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Lyme’s Disease. Introduction. Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, CN Conditions suggested that this was an infectious disease probably transmitted by an arthropod

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  • Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, CN
  • Conditions suggested that this was an infectious disease probably transmitted by an arthropod
  • Further investigation revealed that Lyme disease is caused by the bacterium
causative organism
Causative Organism
  • Borrelia burgdorferi
  • Loosely coiled spirochete
  • 8-20 micrometers
  • Ixodes scapularis ticks are much smaller than common dog and cattle ticks
  • Below adult female, adult male, nymph, and larva on a centimeter scale.
  • Humans acquire disease from bite of nymphal or adult tick.
three stages of disease
Three Stages of Disease
  • Localized rash – erythema chronicum migrans
  • Dissemination to multiple organ systems
  • Chronic disseminated stage often with arthritic symptoms
  • Signs of early disseminated infection usually occur days to weeks after the appearance of a solitary erythema migrans lesion
  • Neurologic – Bell’s Palsy
  • Musculoskeletal manifestations may include migratory joint and muscle pains
  • Late disseminated Lyme disease is intermittent swelling and pain of one or a few joints.
chronic disseminated
Chronic Disseminated
  • Chronic arthritis
  • Chronic axonal polyneuropathy
  • Lyme disease morbidity may be severe, chronic, and disabling.
  • Rarely, if ever, fatal
  • Diagnosed clinically, confirmed serologically.
  • Often appropriate to treat patients with early disease solely on the basis of objective signs and a known exposure.
  • CDC recommends testing initially with a sensitive first test, ELISA or an IFA test, followed by testing with the more specific Western immunoblot (WB) test to corroborate equivocal or positive results obtained with the first test.
  • Patients with early disseminated or late-stage disease usually have strong serological reactivity
  • Antibodies often persist for months or years following successfully treated or untreated infection.
  • seroreactivity alone cannot be used as a marker of active disease
problems with serology
Problems with Serology
  • IFA false positive may occur if patient has syphilis, relapsing fever or RA.
  • IFA interpretation highly subjective
  • EIA lacks sensitivity in early disease.
  • EIA false positives with syphilis, other treponemes, IM and autoimmune disease.
western blot
Western Blot
  • Must be used if the Lyme IgG/IgM antibody serology is equivocal or positive
  • "Osp" refers to outer surface protein of the bacteria.
  • "kDa" is the abbreviation for "kilodalton," which is used for molecular weight designations.
  • Lyme antibodies of importance are against the following molecular weights of the B. burgdorferi antigens: 23-25 kDa (Osp C); 31 kDa (Osp A); 34 kDa (Osp B); 39 kDa; 41 kDa; and 83-93 kDa7.

Lane 1, monoclonal antibodies defining selected antigens to B. burgdorferi Lane 2, human serum (IgG) reactive with the 10 antigens scored in the currently recommended criteria for blot scoring; lines indicate other calibrating antibodies. Molecular masses are in kilodaltons.

  • Single dose doxycycline shortly after tick bite.
  • Lyme disease give doxycycline followed by amoxacillin
  • Neuroborreliosis requires IV antibiotic therapy.