? Which is a LYME DISEASE RASH LYME DISEASE FOUNDATION ONE FINANCIAL PLAZA HARTFORD, CT 06103 Lyme Disease Foundation NIH Award for Public Education District 7980 Rotary International Partners in finding solutions to Tick-borne Disorders Answer: All of them
the Lyme Disease Foundation The Lyme Disease Foundation (LDF) is the premier national nonprofit dedicated to finding solutions for tickborne disorders. Established in 1988 at the request of researchers, it is a partnership between scientific, business, government, and public efforts. Its focus is prevention, detection, treatment, and ultimately, cure of these illnesses. The LDF s three main activities fall within the areas of education, research, and advocacy. The LDF was cofounded by Karen Vanderhoof- and Tom Forschner while they were searching for answers to help save their son who suffered from Lyme disease (LD). Its Board includes the discoverer of the LD bacterium (Dr. Burgdorfer), executives, government leaders (including former Congressman Bedell), physicians, researchers, patients, and public health officials. It was the LDF s activities with the media that made Lyme disease a household term. Donations are always gratefully accepted. Contact us if you want to help. LDF PROGRAMS Journal of Spirochetal and Tick-Borne Diseases - Peerreviewed scientific journal distributed to all US and Canadian health departments, and all US medical libraries. Full length articles on Medscape.com. International Scientific Conferences - Medically accredited annual conferences and satellite programs. National LD Hotline - 800-886-Lyme - Free information, 24 hours a day to approximately 80,000 people each year. www.lyme.org - Web provides help to millions each year. Educational Material - Distributes millions of brochures. Self-Help Groups - Referrals and training. Newsletter - Quarterly issues of LymeLight. Award-winning Television Specials Lifetime Television Network documentary (worldwide telecast) and Public Broadcasting System (US telecast) puppet special (hosted by Luis from Sesame Street). Research - Over $500,000 to date. Congressional Updates - Educational material sent to state and federal legislators. National LD Awareness Month Programs - MAY DC Rally and National Poster Campaign. Media Awareness - Regular contacts and education. Workplace & School Programs - Videos and brochures. Presentations - Active countrywide programs. e.g. lunch & learns, public forums, healthfairs, and company talks. LDF, One Financial Plaza, Hartford, CT 06103 www.lyme.org lymefnd@aol.com 860-525-2000 Hotline: 800-886-LYME the Rotary International Rotary International is a worldwide organization of business and professional people united to provide humanitarian service, encourage high ethical standards in all vocations, and help build world understanding and peace. Formed in Chicago in 1905, Rotary International now has over 1,200,000 members in over 29,000 Rotary clubs in 162 countries. District 7980 consists of 65 Rotary Clubs in the southerly half of Connecticut. Although Rotary clubs are involved in many different types of community service projects, a special focus of Rotary International has always been on health-related programs. Since 1988, Rotary International has undertaken a massive effort in collaboration with the World Health Organization and UNICEF to eradicate polio from the world by the year 2000. This goal will be fully achieved by 2005 as a result of hundreds of thousands of Rotary volunteers and $425 million in contributions by Rotarians. In addition, several Rotary Health, Hunger, and Humanity Grants are made every year to address major problems that adversely affect the health and well-being of people around the globe. With service as their mission, the Rotary Clubs in District 7980 have made commitments to dedicate significant financial and human resources to combat Lyme disease, which affects so many of our Connecticut residents. Our 65 Rotary clubs are happy to partner with the Lyme Disease Foundation in providing information and education in the important effort to combat this dreadful disease. For information about the Rotary Clubs in District 7980 please contact: Governor Richard Benson 20 Milo Drive Madison, CT 06443
