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Borrelia ARTROPOD DISEASE

LYMES DISEASESRELAPSING FEVERVINCENTS ANGINA

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Species

• B.recurrentis –Relapsing fever• B.vincentii –Vincents angina• B.burgdorferi-Lyme disease

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Epidemiology of Borrelia Infections

Borrelia recurrentis

Borrelia spp.

Borrelia burgdorferi

Ixodes spp.

Ornithodoros spp.

Pediculus humanus

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Borrelia is a Spirochete

• Larger, Irregular, wide and open coils

• Motile• GRAM NEGATIVE• Some commensals-

Buccal /genital mucosa

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Borrelia burgdorferi• Cause –LYME DISEASE• Spirochete: slender helical

shaped bacteria• Gram negative• Motile • Extracellular pathogen• Aerobic or microaerophilic

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What is Lyme Disease?

• Lyme disease is caused by Borrelia burgdorferi and is transmitted to humans by the bite of infected Ixoid

ticks. • *Normally lives in mice, squirrels and

other small animals • Blacklegged (deer) ticks• Lone star ticks• American dog ticks

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EPIDEMIOLOGY• Transmitted by Ixodes ticks• Nymph-stage ticks feed on humans-

transmit spirochete• Endemic areas–Northeastern coastal states–Wisconsin & Minnesota–Coast of Oregon & northern California

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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.

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Larva, nymph, and adult female and male Ixodes dammini ticksThey are smaller than we think

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Symptoms• The early symptoms are

mild.IP- 3-30 DAYS• The first symptom is usually

an expanding rash.• Called Erythema Migrans.• a central spot surrounded

by clear skin that in ringed by an expanding red rash looks like bull’s eye.

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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.

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Classic Bull’s Eye Rash

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Arthritis

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Disseminated and Persistant

• 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.

• Persistant- months or years later with chronic arthritis,polyneuropathy,encephalopathy

•

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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.

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Borrelia recurrentis- Relapsing fever• Relapsing fever borreliosis often occurs

with severe bacteraemia.• Borrelia recurrentis is transmitted by the

human body louse; no other animal reservoir

• Lice that feed on infected humans acquire the Borrelia organisms then multiply in the gut of the louse.

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TWO TYPES OF RELAPSING FEVER

• LOUSE BORNE AND TICK BORN

• 1.EPIDEMIC LOUSE BORNE• 2.ENDEMIC TICK BORNE

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Tick-borne = Endemic Relapsing Fever

Sporadic casesTransmitted by soft body ticks

(vectors) from small mammal reservoir

Ticks can multiply and infect new human hosts

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Louse-borne = Epidemic Relapsing Fever

Transmitted person-to-person by human body lice (vectors) from infected human reservoir

Infect host only when louse is injured, e.g during scratching

Therefore, a single louse can only infect a single person

Lice leave host that develops a fever and seek normal temperature host

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Relapse Of Fever

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Morphology /Diagnosis• Gram Negative Irregular Spirals With Pointed Ends• 0.2 to 0.5 microns in width and 5 to 20 microns in

length. visible with light microscopy and have the cork-screw shape

• Culture-Noguchi s MEDIUM, CAM• Vector-Pediculus Humanus Corporis• Ip-2-10 Days• Febrile Onset Of Sudden Onset, fever Subsides After

3-5 Days And It Lasts For 4-10 Days

• Then Another Bout Of Fever Starts…relapse (3-10 Times) For Months Or Years

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B.VINCENTII

• Mouth commensel• Associated with fusiform bacilli• Malnourished or viral infection it cause

ulcers - Gingivostomatitis

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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

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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

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Treatment• Antibiotic therapy• Doxycycline and amoxicillin are used for two to

four weeks in early cases• Doxycycline is also effective • 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

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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

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How to remove ticks

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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