Lyme Disease

10 Key excerpts on "Lyme Disease"

• 

  eBook - ePub

  Emerging Infectious Diseases

  A Guide to Diseases, Causative Agents, and Surveillance

  • Lisa A. Beltz(Author)
  • 2011(Publication Date)
  • Jossey-Bass

    (Publisher)

  PART II BACTERIAL INFECTIONS Passage contains an image CHAPTER 3 Lyme Disease LEARNING OBJECTIVES

  • Define Lyme Disease
  • Describe the spirochete responsible for causing this illness
  • Discuss modes of infection
  • Discuss the host’s response to infection
  • Describe symptomatology and diagnosis
  • Discuss methods of treatment
  • Discuss methods of prevention

  Major Concepts Outbreak

  Lyme Disease was first reported in Connecticut in 1976 as an outbreak of arthritis in an unusually large number of children and adults. It was later found to result from infection by a tickborne spirochete bacterium. A spirochete is a spiral-shaped, rodlike bacterium that has caused diseases such as syphilis and relapsing fever. Nymphal and larval forms of the tick transmit the spirochete to humans. Disease incidence is highest during spring and summer when these ticks are seeking new hosts.

  Symptoms

  The symptoms of Lyme Disease include a combination of a tick bite with or without the presence of a tick, an erythema migrans rash, fever, chills, fatigue, weight change, hair loss, swollen glands, sore throat, irritable bowel, chest pain, shortness of breath, heart palpitations, joint pain and stiffness, muscle pain, headache, tingling or numbness, facial paralysis, double vision, buzzing or ringing in the ears, dizziness, poor balance, light-headedness, difficulty walking, tremor, heart murmur, confusion, forgetfulness, poor short-term memory, mood swings, meningitis, sensitivity to light, recurring hepatitis, and adult respiratory distress syndrome. Lack of prompt treatment may lead to persistent fatigue or malaise, migratory musculoskeletal disorders, chronic encephalopathy and encephalomyelitis, peripheral neuropathy, and difficulty with concentration or memory.

  Setting

  Lyme Disease in the United States occurs primarily in the Northeast along the coast from Maine to Maryland, in portions of the Midwest, and in parts of the Far West. It is also found in temperate areas of Canada, Europe, Africa, Asia, and Australia. Incidence of Lyme Disease has been on the rise due to increased habitats for the tick vectors and the mice and deer on which they feed. The rising incidence is also influenced by greater use of tick habitat by humans and an increase in the construction of human residences in these regions. Southern-tick-associated rash illness (STARI) is a similar disease found in the American Southeast. It results from infection with Borrelia lonestari

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Conquering Lyme Disease

  Science Bridges the Great Divide

  • Brian A. Fallon, Jennifer Sotsky(Authors)
  • 2017(Publication Date)
  • Columbia University Press

    (Publisher)

  1

  WHAT IS Lyme Disease?

  BASIC FACTS

  Lyme Disease (also known as Lyme borreliosis) is the most commonly reported vector-borne illness in the United States. The Centers for Disease Control and Prevention (CDC) estimates that more than 330,000 individuals are diagnosed with Lyme Disease each year in the United States alone. Although the illness was named after a town in Connecticut, Lyme Disease is not confined to the United States. In fact, more than eighty countries have reported cases, and the earliest reports come from Europe, not the United States.

  The causative pathogen, Borellia burgdorferi, is a spirochete or spiral-shaped bacterium that infects humans through the bite of the black-legged tick—sometimes referred to as a “deer tick.” During the initial blood meal by the tick, the B. burgdorferi bacteria are injected into the skin. Among most patients, this then triggers an inflammatory response that manifests as an expanding red rash known as erythema migrans. This is the most common presenting sign of the disease and usually develops within two to thirty days after infection. It is typically a round or oval, solid red rash that grows in size over time; sometimes it resembles a bull’s eye with a red perimeter and a paler central clearing. However, some patients never develop symptoms; the immune system clears the infection on its own and these individuals have no knowledge of having been infected with B. burgdorferi. Others don’t see the rash or have only mild symptoms, so they don’t seek medical attention; these patients may develop more serious manifestations weeks or a month later.

