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LYME DISEASE

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

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  1. LYME DISEASE Mary Grace Stobierski, DVM, MPH, DACVPM Michigan Dept. Community Health

  2. Borrelia burgdorferi

  3. 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

  4. 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

  5. Reported Cases of Lyme Disease, United States 1982-1999

  6. Human Case Reporting

  7. 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

  8. Ixodes scapularis(formerly, I. dammini)

  9. Adult, female I.scapularis

  10. 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

  11. Peromyscus leucopus White-footed Mouse

  12. White-tailed deer

  13. 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

  14. Erythema migrans, with satellite lesion

  15. 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.

  16. Late Lyme Disease • Cardiac • Neurologic • Arthritis • Ocular • Dermatologic

  17. 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.

  18. Ecologic Field Survey

  19. 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

  20. 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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