Borrelia Burgdorferi Infectious Cycle
The infectious cycle of B burgdorferi involves colonization, infection of Ixodes ticks, and then transmission to broad a range of mammalian hosts, including humans. Variation in environmental and host conditions promotes different gene expression and changes in the composition of the membrane proteins of the spirochete. This adaptation is a critical step in the pathogenesis and transmission of Lyme disease.
The Ixodes tick progresses through four stages of development: egg, larva, nymph, and adult . Only larvae, nymphs, and adult female ticks require blood meals, and only ticks in the nymphal and adult stages can transmit B burgdorferi.
The life cycle of Ixodes ticks spans 2 years . The adult lays eggs in the spring, and the larvae emerge in the summer. The larvae feed once, in late summer, on any of a wide variety of small animals . The following spring, the larvae emerge as nymphs. Nymphs feed once, in the spring and summer. The white-footed mouse is the preferred feeding source of nymphs, but other animals apparently suffice. Nymphs molt into adults the following fall and feed once on a larger animal, with the white-tailed deer being the preferred host.
Ticks carry B burgdorferi organisms in their midgut. The bacteria are introduced into the skin by a bite from an infected tick, and disease is transmitted to humans as the spirochete is translocated from the gut to the salivary glands and then to the person at the site of the bite.
Lyme Disease In Qubec
There are a dozen species of ticks in QuÃ©bec. The only species that can transmit Lyme disease in QuÃ©bec and northeastern North America is the Ixodes scapularis tick, also called the deer tick or blacklegged tick.
Since ticks can be transported by birds, they are found in almost all regions of QuÃ©bec. However, not all ticks carry the bacteria. The risk of contracting Lyme disease is highest in sectors where there are established populations of blacklegged ticks that carry Borrelia burgdorferi. In QuÃ©bec, according to available surveillance data, these tick are established in the following areas:
- 500 cases in 2019
- and 274 cases in 2020
The fact that QuÃ©bec winters are less cold than they used to be partly explains the increases before 2020. The warmer climate enables the ticks to survive and grow more easily.
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Blood Tests For Antibodies
Blood tests for detecting antibodies to B. burgdorferi are most reliable several weeks after infection has occurred and are rarely of value during the first 7 to 10 days of illness. During these initial days of infection, these tests can give false negative results .
Most authorities, including the CDC, recommend a 2-step testing process for Lyme disease:
- EIA Test. The first test used is an enzyme immunoassay . The EIA measures IgM and IgG antibodies to the B. burgdorferi spirochete. Positive results from this test still require confirmation with a Western blot test, since the EIA test is often positive even when there has been no infection. Negative results do not require further testing.
- Western Blot or second EIA test. If the EIA test is positive or uncertain, it is followed by the Western blot test. This test is more accurate and is very helpful in confirming the diagnosis but is more expensive and takes longer to complete. The Western blot creates a visual graph showing bands of IgM or IgG antibodies that laboratories use to interpret the immune response. More recently, recommendations have changed to allow for a second EIA in place of the confirmatory Western blot .
- V1sE . This newer FDA-approved test detects a specific component within the EIA IgG antibodies and is being increasingly used instead of the Western Blot to confirm a positive EIA test. Since it is less expensive and more rapidly completed, it may ultimately replace the Western Blot test.
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Is There A Vaccine For Lyme Disease
No vaccine against Lyme disease is currently available for people. Promising new vaccines are under development, among them some that target multiple tick-borne pathogens, and some that target tick saliva. . Vaccination against Lyme and other tick-borne diseases most likely will not remove the need for personal protective measures to prevent tick bites. Even the best vaccines are unable to provide perfect protection from infections, and new pathogens transmitted by ticks continue to be identified.
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Resources For Maine Residents
Public Law, Chapter 340, LD 597, 126th Maine State Legislature: An Act to Inform Persons of the Options for the Treatment of Lyme Disease
- Acknowledges difficulty in diagnosing and treating Lyme disease
- Information on risks of long term antibiotic therapy
Public Law, Chapter 235, LD 422, 127th Maine State Legislature: An Act to Improve Access to Treatments for Lyme Disease
- Allows licensed physicians to prescribe long-term antibiotic therapy to eliminate infection or to control a patients symptoms
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What Should I Do If I Get A Tick Bite
- Do not panic. Getting a tick bite is common, especially in Southern Norway. But you should remove the tick as soon as possible as this can prevent lyme borreliosis. If the tick is removed within 24 hours the chance of getting Lyme borreliosis is very small.
- Be aware that the situation is a bit different for TBE as this virus can be transmitted immidiately after a tick bite . It is therefore not possible to prevent TBE by removing the tick fast, but there is an effective vaccine that prevents infection.
- To remove a tick use a pair of tweezers, a tick removal tool or your own nails. Grasp the tick as close to the skin as possible and pull it straight out. Dont be alarmed if the ticks mouthparts remain in the skin . This does not increase the risk of tick-borne diseases.
