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In contrast, untreated control dogs showed mild to moderate lesions in multiple joints at the time of necropsy, characterized by mononuclear cell infiltrates dominated by plasma cells below the synovial membrane. In addition, plasma cell infiltrations were observed in the tunica adventitia of arteries periarteritis located in the joint capsules of the tarsal joints from all untreated control dogs. The evaluated lymph nodes, which drained large joints and the area of tick attachment left axillary and superficial cervical lymph nodes , appeared normal or showed mild to moderate cortical hyperplasia in untreated as well as in antibiotic-treated dogs.
In addition, a set of 36 buffy-coat samples collected from each dog at 2-week intervals was subjected to PCR. Results are summarized in table 3. During the first 3 months after tick exposure, skin-punch biopsy samples were uniformly positive by culture and by PCR, with only 1 exception. The semiquantitative PCR technique showed clearly that 4 months after tick exposure the quantity of B. After antibiotic treatment, none of the skin-punch biopsy samples and none of the postmortem tissue samples were positive by culture in dogs that had received azithromycin, ceftriaxone, or doxycycline.
At necropsy, 1 to 19 samples of a total of 25 tissue samples were positive by culture and 4—10 by PCR in the 4 control dogs. Testing over individual buffy-coat samples by PCR was not very rewarding, with only 9 positive samples. Positivity of buffy-coat samples occurred at various times throughout the experiment. Results of assays for B. Lanes 1—4 show results before treatment was initiated in the antibiotic treated dog.
Lanes 5—17 show the sporadic detection of B. Specificity of the amplified DNA was verified by Southern blotting, which shows 2 amplicons of different size for B. The right part of the blots shows a titration of B. The canine actin gene was used to assure satisfactory quality and constant quantity of the DNA tested in the experiment. Regular quality assessments of our test systems revealed that by culture we were able to detect a minimum of 1 high-passage spirochete per inoculum data not shown , and 1—10 B.
Cross-contamination was monitored with test tubes containing DNA-free water distributed between the actual samples. These sham samples received the same treatment DNA extraction, transfer, and dilution; PCR amplification as did the tissue samples. In addition, tissue samples from an uninfected dog were extracted and subjected to PCR amplification according to our standard procedure and with the same equipment. Of the 16 tick-infected dogs, episodes of lameness were not seen after approximately day after infection with the exception of that which occurred in 2 dogs. It was of interest to determine whether immunosuppression by corticosteroids would reactivate clinical disease even after antibiotic therapy.
Eight dogs 2 of each group were dosed orally with prednisone for 14 consecutive days, starting and days after the first tick exposure in antibiotic-treated and untreated control dogs, respectively. During the day treatment period, no clinical signs were observed, and, subsequently, all dogs previously treated with antibiotics remained free of clinical disease.
Pain and joint swelling was detectable in large joints of all 4 limbs. Both dogs recovered without medical intervention within 7 and 5 days after the onset of lameness and did not show any additional signs of arthritis during the remaining time of the experiment. Figure 2 shows that antibody titers were not affected by corticosteroids during and after their administration.
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Plasma was drawn before treatment and on the seventh and fourteenth day of treatment, 45 min after dosing orally with prednisone. To investigate whether immunosuppression immediately before necropsy would reactivate latent infection and so yield a higher percentage of positive tissue samples by culture or PCR, we dosed 8 dogs 2 from each group; 4 dogs previously treated with prednisone and 4 dogs which had not received prednisone previously orally with prednisone for 14 consecutive days before euthanasia.
None of the antibiotic-treated dogs became culture positive because of terminal prednisone treatment table 3. In both dogs that had not received antibiotics during the trial, 10 and 19 tissue samples from a set of 25 were culture positive for B. To establish the period for which Borrelia -specific DNA can be detected in mammalian tissue using our probes, we injected 1. PCR analysis revealed that B. A review of the current literature leaves one with the impression that there is considerable controversy with respect to the treatment of Lyme borreliosis and its efficacy.
Many different antibiotics are used during the early and late stages of the disease, may be given orally or intravenously, and it is unclear whether the spirochetal organisms are eliminated by therapy. These questions prompted us to use our well-characterized dog model of acute Lyme arthritis [ 5 , 15 ] to explore 3 different but relevant antibiotics, which are active either extra-and intracellularly azithromycin and doxycycline or only extracellularly ceftriaxone , when administered either orally azithromycin and doxycycline or intravenously ceftriaxone.
We chose to treat our experimentally infected dogs for 1 month and at the dose outlined in the method section to guarantee that the animals received therapy for an adequate time period and dosage. The effects of the different treatment regimens were monitored comprehensively with a large number of samples and parameters to assure that many possible variables were evaluated. Our laboratory has had considerable experience with experimental Lyme borreliosis in the beagle dog. We have found that 2 cycles of tick challenge are more likely to induce clinical arthritis than is 1 cycle.
After about the sixth month of infection, further episodes of clinical signs are not seen in most dogs, although the infection persists. Data from previous experiments [ 5 ] suggest to us that after skin challenge, the infection disseminates and the burden of infection progressively increases to some critical point at which joint inflammation is triggered.
The first episodes of acute arthritis are usually mono- or oligoarthritic, transitory, self-limiting, and probably induced by certain cytokines and chemokines such as interleukin-8 [ 5 ]. The absence of further episodes of arthritis after about the sixth month of infection may reflect the host's capacity to diminish the weight of infection to a low level insufficient to induce synovitis. This process may be evident in the 4 control dogs in this study table 3 , figure 4 , in which sequential skin biopsy samples were positive by culture and PCR for the first 4 months after infection and then often gave negative results.
However, these 4 dogs sustained high levels of specific antibodies against B. The apparent progressive decline in the burden of infection presumably occurs in response to the host's immunological reaction to the infection. The reactivation of severe polyarthritis in the 2 control dogs after a day course of prednisone apparently reflects a disturbance of the balance between subclinical infection and immunity.
