lyme disease Borrelia

Disease History In the early 1900s, manifestation first reported in Europe associated it with tick bites In 1975, outbreak in Lyme, Connecticut Believed to be juvenile rheumatoid arthritis In 1982, spirochetes were identified in the midgut of the black-legged tick (Ixodes scapularis) and named Borrelia burgdorferi. In 1984, Borrelia burgdorferi was isolated from the blood of patients with EM and from the rash lesion itself. Determined etiologic agent Today, it is the most common tick-borne infection in the U.S. more than 16,000 infections each year.

Setting the stage Video 2:02 Click on link

Borrelia is a Spirochete Group or bacteria with a highly characteristic appearance Helical, slender, relatively long cells One of the species of “borrelia” cause lyme disease in human Dr.T.V.Rao MD

Borrelia and Amédée Borrel. Borrelia is a genus of bacteria of the spirochete phylum. It causes borreliosis, a zoonotic, vector-borne disease transmitted primarily by ticks and some by lice, depending on the species. There are 36 known species of Borrelia. The genus was named after the French biologist Amédée Borrel. Dr.T.V.Rao MD

Super kingdom: Bacteria taxonomy Super kingdom: Bacteria Phylum: spirochaetes Order: spirochaetales Family: spirochaelaceae Genus: Borrelia Species: borrelia burgdorferi Dr.T.V.Rao MD

Causative Agent Borrelia burgdorferi sensu stricto Spirochete: slender helical shaped bacteria Gram negative Motile Extracellular pathogen Aerobic or microaerophilic

Population at risk Most Burgdorferi infections result from residential exposure to infected ticks during property maintenance, recreation, and leisure activity The person who engage in outdoor occupations Forestry landscaping Dr.T.V.Rao MD

Lyme Disease Lyme disease is caused by bacteria called Borrelia burgdorferi (B. burgdorferi). Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick. Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975 Dr.T.V.Rao MD

What is lyme disease Lyme disease (named after the town of Lyme, Connecticut, where a number of cases were identified in 1975) is a seriously complex multi-system inflammatory disease that is triggered by the bacterial lipoproteins (BLPs) produced by spiral-shaped bacteria called Borrelia burgdorferi, also called Bb. Bb are difficult to isolate, grow, and study in the laboratory. Dr.T.V.Rao MD

EPIDEMIOLOGY Caused by spirochete Borrelia burgdorferi Transmitted by Ixodes ticks Nymph-stage ticks feed on humans May through July - transmit spirochete Endemic areas Northeastern coastal states Wisconsin & Minnesota Coast of Oregon & northern California

Distribution Mostly localized to states in the northeastern, mid-Atlantic, and north- central regions, and to several counties in northwestern California http://www.cdc.gov/ncidod/dvbid/lyme/ Dr.T.V.Rao MD

Methods of Transmission Vector-borne disease Vector is deer or black-legged tick (Ixodes scapularis) or by the western black-legged tick (Ixodes pacificus) on the Pacific Coast. Transmits B. burgdorferi while feeding on an uninfected host the spirochetes are present in the midgut and migrate during blood feeding to the salivary glands, from which they are transmitted to the host via saliva. B. burgdorferi cannot penetrate intact skin Dr.T.V.Rao MD

Larva, nymph, and adult female and male Ixodes dammini ticks They are smaller than we think Dr.T.V.Rao MD

Ticks life cycle Dr.T.V.Rao MD

What is Lyme Disease? Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans by the bite of infected ticks. *Normally lives in mice, squirrels and other small animals Blacklegged (deer) ticks Lone star ticks American dog ticks

How the infection is initiated When an infected louse feeds on an uninfected human, the organism gains access when the victim crushes the louse or scratches the area where the louse is feeding. B. recurrentis infects the person via mucous membranes and then invades the bloodstream. Dr.T.V.Rao MD

Symptoms The early symptoms are mild and easily overlook. The first symptom is usually an expanding rash. Called erythema migrans. Appear as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that in ringed by an expanding red rash looks like bull’s eye. Dr.T.V.Rao MD

