both sides of the face) • Severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord) • Pain and swelling in the large joints (such as knees) • Shooting pains that may interfere with sleep • Heart palpitations and dizziness due to changes in heartbeat **Many of these symptoms will resolve over a period time (weeks to months), even without treatment.

15. Tick Removal • Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible • Pull upward with steady, even pressure • Don’t twist or jerk the tick, this can cause the mouth-part to break off and remain in the skin • After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water **Avoid folklore remedies such as petroleum jelly, or using heat to make the tick detach from the skin. Better to remove the tick as quickly as possble.

16. Diagnostic Process • Laboratory blood testing can be an important aid in the diagnosis of Lyme disease • Blood test measures antibodies made by white blood cells in response to infection • Lab tests are not recommended for patients who do not have symptoms, typical of Lyme disease

18. Treatment • Antibiotics commonly used for oral treatment include; • Doxycycline, amoxicillin, or cefuroxime axetil • Approximately 10 – 20% of patients treated for Lyme disease with a recommended 2-4 week course of antibiotics will have lingering symptoms, such as; • Fatigue, pain, or joint and muscle aches

19. Cases in United States • Top 5 confirmed cases in the US (confirmed cases per 100,000 population) • New Jersey = 3398 • Wisconsin = 2408 • Connecticut = 2004 • Minnesota = 1185 • Massachusetts = 1801 Total = 24,364 **Hawaii has had zero cases for last 9 years.

20. Cases in Oregon • Confirmed cases (confirmed cases per 100,000 population) ** Oregon = 9 • The highest concentration of infected ticks in Oregon are located from the western end of the Columbia Gorge, near the mouth of the Deschutes River.

21. Why Worry? • Lyme disease is a real threat to families across the U.S., especially during the months that families play outside most frequently.

22. Bibliography • Lyme disease. (2012, JULY 26TH). Retrieved from http://www.cdc.gov/lyme/ • Lyme disease. (2012, OCTOBER 09). Retrieved from http://www.niaid.nih.gov/topics/lymedisease/un derstanding/pages/intro.aspx 3. Lyme disease. (2010, April 26). Retrieved from http://www.aldf.com/lyme.shtml 4. Lyme disease. (2012). Retrieved from http://ldnr.us/lyme_disease_pathophysiology.html