Lyme disease, Rocky Mountain Spotted Fever

PA is #____ in Lyme disease incidence

#2 :(

___% of pt w/ Lyme will not get the rash

10-20

What are the odds of progressing to LD stage 2 if not treated?

2/3 of untreated pts develop stage 2 LD

How long much the tick be attached to spread lyme disease?

24-36 hrs

how long do intermittent migratory monoarthritis episodes last?

3 mos

When do symptoms of Localized Infection of Lyme resolve?

3-4 weeks without treatment

___% of pt w/ Lyme localized infection will get flu like sx

50

Who long must the tick be attached to cause RMSF?

6-10 hours

who gets RMSF?

Anyone that comes in contact with the disease

When does Early Localized Disease (LD) start?

Begins about 1-2 weeks after tick bite

Lyme Disease is caused by what?

Borrelia burgdorfer

Who is more likely to get RMSF?

Caucasians

second choice tx for lyme

Cefuroxime axetil 500mg bid x 3-4 weeks

Who is the typical patient to present with lyme disease?

Children/young adults Those who live in heavily wooded areas

late persistent infection AKA

Chronic disseminated infection

When does Early Disseminated Infection (LD) start?

Days to weeks after inoculation

Diagnosis of RMSF

Difficult to test for CBC, electrolytes, LFTs and renal function may show some abnormalities Diagnosis is confirmed w/ IFA test, latex agglutination, or enzyme immunoassay

What are the vectors of RMSF?

Dog Tick & Wood Tick

Prevention of LD and RMSF

Don't become a tick target (wear appropriate clothes) Tick checks after outside in wooded area Remove ticks on skin quickly and properly Be vigilant for s/s of LD and RMSF

TOC lyme

Doxycycline 100mg bid x 3-4 weeks

Tests available to diagnose Lyme Disease

ELISA or IFA Test--take 6-8weeks from time of tick bit to seroconvert, high false negative

What are the stages of lyme disease clinical manifestations?

Early localized disease Early disseminated infection Late persistent infection

Symptoms of LD Early Localized Infection:

Erythema migrans---may be asymptomatic OR burn OR itch Flu like illness: fever, chills, myalgias

Symptoms of RMSP

Fever >102 Severe HA Myalagies GI sx, insomnia, & photophobia

What is the classic triad for RMSP

Fever, headache, and rash Only present in 5% in first 3 days, but 60-70% second week

Treatment of RMSF

Hospitalization in 74% of confirmed cases---serious illness Doxycycline---DOC Chloramphenicol is altenrative tx (safe for preg) Additional Tx: intubation, transfusion, and tx of shock

The Lyme disease vector

Ixodes Tick

Former Lyme Disease Vaccination

LYMErix used to be available, was about 75% effective, company removed it from market on own

how long does early localized disease (lyme disease) last

Lasts 7-10 days

What is the most common tick-borne illness in the US?

Lyme Disease

RMSF late findings

May involve organ system(s) Myocarditis, arrhythmias, and hypotension Pulmonary edema, pnumonitis Abd pain, anorexia, HSM, and jaundic **DIC, shock, hypotension and death may occur**

How many patients recall the tick bite causing lyme disease?

Only about 25-30%

RMSF Clinical Manifesations

Rash---2-6 days after fever

the most common manifestations of late persistent infx (stage 3) Lyme

Rhemotologic and neurologic manifestations

Rocky Mountain Spotted Fever caused by what?

Rickettsia rickettsii,

most common area of RMSF

SE U.S.

Symptoms of LD Early Disseminated Infection:

Skin---secondary lesions develop similiar to primary but smaller CNS--aseptic meningitis w/ mild HA and neck stiffness, Bells Palsy, Enchephalitis, personality changes & forgetfullness Musculoskeletal System Fatigue and malaise

Describe the Rash of RMSP

Starts on wrists/ankles as maculopapular Spreads centripetally to trunk and extremities Vulva and scrotum involved---diagnostic! Face is spared Palms and sols involved late in course Rash becomes petchial

When is the onset of lyme disease?

Summer and early fall

the tick that spreads is about how big?

a sesame seed

reservoir of RMSF

any small mammal

describe the progression of stage 3 Lyme attacks

each attack is less severe AND shorter in duration.

where are dog ticks most commonly found?

eastern US

describe erythema migrans

flat slightly raised red mark that grows

Incidence of foxes has ______ Incidence of coyotes has ______ thus Lyme disease is ______

foxes decreased coyotes incresaed lyme is up

organism that causes rocky mountain: g+/g-?

gram negative aerobic coccobacillus (NOT a spirochete!)

most common intermittent migratory monoarthritis findings in stage 3 Lyme

knee TMJ

When does Late Persistent Infection (LD) start?

months to years after initial infection

stage 3 Lyme - is the joint going to show spirochete?

nah

stage 3 Lyme: permanent or resolving disability?

permanent :(

where are wood ticks most commonly found?

rockies & canada

systems affected by stage 2 Lyme

skin CNS MS

most common manifestations of early disseminated infection of Lyme

skin changes

afflictions of CNS & PNS in stage 3 Lyme

subacute encephalopathy hemiparesis ataxia seizures cog impairment

why does so much damage occur from Lyme disease?

the host immune response causes a lot of the damage

What are the two ways lyme disease can spread?

Via the lymph-----regional adenopathy By the blood---organs and skin sites

what test will you perform if you get a positive initial test for Lyme?

Western Blot Test - -done after receiving postive ELISA

The Lyme Disease reservoir

White footed field mouse

Who is more likely to die from RMSF?

African Americans

toc for children w/ Lyme

Amoxicillin 500mg tid x 3-4 weeks