Ticks male L ONE STAR TICKS Transmits ehrlichiosis, Lyme/ Lyme-like disease, tularemia, tick paralysis, and a spotted fever Rickettsia pathogen R ELAPSING FEVER TICK Transmits relapsing fever spirochetes Occi/ Burgdorfer, PhD, MD (hon) Preventing Tick Bites Avoid tick-infested areas, avoid sitting directly on the ground, and stay in the center of paths. Wear light-colored long pants and long sleeves when you venture into grass, woods, garden, or beach areas so you can more easily see ticks. Tuck shirt into pants and pants into socks to thwart a tick's effort to crawl onto your skin. Use EPA-approved tick repellents. Wash-off repellents when you return inside. Do frequent tick-checks, including a naked full body exam upon returning inside. A LD vaccine is available for people and pets. engorged engorged male nymphs larva B LACK- LEGGED AND W ESTERN BLACK- LEGGED TICKS Transmits babesiosis, ehrlichiosis, Lyme disease, and powassan encephalitis male AMERICAN DOG ROCKY MOUNTAIN WOOD AND P ACIFIC COAST TICKS Transmits Colorado tick fever, ehrlichiosis, Rocky Mountain spotted fever, tularemia, and tick paralysis Ticks are bloodsucking, external parasites that feed on humans and other mammals, birds, and reptiles. They are totally dependent on the blood/tissue fluids of the host. Worldwide there are over 850 tick species, 100 of which are known to carry diseases. In the U.S. four genera, Amblyomma, Dermacentor, Ixodes and Ornithodoros transmit to humans the vast majority of diseases caused by bacteria, viruses, rickettsiae, toxins and protozoa. Ticks which spread disease are known as "vectors." Ticks that transmit disease may be anywhere there is vegetation - woods, brushy areas, parks, seashore, even your backyard. These ticks can be active and biting yearround, depending on the weather. Ticks can be active in temperatures above freezing - even in the Northeast! In the Northeast heightened risk for LD/HGE/babesiosis transmission by nymphal ticks (causing the majority of human cases) is April to July. Heightened risk for adult tick transmission is October to November and then again in the early spring. On the West coast peak tick season is November to April. In the South, ticks can be active year-round. If a LD/HGE/Babesiosis transmitting tick (Ixodes) has noticeable engorgement, it probably has been attached long enough to transmit disease. Attached tick Removing Ticks Ticks adhere tightly to the skin for two reasons. The tick's mouthparts have reverse harpoon-like barbs that insert into the skin and they secrete an adhering, cement-like substance. 1. Use a fine-point tweezer to grasp the tick at the place of attachment, next to the skin. 2. Gently pull the tick straight out. 3. Place the tick in a small vial labeled with the date, victim's name, address, tick s description (e.g. engorged, color), and estimated hours attached. Mark your calendar too! 4. Wash your hands, then disinfect the tweezer and bite. 5. Call the doctor to decide if treatment is warranted. 6. Watch for indications of a tick-borne disorder. Tick Removal Cautions Teach kids to seek adult help for tick removal. Do not prick, crush, or burn the tick as it may release infectious fluids or tissue. Do not try to smother a tick (e.g. petroleum jelly, nail polish) as it has enough oxygen to complete feeding. If you must use your fingers, use a tissue or leaf to avoid skin contact with infected tick fluids. Direct workplace donations to the LDF through: Community Health Charities, United Way, and Combined Federal Campaign #1724
Reducing Ticks on Property Taking the following actions will lessen the chance for tick exposure when collegues, family, and friends are enjoying the outdoors: Widen trails and move playscapes to non-tick areas. Prune trees, clear brush, remove litter, and mow grass often. Let grass dry thoroughly between waterings, because ticks need moist habitats to live. Remove shrubby overgrowth between your lawn and woods. Modify your property so that it is unattractive to animals that are hosts to ticks: build fences around the property; clear away wood, garbage, and leaf piles; and eliminate stone walls, bird feeders and bird baths. Apply tick-killing chemicals to property. Lyme Disease Lyme disease is a bacterial infection caused by a spirochete named Borrelia burgdorferi (Bb). The bacterium has been in the U.S. for