1. Lymes Disease (Borreliosis)
By Christer Suvatne

2. Introduction Spread by Ticks
Caused by bacteria (borrelia) (Borrelia Burgdorferi)
It causes borreliosis (lymes disease)
The disease is multisystemic – involvement of skin, heart, joints and CNS
Affects mostly young and middle-aged people

3. TICKS Blacklegged Tick (deer tick) Wood Tick (dog tick)
(spreads Lyme disease)
Wood Tick
(dog tick)
(does not spread Lyme disease)
adult male
adult female

4. Can lead to disease: 40-60% adult 20-30% nymph 0% larva
(female)
Adult
(male)
Nymph
Can lead to disease: % adult 20-30% nymph 0% larva
Larva

5. Two-Year Life Cycle of Blacklegged Tick
MEAL 1
Mouse
Bird
EGGS
LARVAE
NYMPHS
MEAL 2
(peak feeding
time May-mid July)
Person
Mouse
Dog
Eggs laid,
adults die
Nymphs molt into adults
MEAL 3
For adults that did not feed in fall
Person
Deer
Dog
SPRING
SUMMER
Larvae molt into nymph stage
WINTER
FALL
To summarize, in the spring of year one, eggs hatch into larvae, have one feeding, molt into nymphs, and go dormant.  In year 2, nymphs take their second feeding.  At this time, the nymph may transmit bacteria to humans, or to wild or domestic mammals.
In the fall, nymphs molt into adult male and female ticks.  The females feed, mate, lay eggs, and die. 
ADULTS
MEAL 3
Person
Deer
Dog
Nymphs dormant

6. Blacklegged Tick Nymph

7. To Get Lyme Disease
Blacklegged tick must be infected with Lyme disease bacteria
Only the nymphs and adult females can transmit the Lyme disease bacteria
Tick must be attached hours before it passes bacteria to host
In order to get Lyme disease, a person must be bitten by a blacklegged tick that is infected with the Lyme disease bacteria.
Remember– not all blacklegged ticks are infected with the bacteria, so not all deer ticks transmit disease.  The tick must be attached for at least hours to transmit the bacteria.
The chance of getting Lyme disease increases the longer the tick is attached.

8. Most cases are children and middle aged people
54% is men
Most usual symptoms is neurological (54%) (248ppl)
Arthritis (15ppl)
totally 238 people were hospitalized in 2006

9. Lymes Disease 3 stages

10. Stage 1 – Early localized infection 3 to 30 days after deer tick bite
Rash (often “bulls-eye”) (red, warm, painless)
Fever
Chills
Headache
Muscle and joint pain
Fatigue
Flue like symptoms
Can develop Borreliosis even if rash is not present

11. Erythema migrans (EM) rash characteristic of Lyme disease
As the rash increases in size, it clears in the middle and develops a red ring around the outside.  This rash: May expand to a very large size, Is usually not painful or itchy, and Often appears on the thighs, groin, trunk, armpit, or back. rash has been reported in about 60 to 80 percent of adults and 50 percent of children

12. Sometimes do not have bulls eye appearance (redden area without an outer ring) Not everyone gets a rash.. the early sign and symptom. (headache, fever, chills etc) is similar to other diseases, so difficult to diagnose Lymes if have no rash

13. Stage 2 – Early disseminated infection
Days to weeks after illness onset
Multiple rashes
Facial paralysis on one side (bells palsy)
Fever, stiff neck, headache -> meningitis
Weakness, numbness, arm/leg pain
Irregular heart beat
Persistent weakness and fatigue

14. Multiple Rashes Reaction as bacteria move through body
Not caused by multiple tick bites
A person may experience multiple rashes, such as you see here.  The rash is not caused from multiple tick bites, but occurs as a reaction when the bacteria move through the body.

15. Multiple Rashes This is another example of a multiple rash.

16. Stage 3 – Late persistent infection
Weeks to months after illness onset
Fatigue
Chronic arthritis (usually affect knees)
Nervous system problems (meningitis) and problems with short term memory, concentration,

17. Joint Swelling
Joint swelling and pain may occur weeks to months after onset of illness if left untreated.
This is an example of Lyme arthritis in the knee.  Joints may become red, swollen, and painful.  Lyme arthritis is generally periodic, but may become chronic in about 10 percent of people.

18. In Norway

20. Statistics

21. Showing numbers in Norway
2007 had the highest cases of lymes disease.

22. References www.facebook.com www.wikipedia.com