Summary of Lyme Disease Presentations

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Summary of Lyme Disease Presentations

• Additions, corrections and discussions

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Prevalence in Minnesota
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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 didnt have Lyme? Is
  that good or bad?

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Wisconsin Prevalence
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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?

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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?

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

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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 shouldnt be used.
• Freezing also works ?
• Trying to preserve the bacteria and/or bacterial
  DNA for further testing.

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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.

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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?

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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 dont remember being bit by a
  tick or have a rash?

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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.
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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?

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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.

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Other tick-borne Pathogens of the Midwest

• Dont 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.

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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?

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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!
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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
  ?.

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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. Well
  keep monitoring in this area and let you know!
  We are now also testing for Anaplasma and Babesia.