over 100 years. Bb is maintained in nature by animals whereby certain ticks bite infected animals, ingest the bacteria, then transmit the infection through subsequent feedings. Humans and pets are incidental hosts to the infected ticks. Vectors of the bacterium include the Western black-legged tick in the western U.S. and the blacklegged tick (formerly known as "deer" tick) in the northcentral and northeast U.S. The lone star tick, found in the rectangle encompassing RI, FL, TX and IA, is a possible secondary vector. LD accounts for 90% of vector-borne infections in the U.S. From 1980 to 2000 approximately 150,00 LD cases have met the government's narrow LD surveillance case reporting criteria. Estimates are that over 2 million people have had LD, costing society about $1 billion per year. Adult dog ticks Note the size and color differences of the two s. Female Ixodes Questing Tick A tick climbs up to the top of vegetation and reaches out to grasp onto a host. 2 Females Male Nymph Male Lone star ticks Note the dot on the back of the adult. Ixodes (LD) ticks Female Lone star ticks Larva (many & very tiny) 3 Females Nymph Engorged Nymph Lone star ticks Note the size differences of the s. Females Males Nymphs LYME DISEASE DIAGNOSIS Lyme disease is a clinical diagnosis, based on signs/symptoms, with consideration given to other factors such as: exposure to endemic areas, history of a tick bite, response to treatment, and test results. There is no test that can first definitely prove that a patient is infected with the LD bacterium and then prove that a patient has become bacterium-free.
LD Clinical Diagnosis Lyme disease usually starts with flu-like symptoms. 60% of light-skinned patients notice an enlarging rash days to weeks after a tick bite. Early symptoms may go unnoticed or quickly disappear, and serious multi-systemic problems may later occur. Because LD can imitate other diseases, it is sometimes misdiagnosed. Sometimes, skin discoloration around the bite site occurs during the bite or soon after tick removal. If it disappears within a day, it is most likely the skin s reaction to the wound and not a sign of LD infection. GENERAL Flu-like signs and symptoms of fatigue, headache, muscle aches, and fever. EM Rashes SKIN One or more erythema migrans (EM) rash, which varies in size and shape; may have rings of varying shades (reddish, purple, or bruised-looking) or be uniformly discolored; may be warm, smooth, or bumpy to the touch; may itch; and can be necrotic (crusty/oozy). Multiple rashes per bite or rash(es) not at a bite-site indicate disseminated LD. Later skin problems can include lymphocytoma (a benign nodule/tumor) and acrodermatitis chronica atropicans "ACA" (discoloration/ degeneration usually of the hands or feet). LD Clinical Diagnosis BRAIN Nerve conduction defects (weakness/paralysis of limbs, loss of reflexes, tingling sensations of the extremities); severe headaches; stiff neck; meningitis; dizziness, fainting; cranial nerve involvement (e.g. change in smell/taste; difficulty chewing, swallowing, or speaking; hoarseness or vocal cord problems; facial paralysis; facial paralysis drooping shoulders; inability to turn head; double vision, deviation of eyeball - wandering or lazy eye, drooping eyelid, light or sound sensitivity; change in hearing), stroke, abnormal brain waves or seizures, sleep disorders, cognitive changes (memory problems, confusion, decreased concentration), and behavioral changes (depression, personality changes). HEART & BLOOD VESSELS Irregular beats, heart block, palpitations, myocarditis, chest pain, vasculitis. LUNGS Difficulty breathing, pneumonia. EYES Vision changes, including blindness, retinal damage, optic atrophy, red eye, conjunctivitis, spots before eyes, inflammation or pain of various parts of the eye. numkerititis JOINTS, MUSCLE Joint pain - intermittent or chronic, usually not symmetrical; sometimes swelling; TMJ-like pain in jaw. Muscle pain, inflammation, cramps, or loss of tone. LIVER Mild liver function abnormalities. STOMACH, INTESTINES Nausea, vomiting, diarrhea, loss of appetite, anorexia. SPLEEN Tenderness, enlargement. PREGNANCY Miscarriage, premature birth, stillbirth, and neonatal deaths (rare). Congenital LD has been described in medical literature and textbooks.