  As the B. burgdorferi

  Sign up to read

  Learn more about book
• 

  eBook - PDF

  Microbiology

  • Edward Bittar(Author)
  • 1998(Publication Date)
  • Elsevier Science

    (Publisher)

  Chapter 14 Lyme Disease LEONARD H. SIGAL Introduction Epidemiology Clinical Description of Lyme Disease Terminology Early Localized Lyme Disease Early Disseminated Lyme Disease Late Lyme Disease Other Possible Features of Disease Pregnancy and Lyme Disease Other Means of Transmission Diagnostic Testing in Lyme Disease Antibiotic Treatment of Lyme Disease Controversies in Treatment of Lyme Disease Persisting Symptoms After Treatment of Lyme Disease Response of Later Features of Lyme Disease How to Deal with the Asymptomatic Seropositive Individual? How to Remove a Tick Concluding Remarks 216 216 217 217 218 218 219 221 221 221 222 223 224 225 225 226 226 227 Principles of Medical Biology, Volume 9A Microbiology, pages 215-231. Copyright 9 1997 by JAI Press Inc. All rights of reproduction in any form reserved. ISBN: 1-55938-814-5 215 216 LEONARD H. SIGAL INTRODUCTION Lyme Disease (LD) is a multi-system inflammatory disease caused by the spiro- chete, Borrelia burgdorferi, spread by the bite of infected Ixodes ticks. In 1975, a group of researchers at Yale University described Lyme arthritis, an outbreak of juvenile rheumatoid arthritis in three small towns in Connecticut (Steere et al., 1977). Five years later, this arthritis was linked to a preceding outbreak, known as erythema migrans (EM) and tick bite. The first report of EM in the Americas was in 1970 in Wisconsin (Scrimenti, 1970). Lyme arthritis, as it was first named, has become known as Lyme Disease in part because of the association with cardiac disease, but also because approximately 10% of untreated patients had a neurologic syndrome essentially identical to a tick-borne neurologic syndrome in Europe, known as Bannwarth's syndrome. The multi-system, inflammatory nature of Lyme Disease, a multi-focal epidemic disease, has thus been established.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Crypto-infections

  Denial, censorship and repression - the truth about what lies behind chronic disease

  • Christian Perronne(Author)
  • 2020(Publication Date)
  • Hammersmith Health Books

    (Publisher)

  11 Chapter 1 The problem of Lyme and other crypto-infections Microbes have coexisted with human beings since the dawn of time and, for better or worse, they have contributed intimately to the organic balance, not to mention the structure and components, of our cells. However, understanding the role of microbes in the genesis of diseases is a long-term task that is far from complete. New microbes emerge regularly, such as the SARS-CoV-2, the new coronavirus responsible for the Covid-19 pandemic. Lyme Disease: a critical moment in understanding infectious processes The microbes that cause Lyme Disease have caused one of the greatest controversies in the history of medicine. Lyme Disease is (usually) the consequence of an infection by the Borrelia burgdorferi bacterium, a small spring-like microbe that can be transmitted by various routes, but most often through the bite of a tick. The colossal number of publications devoted to it shows the intensity of debate surrounding the disease and the crucial nature of the scientific and therapeutic issues to which they relate. Lyme Disease sits at the crossroads of different complementary approaches to understanding and treating infectious diseases in general. Such an understanding has never been more 12 pressing than it is today after decades in which it was assumed infectious diseases were a problem of the past. Epidemics, and especially pandemics, occur regularly to remind humanity that they always are a problem of the present and the future

  Sign up to read

  Learn more about book
• 

  eBook - PDF

  Lyme Borreliosis

  Biological and Clinical Aspects

  • D. Lipsker, B. Jaulhac, P. Itin, G. B. E. Jemec(Authors)
  • 2009(Publication Date)
  • S. Karger

    (Publisher)