- Some people lubricate the tick with butter, petroleum jelly or alcohol in an attempt to remove the tick. We do not recommend this, as it may delay tick removal.
- Contact a doctor if you experience any symptoms that can be related to the tick bite .
Other Causes Of Lyme Disease Symptoms
Sometimes people think they have the symptoms of Lyme disease, but it is a different disease caused by ticks. Diseases caused by tick bites that are known in Australia are:
- Queensland tick typhus
- mammalian meat allergy
Sometimes there is no known diagnosis for symptoms such as fatigue, disordered thinking, disturbances of the senses, joint pain and headaches. These symptoms are real and can be very debilitating. In this case, you doctor will work with you to manage the symptoms and improve your quality of life.
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What Are The Symptoms Of Tbe
The incubation period for TBE is 2-28 days. For TBE there is considerable clinical variation from asymptomatic to severe illness. Some people get no symptoms , some get a mild course of the disease, while some can become very ill. A biphasic course of the disease is common, but not all people experience this. The first phase usually lasts about a week and is often described as a «summer flu», with symptoms such as moderate fever, headaches, muscle aches, nausea, vomiting etc. Some people will recover completely after phase 1 and will probably never know that they have been infected with the TBE virus, unless they are tested for TBE. After a shorter period of symptom improvement and less fever, approximately 30% of people will experience new and more severe symptoms . Typical symptoms in phase 2 are higher fever, severe headache, lethargy, confusion, nausea, vomiting, neck stiffness, muscle aches and paralysis. These are symptoms of meningitis, encephalitis and/or spinal cord inflammation. Adults, especially the elderly, often have a more severe course of illness compared to children. There is no specific antiviral therapy for TBE. Treatment relies on supportive management based on symptom severity. Hospitalization is common. The mortality rate of European TBE is < 1%. The Siberian and Far-Eastern type have a higher mortality rate . In Norway, nobody has died of TBE, but deaths have been registered in Sweden and Finland.
When To Seek Medical Help For A Tick Bite
If you notice a tick on your body, remove it right away and watch carefully for symptoms over the next month. Seek medical care if you develop symptoms.
Remember, most ticks arent infected. And even if theyre infected, most ticks cant spread disease unless theyre in the right stage of life and stay latched on for several hours to days.
If youre in an area that has a high percentage of infected ticks, then youll want to look for ticks and bites very carefully whenever you spend time outdoors.
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Treatment Of Lyme Disease
Early diagnosis and proper antibiotic treatment of Lyme disease is important and can help prevent late Lyme disease. The following treatment regimens reflect CDCs interpretation of the most current data for four important manifestations of Lyme disease. These regimens are consistent with guidanceexternal icon published by the by the Infectious Disease Society of America, American Academy of Neurology, and American College of Rheumatology.
Some patients report persistent symptoms of pain, fatigue, or difficulty thinking even after treatment for Lyme disease. The state of the science relating to persistent symptoms associated with Lyme disease is limited, emerging, and unsettled.
Additional researchexternal icon is needed to better understand how to treat, manage, and support people with persistent symptoms associated with Lyme disease. In light of these research gaps, recommendations for treatment of persistent symptoms in people previously treated for Lyme disease are not provided here.
If you are interested in information on chronic Lyme diseaseexternal icon, see NIHs website.
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How To Avoid Disease
Multiple prevention methods help you avoid being bitten and infected by a tick. By simply observing your outdoor environment and knowing the habitats of ticks, you can reduce your risk of tick interaction. Ticks like to hang out in tall grass and brushy areas. When you know you will be in places like this, wear the right clothing.
Long-sleeve shirts, socks, closed-toe shoes, pants, and hats. The idea is to put a layer of clothing between you and the tick. Also, dont be afraid to use tick repellent. They are safe and effective.
As soon as you come indoors, conduct a full-body tick check. Change clothes and take a quick shower if youve been in heavily wooded areas. Dont forget to check pets for ticks too. While you may not have one, your pet can bring them indoors where they can still find their way to your body.
Finally, if you find a tick, remove it, making sure to remove the head. Pay attention to any new symptoms in the following days or weeks and seek treatment right away from a Lyme-literate doctor who can create the effective treatment plan you deserve.
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What Is Lyme Disease
Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi.
B. burgdorferi is transmitted to humans by a bite from an infected black-legged or deer tick. The tick becomes infected after feeding on infected deer, birds, or mice.
A tick has to be present on the skin for approximately 36 to 48 hours to transmit the infection. Many people with Lyme disease have no memory of a tick bite.
Lyme disease was first recognized in the town of Old Lyme, Connecticut, in 1975. Its the most common tick-borne illness in Europe and the United States.
People who live or spend time in wooded areas known for transmission of the disease are more likely to get this illness. Additionally, people with domesticated animals that visit wooded areas also have a higher risk of getting Lyme disease.
