Summary of Lyme Disease Presentations

1. Summary of Lyme Disease Presentations Additions, corrections and discussions

2. Prevalence in Minnesota

3. Minnesota Statistics • In 2005, there were 918 confirmed cases of Lyme Disease in Minnesota. Most were confirmed through characteristic rash. • What does it take to “confirm” Lyme Disease? • Were people “treated” who didn’t have Lyme? Is that good or bad?

4. Wisconsin Prevalence

5. Wisconsin Statistics • Reportable disease in Wisconsin • 1456 cases reported in 2006. • Shows the same pattern of age groups involved as the national numbers • Why does Wisconsin seemingly have a higher prevalence than Minnesota?

6. Borrelia and Tick Info. • Why does it take approximately 72 hours of attachment for a tick to transmit Borrelia? • Only nymphal and adult female ticks transmit to humans, why? • Deer are not particularly efficient of transmitting disease to ticks, so how is the infection maintained?

8. How Big Are They? Comparison of adult Dermacentor (left) and adult Ixodes. All stages of Ixodes scapularis with a dime for comparison

9. Lyme rash • Remember, the rash is only seen in 70-80% of the cases and most patients never remember seeing a tick • Rash can be “atypical” and spread to be multiple rashes. • Rash may be hot to the touch and burning. • Most physicians will treat without testing if they see the rash. Good or Bad?

10. What do you do if you find a Tick? • Store your tick in an airtight container and bring it to your physician. • They may have you submit it to the local Public Health office. • Ticks can also be dropped in 10-70% ethanol. Isopropyl alcohol probably shouldn’t be used. • Freezing also works  • Trying to preserve the bacteria and/or bacterial DNA for further testing.

11. Treatment • Doxycycline (a tetracycline derivative)- drug of choice. Also effective against Anaplasma phagocytophilum which can be transmitted by the same tick. 21 day regiments are recommended. • Amoxicillin- children and pregnant women cannot take doxycycline (why?). • If you are unable to take either, than cefuroxime axetil. • All drugs should be taken until completion of prescription.

12. Is Lyme Disease Easy to Prevent? • Occasional vs. endemic exposure! • Is wearing of long pants/long sleeves/using DEET really expected if you live in an endemic area? • Tick checks are good, but what if you miss just one tick. • How do we keep our yards and immediate environment safe?

13. What do antibodies tell you? • If you come out positive on an ELISA (a quick antibody detection test) do you begin treatment right away or wait for your confirmation test? • How do you convince a physician to test you for Lyme disease if you don’t remember being bit by a tick or have a rash?

14. IgM test looks for 24 kDa, 39 kDa, 41 kDa. 2/3 need To be present to be positive. IgG test needs 5/10 positives From 18 kDa, 21 kDa, 28 kDa, 30 kDa, 39 kDa, 41 kDa, 45 kDa, 58 kDa, 66 kDa or 93 kDa Lanes 2 and 3 contain patient samples, all other lanes contain controls.

15. Vaccine and Testing • Will being vaccinated make you have a false positive on a Lyme test? • What if you test negative, but were bitten by a tick and feel really bad?

16. Ixodes Pathogens • Two other pathogens can be transmitted by the Ixodes tick. Ticks can be infected with more than one pathogen so you can be co-infected. • Anaplasma phagocytophilum (bacteria/rickettsia)- fever, headaches and other similar symptoms of Lyme without the rash. Luckily, can be treated with the same antibiotics. • Babesia microti- protozoan who is moving into the midwest. Babesia is related to malaria and infects red blood cells. Can be deadly in some, clear on its own in others. Treatment can include clindamycin and quinine.

17. Other tick-borne Pathogens of the Midwest • Don’t forget Rocky Mountain Spotted Fever. Mostly transmitted through the bigger Dermacentor spp. tick, it may be possible from Ixodes too! • Tularemia- Dermacentor is the most common, but Amblyomma and Ixodes is also possible. Plague like sickness in many mammals.

18. And What About Fido • Personally have had 3 dogs test positive for Lyme. 2 were old dogs and were misdiagnosed with arthritis until I insisted on being tested. My current dog is vaccinated, I use Frontline, pull ticks every day and watch her closely. I insisted on a test when I thought she was “tripping” more often than normal. However, with her being vaccinated the vet was willing to “wait” to see if her antibody level was high because she was fighting the infection. What would you have done in this situation? Waited or treated?

19. Well, I treated her. Her antibiotics cost $130. To test for Lyme cost $40. Frontline cost about $15/month and a visit to the vet is $45. The Lyme vaccine costs $15, so if it works for certain dogs, it is probably worth it. However, we heard that it works best if used on dogs that have Low risk, sooooooo……. But look how cute!

20. Other Experiences • Oh, yeah, my husband and son contracted the disease. My son showed the rash and was treated before he had symptoms (though at 3 years old he did NOT like the blood draw). • My husband did not have the rash and got pretty ill before obtaining multiple little rashes all over his body. Both were successfully treated, and cheaper than the dog because I had insurance .

21. So where does that leave us • Dr Essar and myself continue to look for Lyme disease in Ixodes ticks in WI and MN to determine risk in these areas. We tend to see between 11-15% of the ticks test positive for Borrelia using PCR while the ticks collected from my animals and around my house are about 21%. We’ll keep monitoring in this area and let you know! We are now also testing for Anaplasma and Babesia.