Testing A test may support the diagnosis of LD, but cannot be used solely to make the diagnostic decision. No test can definitively "rule-out" Lyme disease. Antibody Tests Antibodies are the immune system's response to fight off infection. Tests strive to be both sensitive (detecting any LD-antibody reaction) and specific (detecting just LD antibodies.) Types of Tests Titer (ELISA or IFA) tests measure the level of Bb antibodies in body fluid. Laboratories use different detection criteria, cut-off points, types of measurements, and reagents. Western blot produces bands indicating the immune system's reactivity to Bb. Labratories differ in their interpretation and reporting of these bands. Western blot sample 7 lanes, with lane 8 being the control. Each lane is a single test. The lines across each lane represents the patient s antibody reaction to different molecular weights of pieces of the Lyme bacterium. Types of Results False Negative tests occur due to: defects in test sensitivity; too low an antibody level to detect (e.g. they are bound to the bacteria, with too few freefloating; the patient taking antibiotics or other drugs; naturally low antibody production); the bacterium has changed, limiting recognition by the immune system; the bacterium has masked itself in some way; or bacterial strain variations. False Positive tests occur due to: test failure, crossreacting antibodies (e.g. syphilis, periodontal disease). Direct Detection Tests Antigen detection tests look for a unique Bb protein in fluid (e.g. urine) of patients. This may be useful for detecting LD in patients taking antibiotics or during a patient s symptom flare-up. Polymerase chain reaction (PCR) tests multiplies the number of Bb DNA to a detectable level. It is expensive and requires expertise. Culturing is difficult and can take weeks. Staining is time consuming and has a low yield. Treatment Treatment varies depending on how early a diagnosis is made. Oral antibiotics may be sufficient for early stages of non-disseminated infection. Longstanding, disseminated disease responds best to one or several courses of intravenous antibiotics. Persisting infection may require extended treatment. No definitive treatment regimens are available for early, disseminated or persisting LD. There is no test to determine that a patient diagnosed with LD has become bacterium-free. An increasing number of patients continue to have manifestations of ongoing disease despite antibiotic treatment. Treatment failures can occur with all protocols. There is scientific evidence that the LD bacterium can persist in some patients despite aggressive treatment. As a result, when treatment is discontinued, some patients develop more serious complications that can lead to permanent damage. Because of the occurrence of continuing symptoms among LD patients, the lack of a test that can prove the patient is bacterium-free, and in light of evidence of persisting infection, some physicians feel it is unethical not to offer an additional antibiotic treatment to patients with continuing manifestations of persisting infection. male 2 engorged nymphs nymph larva Various life stages of Ixodes ticks 1/2 inch 4 engorged (fed) s Unfed Stages of engorgement of Ixodes
Other Tick-Spread Diseases BABESIOSIS Babesiosis is a malaria-like infection caused by several Babesia (B.) protozoa that parasitize red blood cells. There is one species in the east (B. microti) and newly described species from the midwest and West coast. The black-legged tick and probably the western black-legged tick transmit the parasites. Symptoms: Fever, chills, fatigue, headache, muscle pain, and anemia. A blood test may reveal the parasite in red blood cells. Chronic mild infection can occur. Babesiosis is more severe, and sometimes fatal, in elderly people or in those who have had their spleens removed. Immunosuppression may occur. COLORADO TICK FEVER This viral disease occurs