It is noteworthy that at the time of corticosteroid treatment, these dogs had high titers of B. It is also worth mentioning, that both dogs developed severe polyarthritis after prednisone treatment rather than mono- or oligoarthritis. These observations imply that during late infection, the cellular arm of the immune system is crucial for efficiently maintaining the B. Specifically which elements of the host's immunity are responsible for maintaining the infection at a low level remains to be elucidated.
The data generated by this study indicate that at the time when disease manifestations are first appearing, antibiotic treatment of Lyme borreliosis has a long-term benefit for the patient. After all 3 antibiotic treatments, all but 1 dog showed no further clinical signs of spontaneous Lyme arthritis or after immunosuppressive therapy and at the time of necropsy showed only 1 minor joint lesion in 1 dog.
However, antibiotic treatment, documented by high therapeutic concentrations in plasma, frequently did not eliminate B. In antibiotic-treated dogs, B. The detection of borrelial DNA but not viable spirochetes in dogs more than days after antibiotic treatment is interesting and raises several questions. Do the data indicate an ongoing persistent infection in these animals or only the presence of DNA remnants of dead Borrelia ; and secondly, are currently used culture techniques sensitive enough to detect B.
From this study and our previous investigations [ 20 ], it appears likely that B. For example, KELA antibody titers soon fell in response to the antimicrobial drugs, presumably reflecting a progressively declining antigenic mass. Approximately 30—40 days after antibiotic therapy had ended, doxycycline-treated dogs showed constant intermediate antibody levels throughout the posttreatment time period, probably indicative of constant low-level antigen production and stimulation of the immune response.
In contrast, the other antibiotic-treatment groups showed a constant steady, slow decline in antibody titers. In our studies published elsewhere [ 20 ], similar treatment regimens were initiated earlier, at days 50 and 70 after tick exposure. With these protocols, we were able to culture live organisms from 3 antibiotic-treated animals more than 70 and days after therapy had ended. There seems to be a direct relation between the level of antibody titers in antibiotic-treated dogs and the success with which live organisms can be cultured from tissue samples.
In our model, tissue samples collected at necropsy were more likely to be positive in culture when antibiotics abrogated the antibody response to B. It can be asked whether reduced antibody levels after administration of antibiotics may reflect a more general decline in the host's immunological reactivity to the infection, which may even be detrimental in some chronically infected patients and perhaps explains the failure to eliminate the agent from the body.
Detection of microorganisms by PCR is limited by the fact that PCR does not distinguish between live and dead organisms. However, it seems very unlikely that DNA of nonviable organisms persists in mammalian tissue at detectable quantities for more than days. As demonstrated by the injection of heat-killed B. These results are in concordance with a study in which persistent experimental infection with Treponema pallidum , the spirochetal agent of syphilis, was identified by PCR [ 21 ]. The possibility exists that our PCR data contained false-positive results.
To avoid this potential problem, we performed a hazard analysis of all critical points of our procedure to limit and monitor DNA cross-contamination. Necropsy tissues of different dogs were collected on different days; DNA extraction, DNA amplification, and DNA analysis were performed in physically separated rooms; negative control samples containing DNA-free water were distributed among test samples; and tissue samples from an uninfected animals were included in the study.
Furthermore, we did not use a nested-PCR protocol, a technique that is based on 2 rounds of PCR amplifications and is thought to boost sensitivity. The protocol of a nested PCR requires handling of already amplified product and therefore is a potent source of sample contamination.
The questions remain of how this bacterial organism possibly evades the combination of host immunity and antibiotic therapy, and what is the specific effect of the antibiotics we used on the spirochetes. The organism is susceptible to common antibiotics in vitro, especially to those used in this study, although the responsiveness to antibiotics varies among different strains of B. Patients with acute Lyme borreliosis are normally highly responsive to therapy and even chronic cases show a favorable response to antibiotic treatment [ 23 ].
However, patients may show relapses weeks to years after antibiotic therapy [ 24 ], which raises the question of reinfection or reactivation of the primary infection. It appears that B. Alternatively, antibiotics may induce a change in their form from spiral to cystic bodies such that they are unable to actively proliferate in our culture system.
Recently, Brorsen and Brorsen demonstrated that the spirochete can change its form in vitro [ 27 ]. The authors have shown by culture and electron microscopy that B. These cysts survived unfavorable conditions for a long time and converted back into spiral-shaped organisms when transferred back into fresh medium. Interestingly, cystic forms were reported decades ago for other Borrelia species— B.
This may account for the positive PCR results in light of our evidence that DNA of dead spirochetes is detectable in tissue for no longer than 3 weeks. Finally, this comprehensive study provides additional information that extends beyond the issue of antibiotic therapy. We observed that PCR is not always superior to culture in detecting the presence of spirochetes.
In persistently infected dogs, which did not receive antibiotic treatment during the experiment, culture was as sensitive as PCR. An explanation for this observation might be the sample size. Cultures of all our tissue samples were prepared by use of the complete tissue sample after homogenization in a Stomacher. Consequently, it is not surprising that, especially during the late stage of infection when antibody levels were high and animals did not show clinical signs of Lyme borreliosis, tissue samples were likely to be positive in culture and not by PCR, considering a probable low level of infection with few organisms per tissue sample.
Our studies show that at least in the dog, blood is an unreliable tissue to demonstrate B. From a set of 36 buffy-coat samples per dog collected during the course of the experiment no more than 3 samples per dog were positive by PCR. Our titration produced with buffy coat cells of uninfected beagles inoculated with known numbers of B.
