Symptoms of chronic Lyme Disease can include headaches, joint pains, neck stiffness, photophobia (sensitivity to light), stomach problems, tinnitus (ringing in the ears), visual disturbances, palpitations, dizziness, impairedmemory and concentration, seizures, severe fatigue, mood disturbances, and pins and needles in the hands and feet.
2. 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
Further investigation revealed that Lyme disease is
caused by the bacterium
4. Ticks that cause Lyme
disease
Lone Star Tick
Black-legged Tick
Rocky Mountain Tick
5. Three Stages of Disease
Localized rash – erythema chronicum migrans
Dissemination to multiple organ systems
Chronic disseminated stage often with arthritic
symptoms
7. Dissemination
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
migratory joint and muscle pains
Late disseminated Lyme disease is intermittent
swelling and pain of one or a few joints.
may
include
9. Diagnosis
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.
10. Serology
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
11. 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.
12. 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.
13. Treatment
Single dose doxycycline shortly after
tick bite.
Lyme disease give doxycycline followed
by amoxacillin
Neuroborreliosis requires IV antibiotic
therapy.
14. Address: SUITE 3A, EDGECLIFF COURT, 2 NEW McLean
ST, EDGECLIFF, NSW 2027
Email: info@drpeterdobie.com
Telephone: 02 9362 0493
Fax: 02 9363 0767
Dr. Peter Dobie
Thank You