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LYME DISEASE. Mary Grace Stobierski, DVM, MPH, DACVPM Michigan Dept. Community Health. Borrelia burgdorferi. Lyme Disease/ History. 1908 Europe: Bannworth’s syndrome, chronic skin lesions associated with tick bites, later found to be penicillin responsive

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Lyme disease

LYME DISEASE

Mary Grace Stobierski, DVM, MPH, DACVPM

Michigan Dept. Community Health



Lyme disease history
Lyme Disease/ History

1908 Europe: Bannworth’s syndrome, chronic skin lesions associated with tick bites, later found to be penicillin responsive

1975 First description of Lyme arthritis - Old Lyme, CT. Cluster in children.

1983 Isolation of spirochetes from blood, CSF, and skin of patients with Lyme borreliosis

Spirochetes isolated from Ixodes sp. ticks

Willy Burgdorfer identified spirochetes as belonging to genus Borrelia


National case definition f or epidemiologic surveillance

National Case DefinitionFor Epidemiologic Surveillance

A case is defined as:

A person with Erythema Migrans at least 5 cm in diameter; or

A person with at least one late manifestation and laboratory evidence

CDC-1997




Reported lyme disease cases in michigan
Reported Lyme Disease Cases in Michigan

180

180

160

148

140

120

100

76

73

Year Reported

80

52

60

43

44

1991: New Case Definition

40

27

22

25

25

23

20

18

11

20

8

7

0

1984

1987

1990

1993

1996

1999

1984-2000


Ixodes scapularis formerly i dammini
Ixodes scapularis(formerly, I. dammini)


Adult, female

I.scapularis


Ixodes scapularis endemic vs adventitiously introduced
Ixodes scapularis endemic vs adventitiously introduced

  • Endemic

    • All three stages abundant

    • Present from year to year

  • Introduced

    • Only 1 stage - usually individual adults on deer

    • Not present in same location - year to year


Peromyscus leucopus
Peromyscus leucopus

White-footed Mouse



Early lyme disease clinical presentation
Early Lyme DiseaseClinical presentation

  • Incubation period:

    • 3 to 30 days after tick bite

  • Characteristic skin lesion:

    • erythema migrans (EM)

  • Systemic Symptoms Common:

    • malaise, fatigue, headaches, chills, low-grade fever, myalgias, arthralgias



Early lyme disease natural history
Early Lyme DiseaseNatural History

  • Erythema Migrans resolves within 3 to 4 weeks, even without treatment; resolves within days with antibiotics.

  • Minor systemic symptoms, especially fatigue.

  • In the absence of treatment most patients will develop other Lyme Disease manifestations.


Late lyme disease
Late Lyme Disease

  • Cardiac

  • Neurologic

  • Arthritis

  • Ocular

  • Dermatologic


Surveillance definitions
Surveillance Definitions

Surveillance: “The collection, collation and analysis of data and the dissemination to those who need to know.”

-A.D. Langmuir

Passive Surveillance: Health provider initiates reports.

Active Surveillance: Health Department initiates reports.



Ixodes Scapularis

Michigan Submissions

1985-1996

Keweenaw

2

Houghton

3

1

Ontonagon

8

2

Baraga

Gogebic

1

1

Luce

Marquette

Schoolcraft

Alger

1

Chippewa

Mackinac

3

Iron

Dickinson

Delta

9

6

Menominee

Emmet

241

Cheboygan

Presque Isle

Charlevoix

1

Otsego

Montmorency

Alpena

Antrim

Leelanau

Grand Traverse

Alcona

Benzie

Kalkaska

Crawford

Oscoda

1

Manistee

Wexford

Missaukee

Ogemaw

Iosco

Roscommon

Arenac

Gladwin

Mason

Lake

Osceola

Clare

Huron

2

Bay

Midland

Oceana

Mecosta

Isabella

Tuscola

Sanilac

Newaygo

Muskegon

1

Gratiot

Saginaw

1

1

Montcalm

1

3

1

St. Clair

Lapeer

Genesee

Macomb

Shiawassee

Ottawa

Kent

Ionia

Clinton

2

1

1

Oakland

Livingston

Allegan

Barry

Eaton

Ingham

2

1

Wayne

Calhoun

Washtenaw

Jackson

Kalamazoo

Van Buren

4

1

Branch

Cass

Berrien

St. Joseph

Lenawee

Monroe

Hillsdale


Most common tick submissions 1985 1996
Most Common Tick Submissions 1985-1996

No. on:

Tick

No. Submitted Human Dog Other

2554 1302 708 542

824 63 23 737

190 156 17 17

554 103 168 283

333 121 139 73

D. variabilis

D. albipictus

A.

americanum

I. cookei

I. scapularis


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