in the western U.S. The Rocky Mountain wood tick and possibly the Pacific Coast tick transmit the disease. Symptoms: High fever, chills, severe headache, muscle aches, and occasionally a faint rash, which lasts about a week. After a 2-3 day remission, symptoms may recur accompanied by a drop in white blood cells. Complications include encephalitis, heart problems, and/or severe bleeding. EHRLICHIOSIS Ehrlichiosis is a bacterial infection caused by several types of rickettsiae, which invade and kill white blood cells. The American dog, brown dog, lone star, blacklegged, and probably the Western black-legged ticks transmit the pathogens. There are two types of human ehrlichiosis: human granulocytic ehrlichiosis (HGE) and human monocytic ehrlichiosis (HME). Symptoms: Fever, malaise, headache, chills, severe muscle aches or pain, vomiting, anemia, lung infection, decrease in white blood cells, elevated liver enzymes. A rash occurs in a small percentage of people. Neurologic manifestations include seizures, meningitis, confusion, ataxia, cranial nerve palsy, and change in mental status. Delayed treatment can result in death. RELAPSING FEVER This multisystem disease is caused by the spirochetes Borrelia (B.) hermsii, B. turicatae, and B. parkeri. The disease occurs primarily in the western U.S. The pathogen is transmitted by soft ticks, which feed mainly at night and can transmit spirochetes within minutes. Symptoms: Repeating bouts of fever and chills, headache, muscle and joint pain lasting 2-9 days, alternating with days of no fever. Blood tests may detect the bacterium during fever episodes. Other Tick-Spread Diseases RMSF rash on hands and legs ROCKY MOUNTAIN SPOTTED FEVER (RMSF) RMSF, one type of spotted fever, is caused by Rickettsia rickettsii. Though reported from across North America, it is most prevalent in the eastern U.S. The Rocky Mountain wood, American dog, and Pacific Coast ticks transmit the disease. The lone star tick also transmits a spotted fever Rickettsia that causes similar symptoms. Symptoms: Flu-like aches and pain, headache, chills, confusion, light sensitivity, and high fever. A reddish-to-black rash (resembling measles) starts on the extremities (e.g., wrists and ankles) and may spread to the entire body. Death can occur. Doctors must make a clinical diagnosis and treat early as the main cause of death is delayed or improper treatment. TICK PARALYSIS This is a potentially fatal reaction to a paralyzing toxin secreted in the saliva of a tick late in her feeding. Vectors include Rocky Mountain wood, American dog, and lone star ticks. Symptoms: Headache, vomiting, general malaise, loss of motor function and reflexes, followed by paralysis that starts in the lower body and spreads to the rest of the body. Respiratory failure and death can occur. In young children death can occur in one to two days. TULAREMIA (rabbit fever) Tularemia is caused by the bacterium Francisella tularensis. While reported from almost every state, most cases are found in the southcentral U.S., where many are caused by tick-bites. Transmission is by the American dog, lone star, Rocky Mountain wood, and Pacific Coast ticks. Other vectors include deerflies and contact with infected animals/ contaminated water. Symptoms: Repeated spikes of severe fever, swollen lymph nodes that develop into skin ulcers, conjunctivitis, and pneumonia.