  One such fact is that Lyme borreliosis is a disease. Disease is defined as ‘any deviation from or interruption of the normal structure or function of any body part, organ, or system that is mani-fested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown’ [6]. Therefore, there is no disease without signs and/or symptoms, and consequently there is no diagnosis of Lyme borreliosis in the absence of clinical manifestations. The mere proof of an infection with bor-reliae is not sufficient, because the infection may not always result in illness. It ap-pears that the proportion of symptomatic infections is much higher in the USA, at about 90% [7], than in Europe, where fewer than 50% of infections result in clinical illness [8–10]. In addition, demonstration of antibodies to B. burgdorferi s.l. does not Clinical Manifestations and Diagnosis of Lyme Borreliosis 53 discriminate between active infection and an immunologic imprint of previous (symptomatic or asymptomatic) infection. Because signs and symptoms form the ba-sis for recognition of the disease, good knowledge of clinical features is important in diagnosing Lyme borreliosis [2]. Case definitions for Lyme borreliosis are beneficial in everyday clinical practice, and especially for comparing the findings of different researchers. Unfortunately, clinically useful definitions are rare. Those of the Centers for Disease Control and Prevention (CDC) in the USA [11] were made primarily for epidemiologic purposes and are, with the exception of the definition of erythema mi-grans (EM), not applicable in clinical practice, whereas European definitions [12, 13] are somewhat complicated for a busy clinician. Guidelines for diagnosis and treat-ment (management) are also useful.

  Sign up to read

  Learn more about book
• 

  eBook - PDF

  Emerging Infections

  • John I. Gallin, Anthony S. Fauci(Authors)
  • 1998(Publication Date)
  • Academic Press

    (Publisher)

  The rural setting of the case clusters and the identification of erythema migrans as a feature of the illness suggested that the disorder was transmitted by an arthropod. It soon became apparent that Lyme Disease was a multisystem illness that affected primarily the skin, nervous system, heart, or joints (Steere et al., 1977b). Erythema mig- rans also linked Lyme Disease with certain previously described syndromes in Europe, including acrodermatitis chronica artophicans and Bannwarth's syn- drome (Herxheimer and Hartmann, 1902; Bannwarth, 1944). These various syndromes were brought together conclusively in 1982 when Burgdorfer and Barbour isolated a previously unrecognized spirochete, now called 13. burg- dorferi, from I. dammini ticks (Burgdorfer et al., 1982). This spirochete was then recovered from patients with Lyme Disease in the United States (Benach et al., 1983; Steere et al., 1983a) and from those with erythema migrans, Bann- warth's syndrome, or acrodermatitis in Europe; in addition, the immune re- sponses in affected patients were linked conclusively with this organism. Al- though there are regional variations, the basic outlines of the disorder are similar worldwide, and the commonest name for the overall disease is Lyme Disease or Lyme borreliosis. Clinically, this borrelial infection is most like syphilis in its multisystem in- volvement, occurrence in stages, and mimicry of other diseases. Whereas the various manifestations of syphilis were recognized to be a single entity in the nineteenth century, the protean manifestations of Lyme Disease were not recog- nized to be part of single infection until late in the twentieth century. V. CLINICAL MANIFESTATIONS,PATHOGENESIS, AND IMMUNITY A. Early Infection (Stage I: Localized Infection, Stage 2: Disseminated Infection) After injection by the tick, B. burgdorferi first causes local infection of the skin (stage 1) in about 80% of patients (Steere et al., 1983b; Steere, 1989; Nadelman et al., 1996).

  Sign up to read

  Learn more about book
• 

  eBook - PDF

  Lyme Borreliosis in Europe and North America

  Epidemiology and Clinical Practice

  • Sunil K. Sood(Author)
  • 2011(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  CDC: Lyme Disease. United States, 2003–2005. MMWR Morb Mortal Wkly Rep 56:573–576; 2007. CDC: Lyme Disease (Borrelia burgdorferi) 2008 case definition; 2008. CDC: Notice to readers: final 2008 reports of nationally notifiable infectious diseases. MMWR Morb Mortal Wkly Rep 58:856–869; 2009. REFERENCES 27 CDC: http://www.cdc.gov/ncidod/dvbid/lyme/ld_statistics.htm [Accessed January 26, 2011]. Christiansen AH, Molbak K: Neuroborreliosis 1994–2004. Statens Serum Institut; 2005. Coburn J, Fischer JR, Leong JM: Solving a sticky problem. New genetic approaches to host cell adhesion by the Lyme Disease spirochete. Mol Microbiol 57:1182–1195; 2005. Comstedt P, Bergstrom S, Olsen B, Garpmo U, Marjavaara L, Mejlon H, Barbour AG, Bunikis J: Migratory passerine birds as reservoirs of Lyme borreliosis in Europe. Emerg Infect Dis 12:1087–1095; 2006. Daniel M, Kriz B, Danielova V, Materna J, Rudenko N, Holubova J, Schwarzova L, Golovchenko M: Occurrence of ticks infected by tickborne encephalitis virus and Borrelia genospecies in mountains of the Czech Republic. Euro Surveill 10:E0503311; 2005. Dayan NE, Rubin LG, Di John D, Sood SK: Hypoglycorrhachia in Lyme meningitis. Pediatr Infect Dis J 23:370–371; 2004. De Mik EL, van Pelt W, Doctors-van Leeuwen BD, van der Veen A, Schellekens JF, Borgdorff MW: The geographical distribution of tick bites and erythema migrans in general practice in the Netherlands. Int J Epidemiol 26:451–457; 1997. Dennis DT: Epidemiology, ecology, and prevention of Lyme Disease. In Rahn DW, Evans J (eds): Lyme Disease. Philadelphia, American College of Physicians; 1998. Dennis DT: Epidemiology of Lyme borreliosis. In Gray J, Kahl O, Lane RS, Stanek G (eds): Lyme Borreliosis. Biology, Epidemiology and Control. New York, CAB International; 2002. Dennis DT: Rash decisions: Lyme Disease, or not? Clin Infect Dis 41:966–968; 2005. Dotevall L, Alestig K, Hanner P, Norkrans G, Hagberg L: The use of doxycycline in nervous system Borrelia burgdorferi infection.