Therefore, it is likely that only rarely were Borrelia present in blood samples taken sequentially during the course of the experiment. This would substantiate our hypothesis that B. In conclusion, the canine model of acute Lyme arthritis has provided further insight into this disease. We demonstrated that chronic silent infection with B. Positive PCR results after therapy may reflect low-level persistent infection. Further research is needed to uncover the mechanisms that enable B. Max Appel for his help in this project. We are grateful to Mary Beth Matychak for her excellent technical assistance and to Patti Easton for superb testing of all our sera.
Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation. An Experimental Study Reinhard K. Abstract Sixteen specific-pathogen-free beagles were infected with Borrelia burgdorferi. View large Download slide. An avian reservoir Turdus merula of the Lyme borreliosis spirochete.
Borrelia burgdorferi migrates into joint capsules and causes an up-regulation of interleukin-8 in synovial membranes of dogs experimentally infected with ticks. Persistence of serum antibodies of Borrelia burgdorferi in patients treated for Lyme disease. OspA vaccination of mice with established Borrelia burgdorferi infection alters disease but not infection. Doxycycline versus tetracycline therapy for Lyme disease associated with erythema migrans.
Effectiveness of antimicrobial treatment against Borrelia burgdorferi infection in mice. Experimental Lyme disease in dogs produces arthritis and persistent infection. Simultaneous presence of different Borrelia burgdorferi genospecies in biological fluids of Lyme disease patients. Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment. Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of Lyme borreliosis. Ultrastructural demonstration of intracellular localization of Borrelia burgdorferi in Lyme arthritis.
Intracellular persistence of Borrelia burgdorferi in human synovial cells. Transformation of cystic forms of Borrelia burgdorferi to normal, mobile spirochetes.
Morphologic characteristics of certain cultured strains of oral spirochetes and Treponema pallidum as revealed by the electron microscope. Email alerts New issue alert. Receive exclusive offers and updates from Oxford Academic. Related articles in Web of Science Google Scholar. Outcomes with Expectant Management until 34 versus 35 Weeks. A comprehensive computational study. Intentional early delivery versus expectant management for preterm premature rupture of membranes at weeks' gestation: Most patients with neurologic complications of Lyme disease recover completely following treatment with antibiotics.
Those who do not respond are usually given an additional course of antibiotics. As of , however, treatment recommendations for central nervous system CNS complications of Lyme disease are still evolving, and there is ongoing disagreement among specialists regarding the effectiveness of various treatments for PLD. Two other trials are recruiting patients with Lyme disease in order to study the immune system's response to the disorder and to evaluate various treatment regimens.
Patients who are treated early with antibiotics and take their medications on schedule should recover completely from Lyme disease. Most long-term effects of the infection result from misdiagnosis or delayed treatment. Co-infection with such other tick-borne diseases as babesiosis and ehrlichiosis may lead to treatment failures or more severe symptoms. The few fatalities reported with Lyme disease occurred in patients who had also contracted babesiosis.
Neurologic symptoms of early disseminated Lyme disease may last for several months but usually resolve completely. Late neurologic complications of Lyme disease, however, may not respond to antibiotic therapy, particularly if diagnosis and treatment were delayed. Researchers from Cornell- New York Hospital presented a paper at the annual meeting of the American Neurological Association in October that identified nine patients with neuropathies linked to vaccination with LYMErix.
Neurological Complications of Lyme Disease. Box , Bethesda, MD Lyme disease is an infection transmitted by the bite of ticks carrying the spiral-shaped bacterium Borrelia burgdorferi. The disease was named for Lyme, Connecticut, the town where it was first diagnosed in after a puzzling outbreak of arthritis. The organism was named for its discoverer, Willy Burgdorfer. The effects of this disease can be long-term and disabling unless it is recognized and treated properly with antibiotics.
Lyme disease , which is also called Lyme borreliosis, is a vector-borne disease. This term means that it is delivered from one host to another. It is also classified as a zoonosis, which means that it is a disease of animals that can be transmitted to humans under natural conditions. In this case, a tick bearing the Borrelia burgdorferi organism literally inserts it into a host's bloodstream when it bites the host to feed on its blood.
It is important to note that neither Borrelia burgdorferi nor Lyme disease can be transmitted directly from one person to another, or from pets to humans. Controversy clouds the true incidence of Lyme disease because no test is definitively diagnostic for the disease, and many of its symptoms mimic those of so many other diseases. The disease is also found in Scandinavia , continental Europe , the countries of the former Soviet Union , Japan , and China ; in addition, it is possible that it has spread to Australia.
It is a significant public health problem and continues to be diagnosed in increasing numbers. The Centers for Disease Control and Prevention CDC attributes this increase to the growing size of the deer herd and the geographical spread of infected ticks rather than to improved diagnosis. In addition, some epidemiologists believe that the actual incidence of Lyme disease in the United States may be times greater than that reported by the CDC. The risk for acquiring Lyme disease varies, depending on what stage in its life cycle a tick has reached.
A tick passes through three stages of development — larva, nymph, and adult — each of which is dependent on a live host for food. In the United States , Borrelia burgdorferi is borne by ticks of several species in the genus Ixodes , which usually feed on the white-footed mouse and deer and are often called deer ticks. At this stage they are not a problem for humans. Although far more adult ticks than nymphs carry Borrelia burgdorferi , the adult ticks are much larger, more easily noticed, and more likely to be removed before the 24 hours or more of continuous feeding needed to transmit Borrelia burgdorferi.
Lyme disease is caused by Borrelia burgdorferi. That ability explains why symptoms can recur in cycles and can flare up after months or years, even over decades. It is important to note, however, that not many people who are exposed to Borrelia burgdorferi develops the disease. The rash — erythema migrans EM -generally develops within days and usually begins as a round, red patch that expands outward. The rash may look like a bruise on people with dark skin. However, a rash at the site can also be an allergic reaction to the tick saliva rather than an indicator of Lyme disease, particularly if the rash appears in less than three days and disappears only days later.
