Lyme Disease Flashcards
Name of the skin lesion that associated with tick’s bite
Erythema Migrans
What directly cause the Lyme disease?
The cause was found to be a spirochete, Borrelia burgdorferi.
T/F
Arthropod-transmitted viruses in the patients with “Lyme arthritis” associated with the same bacteria from the Lyme disease
False
Steere looked for antibodies against 38 known tick-transmitted infections and 178 other arthropod-transmitted viruses in the patients with “Lyme arthritis”, but no one was positive.
Name of the bacteria causes Lyme disease
Borrelia burgdorferi
Borrelia burgdorferi
Borrelia burgdorferi in the United States
Borrelia mayonii in the upper midwestern U.S.
Borrelia afzelii, B. burgdorferi, B. garinii in Europe and Asia
Borrelia mayonii
the upper midwestern U.S.
Borrelia afzelii, B. burgdorferi, B. garinii
in Europe and Asia
Ixodes ticks
hard ticks. Hard ticks have a plate called a scutum on the dorsum and mouth parts visible when viewed from above.
Ixodes scapularis
in the eastern and north central North America
Ixodes pacificus
in northern California and Oregon
Ixodes persulcatus
in Asia and Eastern Europe
Ixodes ricinus
in Europe and Western Asia
Reservoirs of Borrelia Spirochetes Causing Lyme Disease
In the northeastern U.S it is mainly the white-footed mouse, but chipmunks, voles, shrews, and birds can also serve as reservoirs.
T/F
The mouse maintains a spirochetemia with no symptoms.
True
T/F
In Europe songbirds are the reservoir of B. garinii, in Japan, rodents are the reservoir.
True
Deer and Lyme disease (Exam)
Deer are important for the tick survival (adults feed and winter over on deer), but the deer do not support the survival of the spirochete, as complement in the deer is lytic.
T/F
In the southern U.S., lizards can be hosts for ticks, but lizards are relatively refractory to Borrelia burgdorferi (zoo-prophylactic host)
True
Birds and Lyme disease
Birds are phoretic hosts, carrying the ticks and spirochetes to Canada where the spirochete enzootic cycle is not well established.
% of recall a tick bite in early lyme disease
Only 25% of patients recall a tick bite
T/F
Lyme disease -Erythema migrans progression less than 2 weeks
False
Over 2 weeks
Early Disseminated Lyme Disease occurs within ( ) weeks of the illness
Occurs within 2-3 weeks of the illness
Manifestations from Early Disseminated Lyme Disease
(Exam)
1) Multiple skin lesions of erythema migrans (bacteremic spread back to the skin)
2) Carditis manifested by heart block (first, second, and third degree), at times with myopericarditis
3) Lymphocytic meningitis, cranial nerve palsy(ies), cerebellar ataxia, encephalomyelitis
4) Ocular abnormalities-conjunctivitis (common) with keratitis, iridocyclitis, retinal vasculitis, choroiditis, and/or optic neuropathy possible but not common
T/F Early Lyme disease can cause the 7th cranial nerve palsy
True
T/F Early Lyme disease can cause the carditis
True
Late Lyme Disease
Occurs months to even years after the onset of infection.
Adult, Nymph ,and female only
Late Lyme disease associated with (Exam)
1) Arthritis
2) Peripheral neuropathy, encephalopathy
3) Acrodermatitis chronica atrophicans
Late lyme disease and arthritis
Arthritis
Intermittent swelling (effusion) of one or a few joints, often the knee
Without treatment can be relapsing and resolve over a long period or become chronic
Late lyme disease and Acrodermatitis chronica atrophicans
Acrodermatitis chronica atrophicans
Occurs 6 months to 8 years after onset, in Europe, due to B. afzelii
Extensor surfaces of the hands and feet; bluish-red, edema, then atrophy
T/F
Lyme disease during pregnancy can cause congenital issues
False
There is no definable congenital Lyme disease syndrome.
Pregnant women are treated as are other patients, but doxycycline or tetracycline are not used.
Coinfections seen with Lyme Diseas
Babesia microti (the cause of babesiosis) and Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis) may each be seen in patients with Lyme disease, as the Ixodes ticks can transmit each of the three pathogens.
Coinfections seen with Lyme disease
1) Babesia microti (the cause of babesiosis)
2) Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis)
T/F
The diagnosis of lyme disease is based on serology, with antibody taking at least two weeks to develop.
True
T/F
A positive ELISA screen must be confirmed with a Western blot
to diagnose the Lyme disease
True
T/F There are many false positive IgG test results, making IgG of limited value
Flase
There are many false positive IgM test results, making IgM of limited value
T/F Once a patient has Lyme, the IgM bands may persist for many years.
False Once a patient has Lyme, the IgG bands may persist for many years.
T/F A positive IgG Western blot only indicates infection at some point in time, not necessarily active.
True
Always rule out concomitant ( ) and () infections
Always rule out concomitant Anaplasma and Babesia infections
T/F Culture of Borrelia burgdorferi culture is not available in most clinical labs.
True
How do you isolate spirochete?
In research studies, the spirochete has been isolated from blood, CSF, and skin biopsies.
How to treat early lyme disease?
Doxycycline, amoxicillin, or cefuroxime
How to treat Carditis associated with early lyme disease?
Doxycycline or IV ceftriaxone or IV penicillin with an anti-inflammatory medication
How to treat late lyme disease
Doxycycline, amoxicillin, IV ceftriaxone, or IV penicillin for arthritis
IV ceftriaxone or IV penicillin for peripheral neuropathy
Erythema migrans develops ( ) days after the tick bite, usually within ( ) days; seen in ( ) of patients.
Erythema migrans develops 1-31 days after the tick bite, usually within 7-14 days; seen in 80% of patients.
Locations of erythema migrans
Often near axilla, inguinal region, popliteal fossa, belt line
Features of EM
Expands in size over days
Central clearing, targetoid appearance are common; central blistering can be seen
Border is clearly demarcated
Multiple lesions indicate early dissemination, not multiple bites
Systemic symptoms associated with Early lyme disease
Fatigue, fever, chills, headache, stiff neck, myalgias, arthralgias are commonly seen.
Coinfections seen with Lyme disease
1) Babesia microti (the cause of babesiosis)
2) Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis)
3)
