11 - Lyme Disease

TRUE or FALSE: There are a wire array of FDA approved Lyme tests that can be used in place of the CDC recommended testing.

FALSE

TRUE or FALSE: A prophylactic dose of antibiotics is effective up to five days after tick removal.

False

TRUE or FALSE: According to the CDC, prophylactic treatment should be administered to an individual who has been bitten by a tick regardless of the species.

False

TRUE or FALSE: Every patient with Lyme disease presents with the Erythema Migrans rash.

False

TRUE or FALSE: Lyme testing methods are both sensitive and specific.

False

TRUE or FALSE: Lyme triggered autoimmunity is one proposed etiology of Post Treatment Lyme Disease Syndrome

True

TRUE or FALSE: Prophylactic treatment for Lyme disease is only available in areas where the rate of infection is greater or equal to 20%.

True

TRUE or FALSE: Recent in vitro studies have demonstrated efficacy for the antimicrobial effects of 7 botanicals for the treatment of Lyme disease.

True

TRUE or FALSE: The arthritis associated with disseminated Lyme is migratory

True

What are the main animal reservoirs for borrelia burgdorferi? a. White tail deer and mice b. White tail deer and mosquitos c. Mice and geese d. Geese and mosquitos

White tail deer and mice

The test done to confirm a positive or equivocal Lyme ELISA is a. A western blot b. PCR c. A second ELISA d. A Northern blot

a. A western blot

Which nutrient is used for treating the peripheral neuropathy associated with Post Treatment Lyme Syndrome? a. Alpha-lipoic acid b. Omega 3 fatty acids c. Vitamin C d. B 12

a. Alpha-lipoic acid

Which test is recommended by CDC as first tier testing? a. Antibody testing b. Antigen testing c. Testing for presence of borrelia d. All of these are correct

a. Antibody testing

Select the most common late-Lyme presentation. a. Arthritis b. Respiratory depression c. IBS d. Erythema migrans

a. Arthritis

The cardiac involvement in disseminated Lyme disease: (select all that apply) a. Can involve conduction abnormalities b. There is no cardiac involvement at this stage c. May present as acute myocarditis d. Typically affects the entire cardiovascular system

a. Can involve conduction abnormalities c. May present as acute myocarditis

Which is the preferred antibiotic for the treatment of early Lyme? a. Doxycycline b. Nitrofurantoin c. Meropenem d. Trimethoprim sulfamethoxazole

a. Doxycycline

Neurological symptoms like Bell's palsy or trigeminal neuralgia are not uncommon in individuals with disseminated Lyme disease or Post Treatment lyme Disease. Which botanical may be helpful in treating these symptoms? a. Hypericum perforatum b. Ocimum tenuiflorum c. Melissa officinalis d. Ginkgo biloba

a. Hypericum perforatum

What theories have been proposed to explain the rising rates of Lyme disease? a. Increasing deer population b. Mowed lawns c. Expanding suburbs d. Climate change

a. Increasing deer population c. Expanding suburbs d. Climate change

What is the etiology of late or persistent Lyme disease? a. Lack of adequate treatment b. An autoimmune presentation c. Reinfection d. None of these are true

a. Lack of adequate treatment

How is Post Treatment Lyme Disease Syndrome defined? a. Lyme is successfully treated but the individual continues to present with symptoms b. No successful treatment with continued symptoms c. Reinfection with borrelia d. Successful treatment with complete resolution of symptoms

a. Lyme is successfully treated but the individual continues to present with symptoms

During which stage of the tick lifecycle are humans most likely to be infected with borrelia burgdorferi? a. Nymph stage b. Adult stage c. Larval stage d. Egg stage

a. Nymph stage

Which of the following must be present for a diagnosis of Post Treatment Lyme disease syndrome per the Infectious Disease Society of America a. Prior history of Lyme treated with an acceptable regimen b. Initial resolution/stabilization of objective manifestations c. Onset of subjective symptoms within 6 months of diagnosis d. Persistent (continuously or relapsing) subjective symptoms for at least 6 months after completion of antibiotic therapy

a. Prior history of Lyme treated with an acceptable regimen b. Initial resolution/stabilization of objective manifestations c. Onset of subjective symptoms within 6 months of diagnosis d. Persistent (continuously or relapsing) subjective symptoms for at least 6 months after completion of antibiotic therapy

Which main human disease(s) are spirochetes associated with a. Syphilis b. Lyme disease c. Parkinson's d. Gonorrhea

a. Syphilis b. Lyme disease

Where on the body to ticks typically feed? a. Warm, close spaces like axilla or groin b. Abdomen c. Open, cooler places like arms and legs d. Back

a. Warm, close spaces like axilla or groin

This novel method of Lyme testing is still in it's research phase and most likely will never be used commercially but may be useful in supporting the theory of persistent, antibiotic refractory Lyme disease a. Xenodiagnosis: Naive ticks take a blood meal from possibly infected individual and then are direct tested for the bacteria b. Xenobiotics using synthetic bacteria and looking for mutations c. Phage testing and possible treatment in one d. Microchip sensors to detect Borrelia signature wavelengths

a. Xenodiagnosis: Naive ticks take a blood meal from possibly infected individual and then are direct tested for the bacteria

Which form of hydrotherapy is suggested to be the most beneficial adjunctive therapy in the treatment of Lyme disease? a. Contrast showers b. Hyperthermia with saunas, hot tubs, steam baths c. Warming socks d. Wet sheet wrap

b. Hyperthermia with saunas, hot tubs, steam baths

Why are spirochetes coiled? a. Cell wall structure b. Internalized flagella c. Quaternary structure of their proteins d. They just are

b. Internalized flagella

Which of the following individuals warrants testing for Lyme disease? a. Someone who presents with recent travel to an endemic area with EM rash and history of tick bite b. Someone who lives in an endemic area and presents with migrating arthritis c. Someone presenting with flu-like symptoms d. Someone who has not been in an endemic area and presents with headache

b. Someone who lives in an endemic area and presents with migrating arthritis

Which of the following is correct concerning the stage and symptom presentation? a. Stage 3: acute, localized disease b. Stage 1: acute, localized disease c. Stage 2: late persistent Lyme d. Stage 1: subacute, disseminated disease

b. Stage 1: acute, localized disease

Which nutrient is used to treat the cognitive deficiencies associated with Post Treatment Lyme Syndrome? a. NAC b. Vitamin C c. Acetyl-L-Carnitine d. B6

c. Acetyl-L-Carnitine

Which nutrient is used to treat muscle spasms associated with Post-Treatment Lyme Syndrome? a. NAC b. Vitamin C c. Magnesium d. B complex

c. Magnesium

Which of the following are TRUE about disseminated Lyme disease? a. Typically presents with flu-like symptoms b. Takes hours to develop c. Will involve multiple systems including dermatological, CNS, musculoskeletal and cardiac systems d. Every patient progresses to this stage

c. Will involve multiple systems including dermatological, CNS, musculoskeletal and cardiac systems

Which bacteria is associated with Lyme disease? a. Borrelia burgdorferi b. Borrelia afzelii c. Borrelia garinii d. All of these are associated with Lyme disease

d. All of these are associated with Lyme disease

Which of the following are risk factors associated with Lyme disease? a. Outdoor occupation b. Outdoor recreation c. Living in an endemic region d. All of these are risk factors

d. All of these are risk factors

Which of the following is FALSE? a. Erythema migrans is typically found in axillae, popliteal fossae, groin or waist b. Erythema migrans generally has minimal pain or pruritus c. Erythema migrans rash expands over days d. Erythema migrans rash requires treatment to clear

d. Erythema migrans rash requires treatment to clear