Weeks, months, or even years after an untreated tick bite, symptoms can appear in several forms, including:. Less common effects of Lyme disease are heart abnormalities such as irregular rhythm or cardiac block and eye abnormalities such as swelling of the cornea, tissue, or eye muscles and nerves.
A clear diagnosis of Lyme disease can be difficult, and relies on information the patient provides and the doctor's clinical judgment, particularly through elimination of other possible causes of the symptoms. Lyme disease may mimic other conditions, including chronic fatigue syndrome CFS , multiple sclerosis MS , and other diseases with many symptoms involving multiple body systems.
Differential diagnosis distinguishing kyme disease from other diseases is based on clinical evaluation with laboratory tests used for clarification when necessary. Doctors may not consider Lyme disease if it is rare locally, but will take it into account if a patient mentions vacationing in an area where the disease is commonly found. The treatment for Lyme disease is antibiotic therapy; however, overprescribing of antibiotics can lead to serious problems, so the decision to treat must be made with care.
Disease organisms can develop resistance to families of medications over time, rendering the drugs useless. Furthermore, testing and treatments can be expensive. If a patient has strong indications of Lyme disease symptoms and medical history , the doctor will probably begin treatment on the presumption of this disease.
The benefits of treating early must be weighed against the risks of over treatment. For most patients, oral antibiotics doxycycline or amoxicillin are prescribed for 21 days. When symptoms indicate nervous system involvement or a severe episode of Lyme disease, intravenous antibiotic ceftriaxone may be given for days. Supportive therapies may minimize symptoms of LD or improve the immune response. For example, yogurt and Lactobacillus acidophilus preparations help fight yeast infections, which are common in people on long-term antibiotic therapy.
In addition, botanical medicine and homeopathy can be considered to help bring the body's systems back to a state of health and well being. If aggressive antibiotic therapy is given early, and the patient cooperates fully and sticks to the medication schedule, recovery should be complete. As of late , the best prevention strategy is through minimizing risk of exposure to ticks and using personal protection precautions. Precautions to avoid contact with ticks include moving leaves and brush away from living quarters.
Most important are personal protection techniques when outdoors, such as:. In highly tick-populated areas, each individual should be inspected at the end of the day to look for ticks.
The two most important factors are removing the tick quickly and carefully, and seeking a doctor's evaluation at the first sign of symptoms of Lyme disease. When in an area that may be tick-populated:. Babesiosis — A disease caused by protozoa of the genus Babesia characterized by a malaria-like fever, anemia, vomiting, muscle pain, and enlargement of the spleen. Babesiosis, like Lyme disease, is carried by a tick.
Blood-brain barrier — A blockade of cells separating the circulating blood from elements of the central nervous system CNS ; it acts as a filter, preventing many substances from entering the central nervous system. Cerebrospinal fluid — Clear fluid found around the brain and spinal cord and in the ventricles of the brain. Disseminated — Scattered or distributed throughout the body. Lyme disease that has progressed beyond the stage of localized EM is said to be disseminated. Spirochete — A spiral-shaped bacterium.
The bacteria that cause Lyme disease and syphilis, for example, are spirochetes. Vector — An animal carrier that transfers an infectious organism from one host to another. The vector that transmits Lyme disease from wildlife to humans is the deer tick or black-legged tick. Zoonosis plural, zoonoses — Any disease of animals that can be transmitted to humans under natural conditions. Lyme disease and babesiosis are examples of zoonoses. Lyme disease , which is also known as Lyme borreliosis, is an infection transmitted by the bite of ticks carrying the spiral-shaped bacterium spirochete Borrelia burgdorferi Bb.
The disease was named for Old Lyme, Connecticut, the town where it was first diagnosed in , after a puzzling outbreak of arthritis. The spiral-shaped bacterium was named for its discoverer, Willy Burgdorfer. The effects of this disease can be long-term and disabling, unless it is recognized and treated properly with antibiotics. Lyme disease is a vector-borne disease, which means it is delivered from one host to another. In this case, a tick bearing the Bb organism literally inserts it into a host's bloodstream when it bites the host to feed on its blood.
It is important, however, to note that neither Bb nor Lyme disease can be transmitted directly from one person to another. In addition, some epidemiologists believe that the actual incidence of Lyme disease in the United States may be 5 — 10 times greater than that reported by the CDC. In the United States , Bb is borne by ticks of several species in the genus Ixodes , which usually feed on the white-footed mouse and deer and are often called deer ticks.
Because they are still quite small less than 2 mm in length , they are difficult to spot, giving them ample opportunity to transmit Bb while feeding. Although far more adult ticks than nymphs carry Bb, the adult ticks are much larger, more easily noticed, and more likely to be removed before the 24 hours or more of continuous feeding needed to transmit Bb. Lyme disease is a collection of effects caused by Bb. Once Bb gains entry to the body through a tick bite, it can move through the bloodstream quickly. Only 12 hours after entering the bloodstream, Bb can be found in cerebrospinal fluid which means it can affect the nervous system.
Treating Lyme disease early and thoroughly is important because Bb can hide for long periods within the body in a clinically latent state. It is important to note, however, that not everyone exposed to Bb develops the disease. Lyme disease is usually described in terms of length of infection time since the person was bitten by a tick infected with Bb and whether Bb is localized or disseminated spread through the body by fluids and cells carrying Bb.
Furthermore, when and how symptoms of Lyme. The area of rash eruption might be warm or itch. The rash — erythema migrans EM — generally develops within 3 — 30 days and usually begins as a round, red patch that expands. The rash may look like a bruise on individuals with dark skin. However, a rash at the site can also be an allergic reaction to the tick saliva rather than an indicator of Lyme disease, particularly if the rash appears in less than 3 days and disappears only days later.