History Of Lyme Disease
Lyme disease gets its name from a small coastal town in Connecticut called Lyme. In 1975, a woman brought to the attention of Yale researchers an unusual cluster of more than 51 cases of mostly pediatric arthritis. In 1977, Dr. Allen Steere and Yale colleagues identified and named the 51 clusters Lyme arthritis.â In 1979, the name was changed to âLyme disease,â when Steere and colleague Dr. Steven Malawista discovered additional symptoms linked to the disease such as possible neurological problems and severe fatigue. In 1982 the cause of the disease was discovered by Dr. Willy Burgdorfer. Dr. Burgdorfer published a paper on the infectious agent of Lyme disease and earned the right to have his name placed on the Lyme disease spirochete now known as Borrelia burgdorferi.
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How Long Do Tick
Most tick-borne illness symptoms get better with the right antibiotic. If not treated, symptoms can become more severe, like with Lyme disease and RMSF. But even with quick treatment, up to 20% of people with Lyme disease might have symptoms even after the infection is gone. This is called chronic Lyme or post-treatment Lyme disease syndrome.
Chronic Lyme disease can cause many symptoms, including fatigue, muscle pain, and difficulty concentrating. The symptoms must have started within 6 months of a Lyme infection and last for at least 6 months. More research is needed to better understand why this occurs in some people and not others.
How Is Lyme Disease Diagnosed
An EM rash is a sure sign of Lyme disease, so your doctor can diagnose and treat you without the need for laboratory tests.
An EM rash, often shaped like a bullseye , is a sure sign of Lyme disease. If you develop an EM rash, you should be diagnosed & treated for Lyme disease without the need for further lab tests. EM rashes are not as obvious on darker skin .
For all other cases, your doctor should consider whether your symptoms and risk factors point to a Lyme disease diagnosis. For example:
Were you bitten by a tick?
Did you spend time outdoors in an area where Lyme disease is common?
Recent travel: Lyme disease may be common where you were, even if it is unusual where you live.
Your current symptoms and how long have they been present.
Your full medical history, including previous unexplained symptoms that may help lead to an accurate diagnosis whether that ends up being Lyme or another condition.
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Diagnosis Of The Disease
New-onset Lyme disease is usually diagnosed based on symptoms, the presence of erythema migrans and possible exposure to infected ticks.
In addition, a blood test known as the two-step process is recommended.
The US CDC describes this testing process in its guidelines: Recommendations for Performing and Interpreting the Test from the Second National Conference on Serological Diagnosis of Lyme Disease.
Specifically, the two phases include:
- Stage 1: the EIA test or, less commonly, the immunofluorescence assay is performed.
- Stage 2: if the EIA or IFA are positive or inconclusive, the second test performed is an immunoblot test, also known as a Western blot. If the symptoms are new onset , the IgM Western blot is performed.
If symptoms have been present for more than 30 days, a positive or inconclusive EIA or IFA test is followed by the Western Blot IgG test.
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Later Symptoms Of Lyme Disease
More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include:
- pain and swelling in the joints
- nerve problems such as numbness or pain in your limbs
- memory problems
- difficulty concentrating
Some of these problems will get better slowly with treatment. But they can persist if treatment is started late.
A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome. This is known as post-infectious Lyme disease. It’s not clear exactly why this happens. It’s likely to be related to overactivity of your immune system rather than continued infection.
What Is Lyme Disease Fatigue
Lyme disease is the fifth most reported noticeable disease. However, it is also one of the most underreported diseases in America due to misdiagnoses and faulty test materials. Currently, there are over 476,000 reports of Lyme disease annually, but many reports suggest that number should be much higher. This means hundreds of thousands of people may be suffering the debilitating symptoms of Lyme disease every day. One of the most concerning symptoms is fatigue. Everyone gets tired after a long day at work or after going to the gym for a workout. At night, you fall asleep quickly and wake up refreshed. This is entirely different than Lyme disease fatigue.
How To Protect Your Property And Your Pets
On this last topic, Bloom commented that the majority of flea and tick control medicines on the market work fairly well. He, however, cautioned against using more than one of them in tandem.
In my opinion, it would be overly cautious to use more than one, he says. In other words, I wouldnt use both a collar and a topical prevention, or an oral preventionand a topical. I think thats kind of too much poison for the dog.
You can, however, combine one of the topical or oral preventatives with the Lyme vaccine. So there is a way you can further protect your pet from contracting the disease if you live in an area where deer are prevalent.
If youre looking for an additional way to protect your yard, Bloom recommends having the perimeter sprayed by a pest control company.
Goldstein also recommended treating the perimeter of your property, but his recommendation came in the form of a physical barrier, rather than one of pesticides.
If youre up against woods in your yard, a barrier of wood chips of pebbles will prevent at least the ticks from going across, explains Goldstein. They can be carried across it by an animal, but at least they wont cross a barrier like that.
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