Lyme Disease

[Simon]

hint to sleepy owl to look at his flickr

Ah, that explains the new pictures...
1 - 2 - 3 - 4

[ifititches]

if you get your tick out you can even send it to the Health protection agency to help their research, see

http://www.hpa.org.uk/infections/topics ... ording.htm

( I need an on-line lesson in how to post links neatly without copying and pasting them. Cannot decipher the help instructions on post pages, but guess it's very straightforward once you know how)

there's lots more useful info on the HPA website. They're also holding a conference on it in a couple of week's time

it is "Lyme", not "Lyme's", disease (named after a place in USA) The rash is not always as florid as the picture on the HPA website shows, and isn't always specific for Lyme disease.

Barny, it's tea-tree, not tee-tree oil, but it can be an irritant, so suggest you just use an antiseptic cream if you think you've got it all out and are prone to getting redness afterwards.

Those "big tick" pictures are impressive! In the US, and presumably elsewhere, some ticks are huge though. There are lots of other exciting (to me) but also unplesant diseases they transmit too.

[graeme]

Here's what you're looking for...

http://www.aocd.org/skin/dermatologic_d ... sease.html
http://www.skinsite.com/info_lyme_disease.htm
http://www.bugwood.org/gfcbook/t.html

and now I'm meant to say "Just look at the pictures, don't try an internet diagnosis by reading the words, see your GP". Unfortunately, UK GPs don't seem to take Lyme seriously.

and you often don't get the rash.

Graeme

[John Morris]

Traditional Six Days recommendation:-

Tick removal: douse tick with cheap whisky (or cologne?); then twist vigorously.

Tick prevention: drink enough cheap whisky (or cologne?) before event to set up deterrent alcohol gradient; then try to avoid twisting vigorously.

Somewhat more seriously...

Is the circular rash a definite confirmation of Lyme disease, or just of unspecified tick-induced irritation?

And...

Are the antibiotics used specific for this condition, or will any normal antibiotics course clear the system?

Worried of Worthing...

[Mrs H.]

it is "Lyme", not "Lyme's", disease

That's why i named the thread Lyme Disease

Just noticed BOF have flagged up a front page news story on ticks - i wonder where they got that idea from

[ifititches]

Mrs H, you got it spot on, but quite a few unintentionally subversive posters since have used the "Lyme's" version.

And then one poster appealed for specialist input if they'd got their facts wrong, so couldn't resist the call!

Grovelling apologies to anyone who thought I was pernickety, but I send out results on blood tests for this as part of my work!

[Suzy R Sopham]

Following the coments of many posters that UK GP's don't have a clue about Lyme disease:
Print and take to your GP if you are at all concerned you may have Lyme Disease:

Lyme disease is a tick-borne illness which may produce a distinctive skin lesion - erythema chronicum migrans - caused by a spirochete Borrelia burgdorferi.

The disease was first recognised in Lyme, Connecticut when a large cluster of children developed arthritis.

It is transmitted to man by ticks of the genus Ixodes (in the UK Ixodes ricinus).

Pathogenesis

The spirochaete Borrelia burgdorferi is transmitted to humans by the nymphal form of the tick genus Ixodes. This infection is injected when the nymphs bite. They are at peak activity in spring and summer.

The main vectors are deer and small rodents; thus the disease is common where there are many deer.

B. burgdorferi is not present in the deer, but the tick mates and feeds on them. The female tick drops off, lays eggs which hatch and jump aboard mice, squirrels, sheep and birds.

B. burgdorferi is predominantly an extracellular pathogen.

Borrelia burgdorferi is the spirochaete that causes Lyme disease. Various features of this organism are as follows:

- length 10 - 30 micrometres
- width 0.2 - 0.25 micrometres
- can be cultured in artificial media - in contrast to Treponema pallidum
- has a linear chromosome and linear plasmids, in contrast to other bacteria

Epidemiology

- main reservoirs are thought to be various intermediate and small mammals including rodents belonging to the genera Apodemus
- birds help to distribute infected ticks during their migratory flights
- predominant tick that transmits B. burgdorferi to man in in the UK are the Ixodes ricinis and Ixidis persulcatus
- B. burgdorferi is believed to be transmitted in the saliva of the tick bite. B. burgdorferi is distributed in the midgut of the infected tick and within 24-72 hours it disseminates to other tissues, including the salivary glands. From here the spirochaete is inoculated into the next host.
- haematophagous insects, e.g. mosquitoes, horseflies, deer flies, may transmite B. burgdorferi
affects all age-groups
- early clinical manifestations peak from June to October
- late manifestations occur throughout the year

Clinical features

Like other spirochaetal diseases such as leptospirosis and syphilis the disease divides into 3 stages, although there is considerable overlap between the stages.

Thirty-three percent of patients remember the red macule or papule left by the nymphal tick bite.
early disease manifestations
Only one third of patients are aware of the bite which is a red macule or papule most commonly in the groin, the thigh and the axilla.