Differential diagnosis distinguishing Lyme disease from other diseases is based on clinical evaluation with laboratory tests used for clarification, when necessary. While antibiotics are essential in treating Lyme disease, many alternative therapies may minimize symptoms, improve the immune response, and help treat late disseminated or chronic disease. General nutritional guidelines include drinking plenty of fluids and eating cooked whole grains and fresh vegetables. The intake of sugar, fat, refined carbohydrates, and dairy products should be reduced.
Alternative therapies used in treating Lyme disease include:. Antibiotics can kill Bb only while it is active, rather than while it is dormant. When symptoms indicate nervous system involvement or a severe episode of Lyme disease, intravenous antibiotic ceftriaxone may be given for 14 — 30 days. Co-infection with other infectious organisms spread by ticks in the same areas as Bb babesiosis and ehrlichiosis, for instance may be responsible for treatment failures or more severe symptoms.
In certain cases, Lyme disease has been responsible for deaths, but that is rare. The two most important factors are removing the tick quickly and carefully, and seeking a doctor's evaluation at the first sign of Lyme disease. Coping With Lyme Disease: Henry Holt , The disease was named for Lyme, Connecticut, the town where it was first diagnosed in , after a puzzling outbreak of arthritis. In this case, a tick bearing the B. It is important to note that neither B.
More than 99, cases were reported between and When the numbers for Lyme disease cases reported were tallied, there were 16, new cases, a record high following a drop in reported cases from 13, cases to 11, cases. Controversy clouds the true incidence of Lyme disease because no test is definitively diagnostic for the disease, and the broad spectrum of Lyme disease's symptoms mimic those of so many other diseases. Originally, public health specialists thought Lyme disease was limited geographically in the United States to the East Coast.
Now it is known that it occurs in most states, with the highest number of cases in the eastern third of the country. In the United States , B. It is the next stage, the nymph, that causes most cases of Lyme disease. Because they are still quite small less than 2 mm , they are difficult to spot, giving them ample opportunity to transmit B. Although far more adult ticks than nymphs carry B. Lyme disease is a collection of effects caused by B.
Once the organism gains entry to the body through a tick bite, it can move through the bloodstream quickly. Only 12 hours after entering the bloodstream, B. Treating Lyme disease early and thoroughly is important because B. It is important to note, however, that not everyone exposed to B. Lyme disease is usually described in terms of length of infection time since the person was bitten by a tick infected with B.
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The rash, erythema migrans EM , generally develops within 3 — 30 days and usually begins as a round, red patch that expands. Weeks, months, or even years after an untreated tick bite, symptoms can appear in several forms, including fatigue, neurological problems, such as pain unexplained and not triggered by an injury , Bell's palsy facial paralysis, usually onesided but may be on both sides , mimicking of the inflammation of brain membranes known as meningitis fever, severe headache, stiff neck , and arthritis short episodes of pain and swelling in joints.
Physicians generally know which disease-causing organisms are common in their geographic area. The physician may have to adjust the treatment regimen or change medications based on the patient's response. Treatment can be difficult because B. Finally, antibiotics can kill B. Co-infection with other infectious organisms spread by ticks in the same areas as B. Lyme disease has been responsible for deaths, but that is rare.
An genetically engineered vaccine for Lyme disease was made available in the United States in Immunity requires three injections, the first two given a month apart; a third injection given a year later. Clinical trials conducted in from a large study of 10, adults in many locations showed strong promise of the vaccine's safety and efficacy.
The Centers for Disease Control recommends the vaccine for those who live and work in Lyme disease endemic areas, and who have repeated and prolonged exposure to tick-infested areas e. The Lyme disease vaccine will not prevent other diseases spread by ticks, however, so protective measures against tick bites should still be observed. The vaccine is not recommended for travelers who will have little exposure when visiting areas where Lyme disease has occurred. Most important are personal protection techniques when outdoors, such as using repellents containing DEET, wearing light-colored clothing to maximize ability to see ticks, tucking pant legs into socks or boot top, and checking children frequently for ticks.
The cause initially eluded investigators, who found inconsistencies in the symptoms affecting inhabitants of Old Lyme, Connecticut, where it was first observed, and neighboring communities. The illness manifested itself in one or more symptoms, including fever, chills, lethargy, headaches, muscle aches, backaches, sore throats, nausea, and stiff necks. Some, but not all, victims incurred a rash that resembled a bull's-eye roughly six centimeters in diameter.
While most recovered, about 15 percent were left with neurologic problems and a few with life-threatening cardiac conditions. The disease initially appeared most frequently in the northeastern, north-central, and northwestern United States , in woods and transitional areas between woods and grassy fields. Investigators eventually traced the disease to ticks that transmitted the disease into the bloodstream by burying themselves in human skin. In Willy Burgdorfer of the Rocky Mountain Laboratories in Hamilton, Montana, identified the spiral-shaped bacteria, Borrelia burgdorferi, that causes Lyme disease.
By physicians had detected the disease in the southern United States. Reported cases grew from in to 8, in Symptoms seldom linger in victims who obtain early treatment with antibiotics, although as of doctors disagreed about how easy it is to diagnose the disease and about what to do for patients whose symptoms last beyond the typically effective four-week antibiotic treatment.
Some fear that using additional antibiotics too readily will expose patients to uncomfortable side effects and, worse, engender resistant bacterial strains of the disease. Johns Hopkins University Press, Coping with Lyme Disease. See also Medical Research. Lyme disease or Lyme borreliosis, a nonfatal bacterial infection that causes symptoms ranging from fever and headache to a painful swelling of the joints.
