lyme disease
DESCRIPTION
Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, CNTRANSCRIPT
Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, CN
Conditions suggested that this was an infectious disease probably transmitted by an arthropod
Further investigation revealed that Lyme disease is caused by the bacterium
Introduction
Causative OrganismBorrelia burgdorferi
Loosely coiled spirochete
8-20 micrometers
Ticks that cause Lyme disease
Black-legged Tick
Rocky Mountain Tick
Lone Star Tick
Localized rash – erythema chronicum migrans
Dissemination to multiple organ systems
Chronic disseminated stage often with arthritic symptoms
Three Stages of Disease
Localized Rash
DisseminationSigns of early disseminated infection usually occur
days to weeks after the appearance of a solitary erythema migrans lesion
Neurologic – Bell’s Palsy
Musculoskeletal manifestations may include migratory joint and muscle pains
Late disseminated Lyme disease is intermittent swelling and pain of one or a few joints.
Chronic arthritis
Chronic axonal polyneuropathy
Lyme disease morbidity may be severe, chronic, and disabling.
Rarely, if ever, fatal
Chronic Disseminated
DiagnosisDiagnosed clinically, confirmed serologically.
Often appropriate to treat patients with early disease solely on the basis of objective signs and a known exposure.
CDC recommends testing initially with a sensitive first test, ELISA or an IFA test, followed by testing with the more specific Western immunoblot (WB) test to corroborate equivocal or positive results obtained with the first test.
SerologyPatients with early disseminated or late-stage
disease usually have strong serological reactivity
Antibodies often persist for months or years following successfully treated or untreated infection.
Seroreactivity alone cannot be used as a marker of active disease
Problems with SerologyIFA false positive may occur if patient has syphilis,
relapsing fever or RA.
IFA interpretation highly subjective
EIA lacks sensitivity in early disease.
EIA false positives with syphilis, other treponemes, IM and autoimmune disease.
Western BlotMust be used if the Lyme IgG/IgM antibody
serology is equivocal or positive
"Osp" refers to outer surface protein of the bacteria.
"kDa" is the abbreviation for "kilodalton," which is used for molecular weight designations.
Lyme antibodies of importance are against the following molecular weights of the B. burgdorferi antigens: 23-25 kDa (Osp C); 31 kDa (Osp A); 34 kDa (Osp B); 39 kDa; 41 kDa; and 83-93 kDa7.
TreatmentSingle dose doxycycline shortly after
tick bite.
Lyme disease give doxycycline followed by amoxacillin
Neuroborreliosis requires IV antibiotic therapy.
Thank YouDr. Peter Dobie
Address: SUITE 3A, EDGECLIFF COURT, 2 NEW McLean ST, EDGECLIFF, NSW 2027
Email: [email protected]
Telephone: 02 9362 0493
Fax: 02 9363 0767