LYME DISEASE THE BIG PICTURE

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Delilah Hawkins
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1 Lyme Disease Fact Sheet LYME DISEASE THE BIG PICTURE Lyme disease is the fastest-grwing vectr-brne disease in the nrthern hemisphere. Fr 2012, the Centers fr Disease Cntrl and Preventin (CDC) recrded 30,000 surveillance cases in the US but ttal case numbers are unknwn. Annual statistics reprt nly a fractin f all cases. The CDC reprts surveillance cases and the inclusin criteria fr this grup are very strict. This allws the CDC t track and cmpare cases acrss several parameters but it als means that many cases f Lyme disease are never cunted. As stated n the CDC website, the surveillance criteria were never intended t be used as diagnstic criteria, nr were they meant t define the entire scpe f Lyme disease. The CDC als recgnizes that under-reprting is cmmn, estimating that annual surveillance cases numbers are likely t be 10 times higher. In August 2013, the CDC reprted that cases are likely clser t 300,000, based n a survey f seven natinal labratries, a natinal patient survey and a review f insurance infrmatin. Despite its stated intentin, the CDC actually prmtes a narrw definitin f Lyme disease. The infrmatin it prvides t physicians is limited in scpe and ignres a large bdy f scientific research. Misinfrmed physicians under-diagnse Lyme disease n a grand scale. As dcumented in 4 Natinal Institutes f Health studies, peple with Lyme disease may endure great suffering. Symptms are widespread and variable; they ften wrsen, leaving patients unable t attend schl r wrk. Sme prblems may persist fllwing treatment. The scietal csts f Lyme-related disabilities are tremendus. MINNESOTA On average, 1 in 3 black-legged ticks (deer ticks) carry Brrelia burgdrferi, the bacterial cause f Lyme disease but tick infectin rates vary widely n state-wide and lcal levels. These ticks may als carry ther bacteria and parasites (referred t as c-infectins), cmplicating the clinical picture. Once thught t be fund nly in wded areas, black-legged ticks have expanded their range and are nw fund acrss Minnesta, including the 7-cunty metr. They can be fund in tall grass and in suburban edge landscapes. The state ranks 8 th in the natin, reprting 2,124 surveillance cases t the CDC in MN Department f Health (MDH) distributes inadequate infrmatin n tick-brne diseases t physicians, limiting their knwledge and understanding f these cmplicated illnesses. DIAGNOSIS A rash may appear at the site within 2-30 days f the bite and is indicative f infectin. The typical rash is val and unifrmly clred; untreated, it expands and clears ver several weeks. Only 10-20% f Lyme rashes have the classic bull s-eye appearance. CDC data demnstrates that 30% f the reprted cases develped a rash. Available bld tests fr Lyme disease are unreliable. They are insensitive and ften irreprducible. Lyme bld tests measure the level f antibdies directed against Brrelia burgdrferi. Measurable levels may take 2-6 weeks t develp; thus, tests dne early in infectin may be negative, even when the bacterium is present. Minnesta Lyme Assciatin

2 Lyme Disease Fact Sheet If given early in the infectin, antibitics may turn ff the antibdy respnse prematurely, befre adequate levels are achieved. If treatment is inadequate, patients remain infected but their tests may be negative; this clinical situatin is called sernegative Lyme disease. Lyme disease is a clinical diagnsis, based n expsure t black-legged ticks, symptms and exam findings. Testing may cnfirm a diagnsis but it cannt rule Lyme disease in r ut. C-infectins, such as babesisis and anaplasmsis, are cmmn in MN; their symptms verlap thse f Lyme disease, further cmplicating the diagnstic prcess. TREATMENT Brrelia burgdrferi can attack any system in the bdy, resulting in a wide and variable array f symptms. Treatment regimens are based n disease stage and the bdy systems invlved. Brrelia burgdrferi is highly adaptable. Multiple animal studies and human care reprts have demnstrated persistent infectins fllwing cmmnly used antibitic treatments. Fr these reasns, tick-brne infectins require individualized care and treating physicians must use their clinical judgment. Unfrtunately, the CDC and MDH prmte the use f rigid treatment regimens, based n a handful f flawed studies, while simultaneusly dismissing reprts frm patients and their treating physicians that cntradict the usefulness f such appraches. With few physicians adequately trained in the apprpriate diagnsis and treatment f tickbrne diseases, thusands f patients are left withut access t the treatment they need, becming sicker and less likely t fully recver the lnger they g withut care. MINNESOTA LYME ASSOCIATION Our missin is tw-fld: t prvide a supprtive envirnment fr peple affected by Lyme and ther tick-brne diseases and t educate the public and health prfessinals in the preventin, diagnsis and treatment f these diseases. T fulfill ur missin, MLA: Meets 2nd Tues f every mnth, First Lutheran Church f White Bear Lake Hsts mnthly supprt grup meetings thrughut the state Prvides credentialed speakers cvering a wide range f Lyme-related tpics Spnsrs accredited cntinuing educatin curses n tick-brne diseases fr physicians and nurses Offers schlarships t physicians t attend the annual Internatinal Lyme and Assciated Diseases physician training Hsts a bth at the Minnesta Family Physician Cnference t intrduce physicians t new Lyme disease infrmatin Participates at the Minnesta Academy f Family Physicians Spring Refresher and Physician Assistant Cnference Presents infrmatin n tick-brne diseases t the public via large-scale events such as Linwd Days, the Minnesta Hrse Exp and Warner Nature Center Fall Clr Blast, and smaller cmmunity-based gatherings Accepts speaking invitatins frm private clubs and rganizatins Cllabrates with lawmakers and elected fficials n Lyme-friendly legislatin and plicies Minnesta Lyme Assciatin

11 The Management f Ixdes scapularis Bites in the Upper Midwest Elizabeth L. Malney, MD WMJ. 2011;110(2): Abstract Ixdes scapularis, cmmnly referred t as the deer tick, is the vectr f Lyme disease and anaplasmsis; bth illnesses are endemic t the upper Midwest. Avidance f I scapularis bites is the primary preventative strategy fr bth infectins. Antibitic prphylaxis has been demnstrated t prevent Lyme disease, but similar studies have nt investigated antibitic prphylaxis fr the preventin f anaplasmsis. Thus, recmmendatins regarding the management f I scapularis bites are fcused n the preventin f Lyme disease. This paper reviews the prevailing antibitic prphylaxis recmmendatin fr Lyme disease and the evidence supprting it. Given the additinal risk f acquiring anaplasmsis frm an I scapularis bite in the upper Midwest, this paper prpses an alternative regimen fr antibitic prphylaxis in this regin. MLA respects the need f the Wiscnsin Medical Sciety t track the number f hits they get n this article, and therefre can t prvide the full article here. Please g t the WMS website t print the full article t add t yur tick bite packet.

A Pan-Canadian Framework on Antimicrobial Resistance. Presentation to the National Farmed Animal Health and Welfare Council November 30, 2016

A Pan-Canadian Framework on Antimicrobial Resistance. Presentation to the National Farmed Animal Health and Welfare Council November 30, 2016 A Pan-Canadian Framewrk n Antimicrbial Resistance Presentatin t the Natinal Farmed Animal Health and Welfare Cuncil Nvember 30, 2016 PURPOSE Purpse T prvide an update n the develpment f a Pan-Canadian