The first American case of Lyme's characteristic rash was documented in and the disease was first identified in a cluster at the submarine base in Groton, Conn. It became more widely known and received its common name when it struck a group of families in nearby Lyme, Conn. In the United States the disease occurs mainly in the northeast among people who frequent grassy or wooded areas; the disease is also prevalent in N and central Europe and temperate Asia. It is caused by the spirochetes of the genus Borrelia and is transmitted by the deer tick, genus Ixodes, which lives on deer, mice, dogs, and other animals.
The bite of the tiny red and black tick injects the bacteria into the blood. A red rash develops, often circular with a bull's-eye appearance, followed by flulike symptoms fever, headache, and painful joints. Most people are successfully treated with antibiotics. A small number develop chronic disease with neurological problems, memory loss, arthritis, and eye inflammation. Lyme disease is sometimes accompanied by babesiosis or human granulocytic ehrlichiosis , which also infect the deer tick.
Materials and Methods
See also Rocky Mountain spotted fever. Murray, The Widening Circle ; A. Karlen, Biography of a Germ ; J. Lyme disease is caused by the bacterium Borrelia burgdorferi Bb. The bacterium is carried by ticks and is transmitted to humans through a tick bite. The disease is named for the town of Lyme, Connecticut.
It was in Lyme that the disease was first discovered in , after a series of unexplained cases of arthritis developed. Lyme disease is a vector-borne disease. A vector is an organism that carries a disease from one organism to another. In this case, the vector is the tick. The tick carries the bacterium B. When the tick bites a human, it leaves some of its saliva, along with the bacterium, in the human's bloodstream. The bacterium begins to reproduce and spread. Eventually it causes the symptoms of Lyme disease. Lyme disease accounts for about 90 percent of all reported vector-borne diseases in the United States.
Nearly one hundred thousand cases of the disease were reported between and The true number of cases is difficult to estimate accurately. Some experts think that there are many more cases of the disease than are actually reported. A tick passes through three stages of development: The larva is an immature form of the tick.
It hatches from eggs laid on the ground in summer. Larvae attach themselves to small animals and birds and feed on their blood. At this point, the larvae are no threat to humans. Eventually, larvae develop into nymphs. Nymphs feed off humans. It is at this stage of a tick's life that it is the greatest threat.
A nymph can transmit Lyme disease if it bites a human. A nymph is too small to be seen easily seen, and as a result, people may be bitten without realizing it. Adult ticks feed off humans, mice, and deer. They are sometimes called deer ticks. They can still transmit Lyme disease, but they are larger and easier to see.
They are thus less of a threat to humans, who can pick them off quite easily. The Bb bacterium spreads quickly once it reaches the human bloodstream. It can usually be found in the cerebrospinal fluid CSF only twelve hours after a tick bite. Cerebrospinal fluid is the fluid found in the spinal column. The way symptoms develop following a tick bite varies widely among individuals. Some people have no symptoms at all. Others have a serious attack. Still others develop a chronic long-lasting form of the disease. One factor that complicates the symptoms of Lyme disease is the latency of the bacterium.
Latency means that the bacterium can become inactive for long periods of time. It has not died, but it does not cause any symptoms. Then, at some later date, the bacterium becomes active again and symptoms reappear. The first sign of Lyme disease is usually a rash around the site of the tick bite. It may be warm or itchy. In many cases, the patient may not even notice the rash. Over the next three to thirty days, the rash expands. The center of the rash may clear up, forming a bull's-eye pattern.
Or the center may become red. Other early symptoms of a Lyme infection include headache, fever, chills, fatigue, muscle and joint pain, and swelling of the lymph nodes. Many cases of Lyme disease go unnoticed and untreated. In such cases, new symptoms may appear a few weeks, months, or even years after the tick bite.
One problem in diagnosing Lyme disease is that its symptoms are similar to other disorders. The first task facing a doctor is to eliminate other possible explanations for a patient's symptoms. The doctor will perform tests to ensure that the patient does not have chronic fatigue syndrome see chronic fatigue syndrome entry , multiple sclerosis see multiple sclerosis entry , or some other disease with symptoms similar to those of Lyme disease.
An important aid in diagnosing Lyme disease is a geographical factor. Currently, Lyme disease occurs much more frequently in some parts of the United States than in others. The disease is quite rare in the Rocky Mountain states, for example, but relatively common in the Northeastern states. A doctor is aided in making a diagnosis if he or she can find out what part of the country the patient was in when he or she was bitten by a tick. Lyme disease is caused by a bacterium, so it can be treated with antibiotics.
In general, the earlier treatment begins, the greater the chance of success. The deciding factor is often the appearance of the characteristic rash. Some doctors are cautious about the use of antibiotics with Lyme disease. In many instances, doctor prescribe antibiotics for ailments when they are really not needed. The problem with this practice is that bacteria may become resistant to antibiotics and are no longer killed by drugs that were once effective.
Some doctors therefore wait until they are certain that a patient has Lyme disease before prescribing an antibiotic. A common goal of alternative treatments for Lyme disease is to strengthen overall body health. Practitioners may recommend vitamin and nutritional supplements for this purpose. In addition, some herbs are thought to be effective in treating bacterial diseases like Lyme disease. A popular choice for this purpose is the western herb spilanthes. The vast majority of patients who receive early treatment recover completely from Lyme disease.
The key is that patients remain on the prescribed course of medication as directed by the doctor. Stopping medication too soon can cause relapses and reoccurrence of the disease. A very small number of patients do not respond well to treatment. In the worst cases, people have died of the disorder.
However, this is rare. The approval for the vaccine, which is being manufactured by the U.
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The vaccine was one of two new products being tested. The other vaccine was being tested by the French firm of Pasteur Merieux Connaught. Some authorities have questioned whether a vaccine for Lyme disease is really needed. They point out that the disease can be diagnosed and treated quite easily. Members of the Lyme Disease Foundation have argued, however, that the vaccine will bring relief to countless people who may be exposed to the disease.