Days or weeks later the patient develops:

- erythema chronicum migrans
- constitutional symptoms:
- fever and headache
- stiff neck
- arthralgia and myalgia
- lymphadenopathy
- lethargy and fatigue
- hepatomegaly
- multiple secondary skin lesions
With or without treatment these initial clinical manifestations resolve within 3 to 4 weeks although the dermatologic manifestations may recur.
Medium term manifestations
Weeks or months later if the rash is untreated:

8% develop cardiac features:
myopericarditis, often in young males
and/or conduction defects - a PR interval of greater than 0.3 ms may herald complete heart block
15% get neurological manifestations, which usually occur within four weeks of the initial illness and resolve over 3 months:
meningoradiculoneuritis (Bannwarth's syndrome)
meningitis
cranial neuritis - usually VII, with palsy - very hard to distinguish from Bell's palsy
radicular neuritis
60% get brief attacks of arthritis, and oligoarticular arthritis usually of the large joints, particularly the knee, may occur
Other stage II features include:

secondary erythema chronicum migrans
eye disorders - conjunctivitis, iridocyclitis, choroiditis, optic neuropathy with papilloedema
hepatomegaly
hepatitis
very rarely, a dry cough or testicular swelling
late disease manifestations
Late disease manifestations occur months or years later if the rash has been untreated. These include:

erosive arthritis:
-mono or oligoarticular
-intermittent or chronic
acrodermatitis chronica atrophicans
chronic progressive encephalitis and encephalomyelitis (rare). Lyme encephalitis can be differentiated from multiple sclerosis because of the presence of a specific antibody in the CSF and a higher cell count.
other features include dilated cardiomyopathy and a dermatomyositis-like syndrome

Diagnosis

It is worth assessing the risks by considering the pathogenesis and clinical features of Lyme disease - negative serology does not exclude the diagnosis.

In more than half of people affected by this condition there is no history of tick bite.

The diagnosis is confirmed by serologic testing by indirect immunofluorescence or enzyme-linked immunosorbent assays. IgM peaks at 3-6 weeks; IgG appears more slowly and may take months or years.

The diagnosis is unreliable early. Check Treponema pallidum haemoglutination is negative before accepting a positive result.

The antibody is not affected by treatment. ESR is elevated.

Use of the polymerase chain reaction to detect the presence of Borrelia burgdorferi DNA in specimens from patients may become the most reliable means of determining who has been infected with this organism and when infection has been eliminated.

Treatment

Treatment depends on the stage of the disease.

Early disease (stage I):

treatment is with oral antibiotics. Alternative regimes include doxycycline 200 mg od for 14 days or cefuroxime 500 mg bd for 14 days. Note that doxycycline is contraindicated in children.

Early disseminated infection (stage II):
This stage of the disease is characterised by neurological, cardiac and ocular manifestations.
the carditis is generally self-limiting but may be complicated by life-threatening features such as third degree heart block. These must be managed as if they were due to any other aetiology. The carditis must also be treated with high dose IV antibiotics, e.g. cefotaxime, ceftriaxone or penicillin G.
neurological complications, e.g. Bannwarth's syndrome, are also treated with high dose IV antibiotics.
severe ocular manifestations also require parenteral antibiotic therapy.
effective antibiotic therapy of early disease generally prevents late disease.

Late disease (stage III) Is generally with high dose IV antibiotics, e.g. ceftriaxone.

Prognosis

Despite the popularly held belief that prognosis is grim, most people - especially children - treated have a good outcome. Prognosis is improved by early treatment, although adequate treatment of late disease should also be good. Previous poor prognostication has probably been based on misdiagnosis of Lyme disease in the first instance.

A small subset of patients who are predisposed to arthritic illness tend to have recurrence of the arthritis.

A very small subgroup of adults have been reported as developing late neuroborreliosis.

[J.Tullster]

its like christmas for the midges when im anywhere near, yet most people near me dont get bothered by them, yet im fair haired, and never had a tick.

To be fair Gaz, if I was a tick, I wouldn't want to touch you. Don't know where you've been...

[Barny of Blandford]

After reading all the information and looking at the web site postings my next query is how many people who orienteer have a jab? Is it recommended or suggested for this coutry and/or others or what?
Or am I worrying to much just because I have a habit of picking up ticks at events?
Any comments from medical types or those who have had the jab?

[bedders]

To be fair, I only had it because I'm going to Lithuania where its pretty damn common. You may have to pay for the Tick Bourne Encephylitis one, but its not too expensive, and you'd feel pretty gutted if you got the disease when you could have done something to avoid it. Just as a precaution if you're going to places like this, it should be worth it.

Then again I've heard of two orienteers having been to eastern europe to compete many times without the vaccination, not once have they had any trouble.

[CHS]

The jab is for Tick Bourne Encephylitis which isn't prevelent in this country so there is no point in having it unless you are going to Orienteer abroad somewhere it deemed to be risk.

[Dave]

You may have to pay for the Tick Bourne Encephylitis one, but its not too expensive,

not too expensive! 40 bloody quid for 0.5ml of gunk!

[bedders]

£40...or the possibility of ending up in a wheelchair. Its a bloody vicious illness.

[Blanka]

After reading all the information and looking at the web site postings my next query is how many people who orienteer have a jab? Is it recommended or suggested for this coutry and/or others or what?
Or am I worrying to much just because I have a habit of picking up ticks at events?
Any comments from medical types or those who have had the jab?

Barny, the reason is because people have got two diseases confused here.

Lyme disease is the one that the thread started about and that you CAN'T get vaccinated against.

Tick borne encephalitis has symptoms a bit like meningitis and you CAN get vaccinated against it. TBE is prevalent in many parts of central Europe and the Baltics, but not very much in Britain.

Hope this helps.

[grubby]

[quote="Adventure Racer"]How do you actually tell when you've got a tick? I'm not aware of ever having had one, despite having spent lots of time travelling through tick country where other people have reported getting loads of them. Am I simply immune / they don't like me, or have I not noticed?
quote]

. . . . . .obviously too much testosterone for the little blighters !