Common presenting symptoms in lyme disease Symptoms of early localized Lyme disease (Stage 1) begin days or weeks after infection. They are similar to the flu and may include: Body-wide itching Chills Fever General ill-feeling Headache Light-headedness or fainting Muscle pain Stiff neck There may be a "bull's eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be quite large and expanding in size. Dr.T.V.Rao MD

Classic Bull’s Eye Rash Dr.T.V.Rao MD

Less Classic lesions Dr.T.V.Rao MD

symptoms of early disseminated Lyme disease (Stage 2 and Stage 3 ) Paralysis or weakness in the muscles of the face Muscle pain and pain or swelling in the knees and other large joints Heart problems, such as skipped heartbeats (palpitations) Symptoms of late disseminated Lyme disease (Stage 3) can occur months or years after the initial infection. The most common symptoms are muscle and joint pain. Other symptoms may include: Abnormal muscle movement Muscle weakness Numbness and tingling Speech problems Dr.T.V.Rao MD

Disseminated lyme disease General Profound fatigue, headache, fever severe muscle aches/pain Brain (tingling sensations of the extremities- peripheral neuropathy, facial palsy Eyes :vision changes, retinal damage, optic atropy Skin: rash not at bite site (erythema migrans) Dr.T.V.Rao MD

Relapsing fever Relapsing fever borreliosis often occurs with severe bacteraemia. Borrelia recurrentis is transmitted by the human body louse; no other animal reservoir of B. recurrentis is known. Lice that feed on infected humans acquire the Borrelia organisms that then multiply in the gut of the louse. Dr.T.V.Rao MD

Diagnosis There are number of blood test available Antibody test :ELISA and western blot tests. Although there is false positive and negative results Antigen detection tests Polymerase chain reaction: this test multiplies the of Bb DNA to detectable measurable level Dr.T.V.Rao MD

Diagnosis Serologic data by IFA, ELISA and imunoblotting techniques. Detect presence of IgM or IgG antibodies in patient’s serum against Borrelia burgdorferi Tests are insensitive the first several weeks of infection Western blot is more accurate and is used 6-12 weeks after infection to confirm results Direct Isolation Biopsies of the skin lesions may yield the organism in 50% or more of cases Dr.T.V.Rao MD

Treatment Antibiotic therapy Doxycycline and amoxicillin are used for two to four weeks in early cases Doxycycline is also effective against human granulocytic ehrlichiosis Cefuroxime axetil or erythromycin can be used for patients who are allergic to penicillin or who cannot take tetracycline's. More developed cases, may require treatment with intravenous ceftriaxone or penicillin for 4 weeks or more Dr.T.V.Rao MD

prevention Precautionary routine Wear enclosed shoes and light-clolred clothing with a tight weave to spot ticks easily Scan clothes and any exposed skin Stay on cleared, well- traveled trails Insect repellent containing DEET (Diethyl-meta-tolumide) in skin or cloths Inspect yourself and your children carefully after been heavily bushed area Dr.T.V.Rao MD

Prevention Avoid tick habitats Wear appropriate barrier clothing that follow personal protection procedures Apply insect repellent containing DEET to skin Apply permethrin to clothes Perform regular body checks for ticks Remove ticks promptly with tweezers and clean area with antiseptic Education of the general public Dr.T.V.Rao MD

How to remove ticks Dr.T.V.Rao MD

Prevention of lyme disease Take precautions to avoid direct contact with ticks. Be extra careful during warmer months. Whenever possible: Avoid wooded or bushy areas, or areas with high grasses and leaf litter.. Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Shower soon after coming indoors to wash off any unseen ticks. Dr.T.V.Rao MD

Dr.T.V.Rao MD

Control Habitat modification for ticks -Clear trees and brush  Chemical control of tick populations -Apply pesticides to residential properties Habitat modification for deer and rodents -Keep rodents and deer away from houses and gardens Host management -Deer feeding stations equipped with pesticide applicators -Baited devices to kill ticks on rodents Dr.T.V.Rao MD

Programme Created by Dr. T. V Programme Created by Dr.T.V.Rao MD for Medical and Health Care Professionals Email doctortvrao@gmail.com Dr.T.V.Rao MD