Researchers are currently testing vaccines against Lyme disease. Until they are approved, the best way to prevent Lyme disease is to avoid contact with ticks that carry Bb. Some general recommendations for people who spend time outdoors include:. Coping with Lyme Disease: Lyme Disease Foundation, Inc. Lyme LIME disease is a bacterial infection that is spread to humans by the bite of an infected tick.
Lyme disease was first described in when a group of children in and around Lyme, Connecticut, became ill with arthritis. In its early stage, Lyme disease produces flulike symptoms; if untreated, the disease. It is most commonly carried by very small, immature ticks of the Ixodes iks-O-deez group called deer ticks or black-legged ticks. Deer ticks spread Lyme disease in the northeast, midwest, and some other parts of the United States ; another kind of Ixodes tick, the western black-legged tick, is the source of Lyme disease in the western United States. Lyme disease also occurs in other countries such as China , Japan , and some countries in Europe.
Immature Ixodes ticks called nymph ticks are about the size of a poppy-seed. Adult ticks are only the size of a sesame seed. Lyme disease is not spread from person to person. It is spread by ticks that become infected with Borrelia burgdorferi after feeding on an animal, usually a mouse. To infect a human, the tick must be attached for at least 24 hours.
Just because people are bitten by a tick does not mean that they will get Lyme disease; most tick bites do not cause disease. More than 16, cases of Lyme disease occur each year in the United States , according to the U. Although cases of Lyme disease have been reported in nearly every state, most cases are reported from the northeastern states, including New York , Connecticut, Massachusetts, Rhode Island , New Hampshire , Pennsylvania , New Jersey , Delaware , and Maryland , and from Minnesota , Wisconsin , and California.
These areas contain natural habitats of Ixodes ticks. People who live, play, or work in tick-infested wooded areas or overgrown brush are most at risk of getting the disease. Lyme disease is most common during the late spring and summer months in the United States May through September , when ticks are most active and people are frequently outdoors. Within a few days to weeks after being bitten by an infected tick, about 80 percent of people develop a red circular rash known as erythema migrans air-uh-THEE-muh MY-granz at the site of the bite.
The rash may feel warm, but it is usually not painful or itchy. Some people have no noticeable symptoms or only have the non-specific, flulike symptoms such as fever and headache. As is evident in this map showing the occurrence of Lyme disease in the United States for the year , most of the cases came from the northeastern, north-central, and mid-Atlantic states. If untreated, Lyme disease can progress to the next stage, called the early disseminated stage, as the infection spreads and starts to affect certain body functions. This more advanced stage appears a few weeks to as long as 3 months after a bite by an infected tick.
A late stage of Lyme disease may develop weeks to years later if the disease remains untreated. Diagnosing Lyme disease can be difficult because the symptoms often look like those of other diseases. A known recent tick bite or the erythema migrans rash are often key to the diagnosis of Lyme disease. If any joints are swollen or signs of meningitis are present, joint fluid or spinal fluid is sometimes tested for Lyme disease. Some blood tests for Lyme disease can give false negative results, particularly if done within the first month after infection. False positive test results can also occur.
Because of this, doctors may have difficulty interpreting Lyme disease test results and confirming the diagnosis. Lyme disease is usually treated with antibiotics taken for 3 to 4 weeks. Antibiotics are usually taken by mouth, but in severe or advanced cases of Lyme disease they may be given by injection. If treatment begins at the early stage of the disease, a complete cure is likely; it generally takes a few weeks or months for the symptoms to go away. Sometimes symptoms recur, making it necessary for a patient to take another course of antibiotics.
Children usually recover from Lyme disease faster and with fewer complications than do adults. The best way to prevent Lyme disease is to prevent tick bites. Experts recommend avoiding areas that are likely to be infested with ticks, particularly in the spring and summer when nymph immature ticks feed. For any activity in tick-infested areas, it is wise to:. Applying insect repellents containing 10 percent DEET n, n-diethyl-m toluamide , which is safe to use on children and adults, on both clothes and exposed skin, and permethrin per-ME-thrin which kills ticks on contact on clothes, may also help reduce the risk of tick attachment.
If ticks are found attached to skin, they should be carefully removed with tweezers or forceps. A vaccine to prevent Lyme disease has been developed but is not currently available for use while it is being evaluated for possible side effects. American Lyme Disease Foundation, Inc. The American Lyme Disease Foundation provides information on Lyme disease and other tick-borne illnesses on its website. The Lyme Disease Foundation offers information on tick-borne illnesses and avoiding tick bites on its website.
National Center for Infectious Diseases , U. The website for this U. It contains articles on a variety of health topics, including Lyme disease. Lyme disease lym n. Treatment is with tetracycline or penicillin. It usually begins with a red rash, often accompanied by fever, headache, and pain in the muscles and joints. Untreated, the disease can lead to chronic arthritis, and there may also be involvement of the nervous system , heart, liver, or kidneys. It is treated with antibiotics. It is caused by the spirochete Borrelia burgdorferi , which is transmitted by ticks.
Lyme disease is an infection transmitted by the bite of ticks carrying the spiral-shaped bacterium Borrelia burgdorferi Bb. The effects of this disease can be long-term and disabling unless it is recognized early and treated properly with antibiotics. It is important to note that neither Bb nor Lyme disease can be transmitted from one person to another.
When the numbers for Lyme disease cases reported were tallied, there were almost 23, new cases. Originally, public health specialists assumed Lyme disease was limited geographically in the United States to the East Coast. It is now known that Lyme disease occurs in most states, with the highest number of cases in the eastern third of the country. In the United States , Bb is borne by ticks of several species in the genus Ixodes, which usually feed on the white-footed mouse and deer and are often called deer ticks.
