Lyme disease is a tick-borne illness caused by the Borrelia burgdorferi bacteria transmitted through the bite of an infected blacklegged tick; the highest risk areas are the Northeast, Mid-Atlantic, Wisconsin and Minnesota. Symptoms may include a characteristic bullseye rash called erythema migrans along with fever, headache, and fatigue, and if left untreated it can spread to the joints, heart and nervous system.

1. Lyme Disease 2015
March 9, 2015
Daniel M. Sullivan MD FACP
Medicine Institute

2. What is it?
• Lyme Disease is a tick borne illness
• Bacteria is transmitted under the
skin through a tick bite.
• Borrelia Burgdorferei in the United
States
- Blacklegged ticks are the source

3. Blacklegged Ticks (Ixodes scapularis)
http://www.cdc.gov/lyme/transmission/blacklegged.html

4. Ticks need 36 hours of
attachment to transmit disease
• The ticks are often in the nymph stage
• 2 mm in size

5. Ixodes scapularis ticks demonstrating changes in
blood engorgement after various durations of
attachment
Gary P. Wormser et al. Clin Infect Dis. 2006;43:1089-1134

6. Typical Symptoms
• Fever
• Headache
• Fatigue
• Rash

7. Erythema Migrans
• Rash is called Erythema Migrans
• Looks like a red bulls eye with a white
center
http://www.cdc.gov/ticks/symptoms.html

8. If Untreated
• Spreads to Joints
• Heart
• Nervous System

9. Diagnosis is Based on
Symptoms
• Red expanding rash
• Fatigue, Chills, Fever
• Headache, Muscle, and Joint Aches
• Swollen Lymph Nodes

10. Lab Testing
• Should be done if exposed to
blacklegged ticks and have symptoms

11. Treatment
If diagnosed with symptoms & lab
testing…..
Most cases resolve with a few weeks of
antibiotics

12. Prevention
• Daily visual inspection of skin & clothes
• Use insect repellent
• Remove the tick promptly
• Reducing tick habitat
http://www2.epa.gov/insect-repellents

13. Prevention
1. Once the tick has been isolated
and clearly visible and free from
obstruction, place the wide part
of the notch on the skin near the
tick (hold skin taut if necessary).
2. Applying slight pressure
downward on the skin, slide the
remover forward so the small
part of the notch is framing the
tick. Continuous forward sliding
motion detaches the tick. (Do not
pry, lever or lift up - slide
forward.)
3. Clean your tick remover with
alcohol or similar disinfectant.
4. Although the spoons can be
disinfected, please use your
spoon only.
How to Remove a Tick Using a Tick Spoon Remover

14. Where is the Highest Risk
• Northeast and Mid-Atlantic
• Wisconsin and Minnesota
• Northern California

15. Reported cases of Lyme disease, United
States, 2013
Though Lyme disease cases have been reported in nearly every state, cases are reported
from the infected person’s county of residence, not they place where they were infected.
http://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf

16. Reported Lyme disease cases in the United
States from 1990-2013
http://module.lymediseaseassociation.net/Maps/

17. Can the Blood Test be
Wrong?
• Often the test is negative during the
rash stage of the illness in the first few
weeks

18. If the Blood test is still
positive is infection still
present?
• The blood test measures antibodies
and stays positive for years.

19. Standard Treatment
• Early disease is treated with
doxycycline or amoxicillin
• Later disease in the nervous system
may need intravenous antibiotics

20. Questions
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