Lymes Disease

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

By: shan210420 (96 month(s) ago)

gud

Presentation Transcript

Introduction : 

Introduction Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, CT. Conditions suggested that this was an infectious disease probably transmitted by an arthropod. Further investigation revealed that Lyme disease is caused by the bacterium.

Minnesota Lymes 1998 & 2002(NO MAP FOR WI thanks to DNR!) : 

Minnesota Lymes 1998 & 2002(NO MAP FOR WI thanks to DNR!)

Causative Organism : 

Causative Organism Borrelia burgdorferi Loosely coiled spirochete 8-20 micrometers

Vector : 

Vector Ixodes scapularis ticks are much smaller than common dog and cattle ticks Below adult female, adult male, nymph, and larva on a centimeter scale. Humans acquire disease from bite of nymphal or adult tick.

Deer Tick v.s. Wood Tick : 

Deer Tick v.s. Wood Tick

Deer Tick Life Cycle : 

Deer Tick Life Cycle

Tick Waiting to Attack : 

Tick Waiting to Attack

Tick Mouthparts : 

Tick Mouthparts

Three Stages of Disease : 

Three Stages of Disease Localized rash – erythema chronicum migrans Dissemination to multiple organ systems Chronic disseminated stage often with arthritic symptoms

Localized Rash : 

Localized Rash

Dissemination : 

Dissemination Signs 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 Disseminated : 

Chronic Disseminated Chronic arthritis. Chronic axonal polyneuropathy (Inflamation of the nerves, muscle weakness and paralysis). Lyme disease morbidity may be severe, chronic, and disabling. Rarely, if ever, fatal.

CLINICAL DESCRIPTIONS OF NEUROBORRELIOSIS CENTRAL NERVOUS SYSTEM INVOLVEMENT : 

CLINICAL DESCRIPTIONS OF NEUROBORRELIOSIS CENTRAL NERVOUS SYSTEM INVOLVEMENT MENINGISMUS: Patients may present with headache and stiff neck without evidence of CSF inflammation. Since early CNS seeding has been described, as well as culture positivity during latent disease without concurrent CNS inflammatory changes, these symptoms probably indicate active infection. Stiff neck might alternatively be due to axonal degenerative changes of the cervical paraspinal musculature, but there should be other evidence of a more widespread neuropathy when this is the case. LYMPHOCYTIC MENINGITIS: Lymphocytic Meningitis may appear to be indistinguishable from aseptic meningitis during early-disseminated disease (weeks to months after inoculation with B. burgdorferi). Most patients will have headaches that will fluctuate in intensity. Associated features may include a cranial neuropathy in about one-third. Low-grade encephalopathy is present in up to one-half, with mild memory concentration deficits, mood changes, and sleep disturbance. MENINGOENCEPHALOMYELITIS: Rarely, focal parenchymal CNS lesions occur. The MRI may show punctate white matter lesions best seen on T2-weighted images; larger lesions occur infrequently. One brain biopsy showed increased numbers of microglia cells, rare spirochetes, and minimal inflammation. Transverse myelitis, movement disorders (extrapyramidal cerebellar, chorea and myoclonus), and hemiparesis can occur. PSYCHIATRIC DISORDERS: Psychosis, mood swings (mild or bipolar), profound personality changes, depression, anorexia nervosa, obsessive-compulsive disorder, and panic attacks may occur. CSF may be normal. SUBACUTE ENCEPHALOPATHY (SAE): The most common chronic CNS manifestation is a SAE, characterized by memory problems and depression. Many patients (or their families) will complain of their excessive daytime sleepiness and extreme irritability. These patients generally come to the office disorganized (despite a supreme effort to be organized), unable to give a coherent history. They will bring copious notes, which are invariably in the wrong order. Most patients will complain of fatigue, and about one-half have headaches. Coincident polyneuropathy is very common with spinal or radicular pain, or distal paresthesias.

Diagnosis : 

Diagnosis Diagnosed 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.

Serology : 

Serology Patients 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 (also in vaccinated individuals). seroreactivity alone cannot be used as a marker of active disease.

Problems with Serology : 

Problems with Serology IFA 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. JUST KNOW PROBLEMS WITH SEROLOGY AND DIAGNOSIS

Western Blot : 

Western Blot Must 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.

Lane 1, monoclonal antibodies defining selected antigens to B. burgdorferi Lane 2, human serum (IgG) reactive with the 10 antigens scored in the currently recommended criteria for blot scoring; lines indicate other calibrating antibodies. Molecular masses are in kilodaltons. : 

Lane 1, monoclonal antibodies defining selected antigens to B. burgdorferi Lane 2, human serum (IgG) reactive with the 10 antigens scored in the currently recommended criteria for blot scoring; lines indicate other calibrating antibodies. Molecular masses are in kilodaltons.

Treatment : 

Treatment Single dose doxycycline shortly after tick bite. Lyme disease pos. result, give doxycycline followed by amoxacillin Neuroborreliosis requires IV antibiotic therapy.

PREVENTION!!! : 

PREVENTION!!! Avoid Tick Habitats. Use Personal Protection (Light colored clothing, boots, long sleeved shirts and pants tucked in, DEET). Reduce Tick Habitat (Remove leaf litter, brush, woodpiles or rodent habitat, cut grass). Remove Tick Properly. Seek Medical Attention for Symptoms.

authorStream Live Help