>appear within several weeks after the tick bite, even
Lyme disease
>is an infection caused by the bacteriumBorrelia
burgdorferi, usually found in animals such as
mice and deer.
>Ixodes ticks can pick up the bacteria when they
bite an infected animal, then transmit it to a
person, which can lead to Lyme disease.
Ticks
>live in shady, moist ground
cover
>cling to tall grass, brush,
shrubs, and low tree branches.
>attach themselves to a
suitable host as it passes by
>small and can be hard to see
Immature ticks, or nymphs,
>are about the size of a poppy
seed.
*Lawns and gardens may harbor ticks, especially
at the edges of woods and forests and around old
stone walls (areas where deer and mice, the
primary hosts of the deer tick, thrive).
Signs and Symptoms
Lyme disease can affect:
>skin
>joints
>nervous system
>other organ systems
*Symptoms, and their severity,
can vary from person to person.
Three Stages (though not everyone experiences
all stages)
Stage I Early localized infection
Erythema migrans-
>The first sign of infection
>Circular rash
> Appears within 1–2 weeks of infection
but may develop up to 30 days after the
tick bite.
>"bull's-eye" appearance, with a central
red spot surrounded by clear skin that is
ringed by an expanding red rash
>It may also appear as an expanding
ring of solid redness.
>It may be warm to the touch and is
usually not painful or itchy.
>difficult to see on people with darker
skin tones, where it may take on a
bruise-like appearance. The rash
usually resolves in about a month.
*Although this rash is considered typical of Lyme
disease, many patients never develop it.
flu-like symptoms:
swollen lymph nodes
fatigue
headache
muscle aches.
Stage II Early disseminated infection
>Left untreated, the infection can spread
to other parts of the body.
Symptoms:
>The person may feel very tired and
unwell, or may have more areas of rash
that aren't at the site of the bite.
in someone who has not developed the initial rash.
*Lyme disease Stage II can affect:
Heart
>leading to an irregular heart rhythm or
chest pain
Nervous system
>causing facial paralysis (Bell's palsy)
>tingling and numbness in the arms and legs
>headaches and neck stiffness, which may be a sign
of meningitis
Masculoskeletal
>Swelling and pain in the large joints can also occur.
Stage III Late persistent infection
Symptoms
>appear any time from weeks to years after an
infectious tick bite and include
>Arthritis particularly in the knees (adults)
>Cognitive deterioration
At Risk:
>depends on an individual's exposure to ticks
>Kids and adults who spend a lot of time outdoors —
particularly in or near wooded areas
>Lyme disease contracted during pregnancy may
infect the fetus.
>Domestic animals dogs, cats
*Nsg Advice
>Tell to the pet owner to talk with your veterinarian
about what kinds of tick-control products and other
protective measures you can take for your pet.
Diagnosis
Circular bull's-eye rash (Pathognomonic Sign)
>the most telling symptom of Lyme disease is the
>consider taking a picture of any suspicious rash on
your child if you are unable to see the doctor
immediately
Blood tests are not necessary
>Because the rash can rapidly disappear
Bull's-eye rash never formed
>Blood tests can help diagnose Lyme disease by
detecting the presence of antibodies to Borrelia
burgdorferi in the patient's blood
>can give inaccurate results if done within a month
after initial infection, since it takes time for the
antibodies to develop
> The bacteria may persist in the body for
months or even years, despite the production of anti-B.
burgdorferi antibodies by the immune system.[32]
*Lyme disease can be difficult to diagnose because it may
resemble many other medical conditions
Treating Lyme disease
Pharmacotherapy:
If diagnosed quickly and treated with antibiotics
>antibiotics administered for 3 to 4 weeks.
*Lyme disease in children is almost always treatable.
*The skin rash usually goes away within several days after
starting treatment,
*Other signs and symptoms may persist for several weeks.
Prevention
>Vaccination
-A recombinant
vaccine against Lyme
disease, based on the outer
surface protein A (OspA)
of B. burgdorferi, was
developed
byGlaxoSmithKline
-hundreds of vaccine
recipients reported that they
had
developed autoimmuneside
effects
-These claims were
investigated by the FDA and
the U.S. Centers for
Disease Control (CDC),
who found no connection
between the vaccine and
the autoimmune complaints
>avoid contact with soil, leaves, and
vegetation as much as possible,
especially during May, June, and July,
when ticks have not yet matured and
are harder to detect.
Management
>Ticks can bite anywhere, but they prefer certain
areas of the body, such as:
>behind the ears
>back of the neck
>armpits
>groin
>behind the knees
>If you find a tick on your child, call your doctor,
who may want you to save the tick after removal (you
can put it in a jar of alcohol to kill it).
>Use tweezers to grasp the tick firmly at its head
or mouth, next to your child's skin.
>Pull firmly and steadily on the tick until it let
goes, then swab the bite site with alcohol.
*Myths abound about ways to kill ticks (such as using
petroleum jelly or a lit match), but don't try them — these
methods don't work.
When to Call the Doctor
If your child has a bull's-eye rash or other
symptoms that can occur in Lyme disease —
such as swollen lymph glands near a tick bite,
general achiness, headache, or fever
— call your doctor right away.

