Lyme Disease

Prevention, Diagnosis, and Treatment

Keith Berndtson, MD

Preventing Tick BitesOn People

1. Avoid direct contact with ticks by avoiding wooded or bushy areas and walking in the center of trails.

2. Repel ticks with DEET >20% placed on skin (avoid hands, eyes, and mouth) and use permethrin-treated clothing.

3. Find and properly remove ticks from your body, gear, and pets. a. Inspect clothes, dryer-tumble in high heat for 10 minutes.b. Inspect children, gear, and pets before entering house. c. Bathe or shower within 2 hours.d. After shower use two mirrors to do a full body check with special attention to hair, ears, armpits, and groins.

www.travelreadymd.com/how-to-make-your-clothing-insect-repellent/

DEET Lemon Eucalyptus

Preventing Tick BitesOn Pets

1. Check pets for ticks daily, best right after being outside.

2. If a tick is found, remove it right away.

3. Ask the vet to do a tick check with each exam.

4. Consult your vet about tick repellents for your pet.

5. Reduce tick habitat in your yard.

6. Use tick collars* for dogs and cats.

*(contain propoxur, S-methoprene so consult your vet)

Preventing Tick Bites

1. Use landscaping principles to create tick-safe zones.

2. Mow frequently and keep leaves raked.

3. Clear tall grasses and brush from around the home.

4. Place a 3-ft. gravel barrier between lawns and wooded areas.

5. Keep playgrounds and furniture away from wooded edges.

6. Stack wood, keep it dry, and reduce habitat for rodents.

In the Yard

How to Remove a Tick1. Use fine or special tweezers to grasp tick as close to the skin as possible.

2. Pull upward with steady pressure to avoid leaving mouth in the the skin.

3. If mouth remains in skin, remove it. If buried, leave it and monitor.

4. Clean the bite zone and your hands with alcohol, then soap and water.

5. Do not use nail polish or intense heat to remove ticks.

6. Save the tick in a baggie or under clear tape on white paper.

Identifying a Tick

Embedded Deer Tick larva

Deer Tick mouth parts

Lyme diseaseBabesiaBartonellaEhrlichiaAnaplasmaPowassan virus

Rocky mtn.spotted fever

B. americanaB. andersonii

EhrlichiaBorrelia?

July 2012 Illinois Tick survey

56.4% of over 1,067 ticks collected from 17 sites in Cook, Lake, McHenry, and DuPage counties were deer ticks.

Dispersal of Borrelia burgdorferi by songbirds can help account for the dramatic increase in the incidence of tick-borne diseases in North America and Europe over the past 16 years.

Bloated tick on a Cedar Waxwing

The Deer Tick Life Cycle

Year 1:1. 100 Adult Ticks Lay Eggs Assume: 2500 Eggs per Tick

2. 250,000 Eggs Total Assume: 80% Hatch

3. 200,000 Larvae Assume: 10% Find a Host, Feed, and Molt

Year 2:4. 20,000 Nymphs Assume: 10% Find a Host, Feed, and Molt

5. 2000 Adult Ticks Assume: 10% Mate, and Lay Eggs

6. 200 Adults Lay Eggs, Complete the Cycle RESULT:Double the starting population in two years.

A Crude Model for Deer TickPopulation Expansion

Signs of Lyme Disease

Lyme Arthritis

•Migrating oligoarthritis (one or a few larger joints at a time, changing over time).

•Occurs in > 60% of untreated Lyme patients.

•Variable response to antibiotics and anti-inflammatories. Best results with early treatment.Classic Bull’s Eye Classic Bell’s Palsy

Symptoms of Lyme Disease

1. CDC website woefully inadequate on this subject.

2. Over 50 symptoms documented for acute and persistent Lyme.

3. Early dissemination: days to weeks.

4. Late dissemination: weeks to months.

5. Main destination: matrix tissuea. Jointsb. Heartc. Brain and nervous systemsd.Various other organs

6. Common with late dissemination:a. Severe fatigueb. Joint and muscle achesc. Depression, anxietyd. Memory loss, brain foge. Poor sleep

Diagnosis and Testing

1. CDC website woefully inadequate on this subject.

2. Two-step method averages a 50% false negative rate.

3. Virginia and Maine passed laws requiring MDs to inform patients that a negative two-step test does not rule out Lyme disease.

3. To avoid persistent Lyme, early detection is essential.

4. IgX method misses fewer cases than 2-step method.

5. iSpot Lyme test: only 16% false negatives and only 6% false positives.

7. The search is on for tests with better abilities to rule in (sensitivity) and rule out (specificity) cases of Lyme and associated diseases.

ILADS

TreatmentPatients Caught in the Crossfire

Given the lack of reliable biomarkers for use in monitoring responses to therapy for chronic Lyme disease, outcomes evaluation must rely on methods for assessing the subjective dimensions of the patient’s experience with therapy.

Physical Symptoms

Social

Mental

OverallFunction

Outlook ILADS

??

Who will help me?

The Rationalists The Empiricists

Finding reasonsto treat

Finding reasons not to treat

What are doctors to supposed to do?

Evidence for Immune Evasion and Persistent Infection in Lyme Disease

2. Bb uses host proteins, antigen masking and variation, elite motility skills, strategic niche-seeking, horizontal gene transfer, atypical forms, biofilm-like behavior, and antibiotic tolerance to help it persist within mammalian hosts.

1. Bb has an unusually adaptive combined genome that encodes for a powerful set of immune evasion capabilities.

3. In mice and primates, Bb subsets are proven to remain viable and infective despite culture negativity following antibiotic challenge.

4. Immune suppressed mice are more susceptible to the reactivation of viable Bb that persist despite antibiotic challenge.

5. Solid evidence supports the existence of persistent Lyme disease. Health care policy needs to accommodate efforts to prevent, detect, and treat it.

“The question is no longer whether Lyme disease can survive antibiotic challenge in order to become a persistent infection.Our task in the new era is to determine which patients suffer from persistent Lyme disease, and to keep pressing for evidence-based wisdom to guide the physicians called upon to treat them.”

- Keith Berndtson, MD

Conclusion

15 N. Prospect Park Ridge, IL 60068

847-232-9800www.parkridgemultimed.com

Patient-centeredsystems medicine.