Because they are still quite small less than 2 mm , they are difficult to spot, giving them ample opportunity to transmit Bb while feeding. Treating Lyme disease early and thoroughly is important because Bb can hide for long periods within the body in a clinically latent resting state. Furthermore, when and how symptoms of Lyme disease appear can vary widely from person to person.
The rash — erythema migrans EM — generally develops within days and usually begins as a round, red patch that expands. However, a rash at the site can also be an allergic reaction to the tick saliva rather than an indicator of Lyme disease, particularly if the rash appears in fewer than three days and disappears only days later. A two-laboratory-test approach using the same blood sample is common to confirm the results. Because of the potential for misleading results false-positive and false-negative , laboratory tests alone do not establish the diagnosis.
A physician may not consider a diagnosis of Lyme disease if it is rare locally, but will take it into account if a patient mentions vacationing in an area where the disease is commonly found. The treatment for Lyme disease consists of antibiotic therapy. The Infectious Diseases Society of America recommends a single dose of doxycycline for adults and children eight years of age and older for preventative treatment after a tick bite if several conditions are met.
The attached tick should identified as an adult or nymph I. Scapularis tick that is estimated to have been attached for 36 hours or longer, preventative treatment should begin within 72 hours of the time that the tick was removed, the local rate of infection of these ticks with B.
Longer courses of antibiotics are recommended for treatment of a person with a rash resembling EM or one who has arthritis, a history of an EM-type rash, and a previous tick bite. The benefits of treating early must be weighed against the risks of overtreatment.
Another concern is that insurance coverage for long-term antibiotic therapy may be limited by the insurer or by law in some states. For most persons, oral antibiotics doxycycline, amoxicillin, or cefuroxime axetil are prescribed for days. Corticosteroids oral may be prescribed if eye abnormalities occur.
Oral ceftriazine is also commonly prescribed for Lyme arthritis. A western herb, spilanthes Spilanthes spp. The best prevention strategy is through minimizing risk of exposure to ticks and using personal protection precautions. There is also research into vaccination against the tick vector to prevent the tick from feeding long enough to transmit the infection. Cerebrospinal fluid — Fluid made in chambers within the brain; this fluid then flows over the surface of the brain and spinal cord , providing nutrition to cells of the nervous system, as well as cushioning.
Vector-borne — Delivered from one host to another, as in an insect or tick bearing an organism causing an infectious disease. Liegner, Kenneth, and D. Centers for Disease Control. Disease History, Characteristics, and Transmission. Lyme disease is a bacterial infection caused by the spirochete corkscrew-shaped bacterium Borrelia burgdorferi.
It is transmitted to humans through the bites of several kinds of ticks, including deer ticks Ixodes scapularis and the western black-legged tick Ixodes pacificus in the United States and Ixodes ricinis in Europe. The untreated disease presents in two or three stages, starting with a localized infection that produces a skin rash and sometimes fever, headache, and other symptoms. The second stage may involve arthritis, neurological symptoms, such as depression and Bell's facial palsy, and meningitis inflammation of the membranes that enclose the central nervous system.
In the third stage, longterm arthritis and neurological symptoms may occur. The disease is treated using antibiotics. Earlier treatment is more effective, as the symptoms of untreated Lyme disease may take years to reverse or be irreversible. There is controversy between Lyme patient advocacy groups and many doctors about the existence of hard-to-detect, chronic Lyme infection and the advisability of treating such infections with antibiotics.
Lyme disease has probably existed for centuries. Judging by case records, observations of what was probably Lyme disease were recorded in Germany and Scandinavia in the late nineteenth and early twentieth centuries. Examination of museum specimens of deer ticks collected in the United States has detected Lyme disease bacteria dating to the s. In , some mothers in the town of Lyme, Connecticut—for which the disease is named—began noticing arthritis, fatigue, erythema migrans rashes, and other symptoms in about 50 local children. Two of these women, Judith Mensch and Polly Murray, began tracking the cases by recording dates and locations.
Several of the children recalled being bitten by a tick just before becoming ill. Murray called rheumatologist Allen Steer, who investigated the cases and concluded that a tick-borne pathogen was to blame for the disease. Thus, the existence of Lyme disease was recognized and its transmission by ticks was known in However, the specific pathogen causing the disease was still unknown. National Institutes of Health , was studying the transmission of Rocky Mountain spotted fever by ticks. Studying the microorganisms found in black-legged ticks one of the two U.
Within a year, this bacterium had been named Borrelia burgdorferi in Burgdorfer's honor. In , other researchers found Borrelia burgdorferi in deer ticks. By combining cultured B. This showed that the blood donors had been infected with B. Finally, in , researchers found B. In the years since , there has been persistent controversy over the question of whether Lyme disease can exist in a chronic form that is not detected by standard tests, causing a wide range of neurological and other symptoms that overlap with those of fibromyalgia and chronic fatigue syndrome.
There is also expert disagreement over the question of whether treatment of possible chronic Lyme infection with antibiotics is good medical practice. Lyme disease is caused by the spirochete B. Spirochetes are corkscrewor helix-shaped bacteria. In the space between the two layers are flagella. Each flagellum is a long, hairlike filament attached to a rotating base embedded in the outer cell wall.
Many types of bacteria have flagella, but normally the flagella protrude into the bacterium's environment and are used for propulsion like tiny outboard propellers. A spirochete uses a different strategy—its internal flagella wrap lengthwise around the inner layer of the bacterium, forcing it into its characteristic corkscrew shape. Furthermore, as the flagella rotate, they cause the whole shape of the bacterium to change as if it were rotating on its axis.
Just as an actual corkscrew is driven into a cork by rotating, a spirochete progresses through the medium in which it is embedded. Its corkscrewing mode of locomotion gives it a mobility advantage over other bacteria in more viscous thicker, stickier media. Both syphilis and Lyme disease are caused by spirochetes.