Lyme Disease

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Lyme Disease

• Walter Eisenhauer MMS, PA-C

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Definition

• Lyme Borreliosis
• Tick transmitted spirochetal illness
• Typically begins with characteristic expanding
  skin lesion (Erythema chronicum migrans, stage 1-
  localized infection)
• Spirochetes then spread hematogenously to many
  different sites (stage 2)
• Skin AV nodal block
• Articular surfaces
• cranial or peripheral neuritis
• carditis

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Definition

• Months to years later
• Intermittent/chronic arthritis
• chronic encephalopathy
• polyneuropathy
• (stage 3, persistent infection)

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Etiologic Agent

• Borrelia Burgdorferi
• Culture difficult
• Three distinct groups- those in US B Burgdorferi
  senso stricto
• Other strains identified
• variance probably responsible for variations in
  expression in various geographic regions

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Epidemiology

• Distribution correlates with geographic ranges of
  Ixodid ticks
• Dammini (scapularis) principle in NE US
• 20 of ticks infected
• white footed mouse preferred host of immature
  larval and nymphal stage
• white tailed deer-adult stage host
• Pacificus- western states
• Ricinus-Europe

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Top States for Lyme Disease, 1996 (Cases per
100,000) Connecticut 94.8 Rhode Island 53.9
New York 29.2 New Jersey 27.4 Delaware 23.9
Pennsylvania 23.3 Maryland 8.8
Wisconsin 7.7 National Average 6.2 Source
Centers for Disease Control and Prevention
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Epidemiology

• Now most common vector spread infection in the US
• 50k cases reported within last 10 years
• Onset during summer months
• Hiking, camping hunting trips most commonly
  associated with infection

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Pathogenesis

• IGM antibodies peak between week 3 6 weeks

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Pathogenesis

• IGG antibodies gradually over months
• Potent inducer of pro-inflammatory cytokines
• Interleukin 1b
• TNF
• Mild vasculitis present on tissue biopsy

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Early Infection
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Early Infection

• Incubation 3-32 days
• Expands from site of tick bite
• Center may become intensely red, indurated,
  necrotic
• 25 do not exhibit this manifestation
• Tick bite often not remembered

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Tick
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Stage 1

• Thigh, Groin, Axilla most common sites but can be
  anywhere
• Lesion will resolve spontaneously

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Stage 2

• Secondary Dermatitis.
• Frequently accompanied by by severe headache,
  mild neck stiffness, fever, chills, migratory
  musculoskeletal pain.
• Less commonly generalized lymphadnopathy,
  splenomegaly, hepatitis, sore throat.

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Stage 2

• 15 of untreated patients develop frank
  neurologic abnormalities
• encephalitis
• cranial neuritis
• sensory radiculopathy

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Stage 2

• 8 develop cardiac abnormalities
• fluctuating degrees of AV block
• first degree, Wenckebach, complete heart block

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Stage 3

• 60 of untreated will develop frank arthritis
• Encephalopathy affecting mood, memory sleep
• Polyneuropathy
• Chronic neuroborreliosis very similar to tertiary
  neurosyphillis

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Diagnosis

• Recognition of characteristic clinical picture
• Serologic testing does not differentiate between
  active and inactive infection

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Diagnosis

• Seronegative Lyme disease is usually a mild
  attenuated infection
• Two step serologic approach
• Elisa
• Western blot- 2 of the following three bands
  present 23, 39, 41kDa

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Treatment
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Prevention

• Recombinant Lyme Vaccine Recently approved by FDA
• 80 affective in preventing disease in endemic
  areas
• 3 dose course day 1, 30, 365

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Prevention

• ?? About boosters ?? Yearly
• ?? Induces autoimmune arthritis
• CDC-Division of Vector-Borne Infectious
  DiseasesLyme Disease Introduction
• USDA-Lyme Disease-Fighting Project In Northeast
  To Enlist Deer
• By

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Resources