  Sign up to read

  Learn more about book
• 

  eBook - PDF

  Everything You Need to Know About Lyme Disease and Other Tick-Borne Disorders

  • Karen Vanderhoof-Forschner(Author)
  • 2004(Publication Date)
  • Wiley

    (Publisher)

  49 Signs and Symptoms of Lyme Disease Especially troubling is that disease manifestations in children may easily be mistaken for intentional misbehavior. Because concentration problems are characteristic, Lyme Disease may also be wrongly diagnosed as attention deficit disorder. The risk that a child may not receive proper medical treatment or may be wrongly thought to have some sort of psychological or behavioral problem speaks volumes about the need to push scientific research along. Lyme Disease resulting in death has been reported and published in peer- reviewed academic literature. For example, at least four papers describe the deaths of symptomatic patients in whom autopsies revealed Bb spirochetes in the heart. There have also been reports in the medical literature of Lyme Disease–associated stroke. Nonetheless, there is a reluctance on the part of the scientific establishment to publish about such deaths, or to directly at- tribute death to Lyme Disease, which makes it enormously difficult to know how often death actually results. The signs and symptoms of Lyme Disease described here are extraordi- narily extensive. While you are highly unlikely to experience all, or even most, of them, it is important to know what might be associated with this infection so that you can seek appropriate medical help promptly. Also important is the new recognition of the Tick Triad of Lyme Disease, ehrlichiosis, and babesiosis. According to some studies, coinfection rates run about 26% for Lyme Disease and babesiosis, and slightly less for Lyme dis- ease and ehrlichiosis. While the specific strains and vectors differ, there is the same combination of the triad in the Northeast, South, and West Coast. Cross- reactions in testing are rare, and test for one disease will miss the others. LOCALIZED DISEASE Erythema Migrans Rash The first and most characteristic sign of Lyme Disease is a single erythema migrans (EM) rash, which appears at the site of a tick bite.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Manual of Clinical Microbiology

  • Karen C. Carroll, Michael A. Pfaller, Marie Louise Landry, Alexander J. McAdam, Robin Patel, Sandra S. Richter, David W. Warnock, Karen C. Carroll, Michael A. Pfaller, Marie Louise Landry, Alexander J. McAdam, Robin Patel, Sandra S. Richter, David W. Warnock(Authors)
  • 2019(Publication Date)
  • ASM Press

    (Publisher)

  12 ). Recent estimates by the CDC suggest that the true incidence is closer to 300,000 cases/year. Although endemic throughout most of Europe, Lyme borreliosis is a notifiable disease in only a few of the countries in which it occurs; nonetheless, over 85,000 cases/year were reported from 18 countries in 2006, and significant increases in rates of incidence have been documented in parts of this region as well.

  TAXONOMY

  Borreliae belong to the order Spirochaetales, which encompasses the families Spirochaetaceae and Leptospiraceae. Within the Spirochaetacea, two genera, Borrelia and Treponema, cause human disease. Borreliae are agents of LBRF and both tick-borne Lyme borreliosis and relapsing fever. The type species of the genus Borrelia is Borrelia anserina, which causes borreliosis in birds. Based on rrs (16S rRNA gene) sequence analyses, spirochetes form a distinct entity (division D) within the eubacterial kingdom. They are neither Gram positive nor Gram negative. In the case of the spirochetes, morphological criteria and DNA data produce concordant phylogenies, a rare trait in other bacterial groups.

