Lyme Disease

1
Lyme Disease
Dr. Peter Dobie
2
Introduction

• 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

3
Causative Organism

• Borrelia burgdorferi
• Loosely coiled spirochete
• 8-20 micrometers

4
Ticks that cause Lyme disease
Lone Star Tick
Black-legged Tick
Rocky Mountain Tick
5
Three Stages of Disease

• Localized rash erythema chronicum migrans
• Dissemination to multiple organ systems
• Chronic disseminated stage often with arthritic
  symptoms

6
Localized Rash
7
Dissemination

• Signs of early disseminated infection usually
  occur days to weeks after the appearance of a
  solitary erythema migrans lesion
• Neurologic Bells 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.

8
Chronic Disseminated

• Chronic arthritis
• Chronic axonal polyneuropathy
• Lyme disease morbidity may be severe, chronic,
  and disabling.
• Rarely, if ever, fatal

9
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.

10
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.
• Seroreactivity alone cannot be used as a marker
  of active disease

11
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.

12
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.

13
Treatment

• Single dose doxycycline shortly after tick bite.
• Lyme disease give doxycycline followed by
  amoxacillin
• Neuroborreliosis requires IV antibiotic therapy.

14
Thank You
Address SUITE 3A, EDGECLIFF COURT, 2 NEW McLean
ST, EDGECLIFF, NSW 2027   Email
info_at_drpeterdobie.com   Telephone [phone]
  Fax [phone]
Dr. Peter Dobie