EDUCATIONAL MATERIALS * CDC Approved GENERAL LYMELIGHT Quarterly newsletter to donors of $25 or more. EVERYTHING YOU NEED TO KNOW ABOUT LD (Wiley& Sons) $18. Book of symptoms, diagnosis, testing, treatment, pets, personal protection, property management, other tick-borne disorders, and other information resources. $6 is a donation to the LDF. 3nd printing. MANY FACES OF LD $15. Book of stories of patient experiences with tick-borne disorders (esp. Lyme disease). 5th printing. LD WHAT YOU SHOULD KNOW * $25. 1 hour video covering transmission, prevention, microbiology, diagnosis (including symptoms), treatment, and patient & researcher interviews. LD WHAT YOU SHOULD KNOW * $20. 1/2 hr. video covering transmission, prevention, symptoms, diagnosis, & treatment. FACES OF LD $15. 1/2 hr. video Lifetime TV Network documentary. TICK WALLET CARD $20 for 200. Card. Diseases, removal, symptoms. LD & PETS $20 for 200. Brochure of symptoms, treatment. TICK SPREAD DISEASES $20 for 200. New brochure of symptoms, diagnosis, treatment. Incl. LD, ehrlichiosis, babesiosis, more. COMMUNITY EDUCATION SLIDE SHOW * $25. Slides with script. WHAT LD IS... PREVENTION POSTER * $10 folded, $15 rolled. Large picture poster showing prevention techniques & symptoms. LD COMMUNITY EDUCATION PROGRAM* $100. Multiple piece Display. Incl. a lightweight, tabletop display, carrying case, What LD is.. poster, Comm. Ed. slide show, LD: Facts for Kids, LD: What You Should Know, 200 brochures and Tick Wallet Cards. THE WORKS $175. Multiple piece Display. Incl. LD Comm. Ed. Program, Satellite Medical video, and LD Scientific Investigator Program. TICK LAPEL PIN $15 ea. 1 Wooden pin. Lone star, LD, or dog tick. KIDS LD: FACTS FOR KIDS * $25 Four 18 min. videos (2-English, 2- Spanish). Dr. Ticked-Off (grades K-3), WTIK: Do A Tick - Check (grades 4-8). Hosted by Luis from Sesame Street. Award winner at Int l Communication Film & Video Festival. PBS TV Special LD SCIENTIFIC INVESTIGATOR PROGRAM * $20 School training program using LD to teach Jr. High students about the scientific method. Incl. LD: An Investigative Survey on Personal Prevention instructional video, LD: Teacher s Lesson Plan (1-day & 4- day) handbook, survey forms and brochures. THE SCHOOL PROGRAM $200. For distribution to school and parents. 1,000 wallet cards; 1,000 brochures; 5 LD is... prevention posters; video programs (LD: Facts for Kids, LD Scientific Investigator: LD What You Should Know). WORKPLACE WORKPLACE EDUCATION PROGRAM * $50. Group education. Incl. 1/2 hr video of What You Should Know, brochures, employer handbook, payroll inserts, posters, and slide show. SCIENTIFIC/MEDICAL SELF-HELP PROGRAM * $10. Running a S-H group. 1/2 hr video, manuals, brochures, sample press releases, and posters. SATELLITE MEDICAL CONFERENCE $15. 3 hr. video of 1998 CME d program: Diagnosis, testing, treatment, and public health. Keynote: Willy Burgdorfer, PhD, MD (hon) discoverer of the LD bacterium. JOURNAL OF SPIROCHETAL & TICK-BORNE DISEASES Peerreviewed quarterly journal. Call 800-257-8290. Physician $75yr; institution $90yr; student, fellow, resident $45yr; Canada+$10. TICK-BORNE DISORDER PACKET $20. Misc. pieces. Brochures, medical articles, insurance information, poster, and more. LD SCIENTIFIC PACKET $30. Copies of a variety of scientific articles, including testing and treatment. LD CHRONIC PACKET $30. Chronic LD articles and more. CONFERENCE COMPENDIUM $40. Latest LDF conference articles. LD SCIENTIFIC SLIDE SHOW $40. Slides with script. Order FORM Donations: ($25 and above receive the newsletter) $ 25 Friend $ 50 Supporter $ 100 Sponsor professional/business $ 250 Patron also receives a certificate $1,000 Sustaining Patron (name on plaque at LDF office) $1,000 Scientific Circle (MD s, PhD s, RN s, etc.) $ Other Special Donations: In Honor of In Memory of Acknowledgement is to be sent to (name, address): Donations of $1,000 or more Name to be placed on plaque at LDF Office (please print) To Order Material Item # Final Price (Price includes shipping) TOTAL Make checks payable to: LYME DISEASE FOUNDATION Credit Card Charges Card Type: MC Visa AMEX Expiration / Account # Cardholder name Signature Your Information Name Company Address City State / Province Zip Country Phone ( ) Fax ( ) I Want to Volunteer Send information on: Education, public Education, medical Self-Help Group Fundraising Media Awareness Government Relations Mail to: Lyme Disease Foundation One Financial Plaza, Hartford, CT 06103