  DESCRIPTION OF THE GENUS

  Common Characteristics

  Borreliae (Fig. 2 and 3 ) are similar in length (8 to 30 μm) to, but wider (0.2 to 0.5 μm) than, the two other human-pathogenic spirochetes, the treponemes and the leptospires (13 ). They are highly motile organisms, with corkscrew and oscillating motility enabling movement through highly viscous mediums, such as connective tissue. In contrast to the exoflagella of other bacteria, the flagella of spirochetes are endoflagella. The endoflagella (7 to 20 per terminus) are localized beneath the outer membrane and insert subterminally at one end or the other of the protoplasmic cylinder. The protoplasmic cylinder consists of a peptidoglycan layer and an inner membrane which encloses the internal components of the cell (13 ). If cultivable, borreliae grow slowly under microaerophilic (14 ) or anaerobic (15

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Case Studies in Infectious Disease

  • Peter Lydyard, Michael Cole, John Holton, Will Irving, Nino Porakishvili, Pradhib Venkatesan, Kate Ward(Authors)
  • 2023(Publication Date)
  • CRC Press

    (Publisher)

  Borrelia burgdorferi and related species

  A 45-year-old woman was on vacation in Cape Cod, Massachusetts and decided to attend an outdoor music festival. In order to get there, she walked 3 miles each way at night, through a dark, wooded, grassy area. Shortly thereafter, she developed nonspecific symptoms that included fever, headache, muscle aches, mild neck stiffness, and joint pain. She also noticed an oval “bull’s eye” rash on her right arm, which increased in size and cleared in the center. Over the ensuing month, she felt increasingly fatigued and developed facial paralysis (Bell’s palsy) (Figure 2.1 ), which precipitated a visit to her family physician. She couldn’t remember being bitten by a tick but based on her description of the rash and her other symptoms, her doctor suspected Lyme Disease and took a blood sample for serology. Enzyme immunoassay and Western blot confirmed the presence of Borrelia burgdorferi -reactive antibodies. After confirming that the patient was not pregnant, she was prescribed doxycycline 100 mg twice daily for 30 days.

  Figure 2.1

  Bell’s palsy: this is demonstrated by drooping at the left corner of the mouth, loss of the left naso-labial fold, and inability to completely close the left eye (not shown in image). Reprint permission kindly granted by Dr Charles Goldberg, MD, and Regents of the University of California.

  1. WHAT IS THE CAUSATIVE AGENT, HOW DOES IT ENTER THE BODY AND HOW DOES IT SPREAD A) WITHIN THE BODY AND B) FROM PERSON TO PERSON?

  CAUSATIVE AGENT

  The patient has Lyme Disease. The causative agent of Lyme Disease is Borrelia burgdorferi sensu lato (meaning in the broad sense). There are at least 20 genospecies within the Borrelia burgdorferi complex (B. burgdorferi sensu lato) worldwide. The three main pathogenic genospecies comprising this group are B. burgdorferi sensu stricto, B. garinii, and B. afzelii. Strains found in North America belong to B. burgdorferi sensu stricto whereas all three species are found in Europe and Asia. Borreliae are microaerophilic spirochetes (Figure 2.2 ) that are extremely difficult to culture because of their complex nutrient requirements. Thus, they are usually detected by the immune response they induce in blood of the infected person (see above and Section 4 ). The bacteria have a gram-negative wall structure and have a spiral mode of motility produced by axial filaments termed endoflagella. In contrast to the usual type of flagella exhibited by gram-negative bacteria that are anchored in the cytoplasmic membrane and extend through the cell wall into the external environment of the cell, the endoflagella of borreliae are found within the periplasmic space contained between a semi-rigid peptidoglycan layer and a multi-layer, flexible outer-membrane sheath. Rotation of the endoflagella within the periplasmic space causes the borreliae to move in a cork-screw fashion (Figure 2.2 ). Borreliae lack lipopolysaccharide in their outer membrane (OM); instead the OM contains phospho- and glycolipids. Importantly, OM lipoproteins are phase variable during the infection cycle. In addition, Borrelia

  Sign up to read

  Learn more about book