>When you do venture into the great

outdoors, follow these tips:
>Wear enclosed shoes and
boots
>long-sleeved shirts
>long pants

>Tuck pants into boots or shoes to

prevent ticks from crawling up legs.

>Wear light-colored clothing to help you

see ticks easily

>Keep long hair pulled back or placed in

a cap for added protection.

>When outside, don't sit on the ground.

>While outdoors, check yourself and

your child frequently for ticks.

>Wash all clothes after leaving tick-

infested areas, and bathe and shampoo
your child thoroughly to eliminate any
unseen ticks

>Insect repellents containing DEET

(look for N,N-diethyl-meta-toluamide)
can help to repel ticks.
Choose one with a 10% to 30%
concentration of DEET.
Generally, DEET should not be
applied more than once a day,
and is not recommended for
babies younger than 2 months.
DEET can be used on exposed
skin, as well as clothing, socks,
and shoes, but should not be
used on the face, under
clothing, or on the hands of
young children.

You can help keep ticks away from your house by

keeping lawns mowed and trimmed; clearing
brush, leaf litter, and tall grass; and stacking
woodpiles off the ground.
 Pathophysiology of Lyme disease

B. burgdorferi is injected into the skin by the bite of an infected Ixodes tick.

The spirochetes multiply and migrate outward within the dermis.

appearance of the characteristic EM lesion

activation inflammatory response to the bacteria

The spirochetes may avoid the immune response by decreasing expression of surface proteins that
are targeted by antibodies, antigenic variation of the VlsE surface protein, inactivating key immune
components such as complement, and hiding in the extracellular matrix, which may interfere with the
function of immune factors.

Neutrophils fail to appear in the developing EM lesion

permitting the bacteria to survive

andbloodstream
The spirochetes spread via the eventually spread
to joints, heart, nervous system,
throughout the body
and distant skin sites

The spread of B. burgdorferi is aided by the attachment of the host

protease plasmin to the surface of the spirochete.
 B. burgdorferi In the brain

induce astrocytes to
undergo astrogliosis
(proliferation followed
by apoptosis),

The spirochetes may also induce host cells to

secrete products toxic to nerve cells,
including quinolinic acid and thecytokines IL-
6 and TNF-alpha,

which can produce fatigue and malaise.

Both microglia and astrocytes secrete IL-6

and TNF-alpha in the presence of the
spirochete. IL-6 is also significantly indicated
in cognitive impairment.

chronic secretion of stress hormones as a

result of Borrelia infection may reduce the
effect ofneurotransmitters, or other receptors in
the brain by cell-mediated pro-inflammatory
pathways,

mediated via thehypothalamic-pituitary-adrenal

axis

tryptophan, a precursor to serotonin appears to

be reduced
leading within
to the the centralofnervous
dysregulation neurohormones,
system(CNS)
specifically in a number of
glucocorticoids andinfectious diseases
catecholamines,
thatmajor
affect stress
neurodysfunction
the the brain, including Lyme
hormones