Lymes Disease (Borreliosis) By Christer Suvatne

Introduction Spread by Ticks Caused by bacteria (borrelia) (Borrelia Burgdorferi) It causes borreliosis (lymes disease) The disease is multisystemic – involvement of skin, heart, joints and CNS Affects mostly young and middle-aged people

TICKS Blacklegged Tick (deer tick) Wood Tick (dog tick) (spreads Lyme disease) Wood Tick (dog tick) (does not spread Lyme disease) adult male adult female

Can lead to disease: 40-60% adult 20-30% nymph 0% larva (female) Adult (male) Nymph Can lead to disease: 40-60% adult 20-30% nymph 0% larva Larva

Two-Year Life Cycle of Blacklegged Tick MEAL 1 Mouse Bird EGGS LARVAE NYMPHS MEAL 2 (peak feeding time May-mid July) Person Mouse Dog Eggs laid, adults die Nymphs molt into adults MEAL 3 For adults that did not feed in fall Person Deer Dog SPRING SUMMER Larvae molt into nymph stage WINTER FALL To summarize, in the spring of year one, eggs hatch into larvae, have one feeding, molt into nymphs, and go dormant.  In year 2, nymphs take their second feeding.  At this time, the nymph may transmit bacteria to humans, or to wild or domestic mammals. In the fall, nymphs molt into adult male and female ticks.  The females feed, mate, lay eggs, and die.  ADULTS MEAL 3 Person Deer Dog Nymphs dormant

Blacklegged Tick Nymph

To Get Lyme Disease Blacklegged tick must be infected with Lyme disease bacteria Only the nymphs and adult females can transmit the Lyme disease bacteria Tick must be attached 24 - 48 hours before it passes bacteria to host In order to get Lyme disease, a person must be bitten by a blacklegged tick that is infected with the Lyme disease bacteria. Remember– not all blacklegged ticks are infected with the bacteria, so not all deer ticks transmit disease.  The tick must be attached for at least 24-48 hours to transmit the bacteria. The chance of getting Lyme disease increases the longer the tick is attached.

Most cases are children and middle aged people 54% is men Most usual symptoms is neurological (54%) (248ppl) Arthritis (15ppl) totally 238 people were hospitalized in 2006

Lymes Disease 3 stages

Stage 1 – Early localized infection 3 to 30 days after deer tick bite Rash (often “bulls-eye”) (red, warm, painless) Fever Chills Headache Muscle and joint pain Fatigue Flue like symptoms Can develop Borreliosis even if rash is not present

Erythema migrans (EM) rash characteristic of Lyme disease As the rash increases in size, it clears in the middle and develops a red ring around the outside.  This rash: May expand to a very large size, Is usually not painful or itchy, and Often appears on the thighs, groin, trunk, armpit, or back. rash has been reported in about 60 to 80 percent of adults and 50 percent of children

Sometimes do not have bulls eye appearance (redden area without an outer ring) Not everyone gets a rash.. the early sign and symptom. (headache, fever, chills etc) is similar to other diseases, so difficult to diagnose Lymes if have no rash

Stage 2 – Early disseminated infection Days to weeks after illness onset Multiple rashes Facial paralysis on one side (bells palsy) Fever, stiff neck, headache -> meningitis Weakness, numbness, arm/leg pain Irregular heart beat Persistent weakness and fatigue

Multiple Rashes Reaction as bacteria move through body Not caused by multiple tick bites A person may experience multiple rashes, such as you see here.  The rash is not caused from multiple tick bites, but occurs as a reaction when the bacteria move through the body.

Multiple Rashes This is another example of a multiple rash.

Stage 3 – Late persistent infection Weeks to months after illness onset Fatigue Chronic arthritis (usually affect knees) Nervous system problems (meningitis) and problems with short term memory, concentration,

Joint Swelling Joint swelling and pain may occur weeks to months after onset of illness if left untreated. This is an example of Lyme arthritis in the knee.  Joints may become red, swollen, and painful.  Lyme arthritis is generally periodic, but may become chronic in about 10 percent of people.

In Norway

Statistics 1997-2006

Showing numbers in Norway 2007 had the highest cases of lymes disease.

References www.facebook.com www.wikipedia.com http://www.lymediseaseassociation.org/ http://www.tidsskriftet.no/?seks_id=1690011