LYME DISEASE Mary Grace Stobierski DVM MPH DACVPM

LYME DISEASE Mary Grace Stobierski, DVM, MPH, DACVPM Michigan Dept. Community Health

Borrelia burgdorferi

Lyme Disease/ History 1908 Europe: Bannworth’s syndrome, chronic skin lesions associated with tick bites, later found to be penicillin responsive 1975 First description of Lyme arthritis - Old Lyme, CT. Cluster in children. 1983 Isolation of spirochetes from blood, CSF, and skin of patients with Lyme borreliosis Spirochetes isolated from Ixodes sp. ticks Willy Burgdorfer identified spirochetes as belonging to genus Borrelia

National Case Definition For Epidemiologic Surveillance A case is defined as: n. A person with Erythema Migrans at least 5 cm in diameter; or n. A person with at least one late manifestation and laboratory evidence CDC-1997

Reported Cases of Lyme Disease, United States 1982 -1999

Human Case Reporting

Reported Lyme Disease Cases in Michigan 180 160 148 120 100 80 60 76 Year Reported 73 52 43 44 40 252027 23 22 25 1811 20 7 8 0 1984 1987 1990 1993 1996 1999 1984 -2000 1991: New Case Definition

Ixodes scapularis (formerly, I. dammini)

Adult, female I. scapularis

Ixodes scapularis endemic vs adventitiously introduced n Endemic – All three stages abundant – Present from year to year n Introduced – Only 1 stage - usually individual adults on deer – Not present in same location - year to year

Peromyscus leucopus White-footed Mouse

White-tailed deer

Early Lyme Disease Clinical presentation n Incubation period: – 3 to 30 days after tick bite n Characteristic skin lesion: – erythema migrans (EM) n Systemic Symptoms Common: – malaise, fatigue, headaches, chills, low-grade fever, myalgias, arthralgias

Erythema migrans, with satellite lesion

Early Lyme Disease Natural History n n n Erythema Migrans resolves within 3 to 4 weeks, even without treatment; resolves within days with antibiotics. Minor systemic symptoms, especially fatigue. In the absence of treatment most patients will develop other Lyme Disease manifestations.

Late Lyme Disease n Cardiac n Neurologic n Arthritis n Ocular n Dermatologic

Surveillance Definitions Surveillance: “The collection, collation and analysis of data and the dissemination to those who need to know. ” -A. D. Langmuir Passive Surveillance: Health provider initiates reports. Active Surveillance: Health Department initiates reports.

Ecologic Field Survey

Ixodes Scapularis Michigan Submissions 1985 -1996 Keweenaw 2 Houghton 3 1 Ontonagon 8 Baraga 2 Gogebic 1 Iron Luce Marquette Schoolcraft Alger Dickinson 9 6 3 Delta 1 Mackinac Chippewa 1 Menominee Emmet 241 Cheboygan Charlevoix Leelanau 1 Benzie Otsego Antrim Grand Traverse Kalkaska Wexford Missaukee Presque Isle Montmorency Crawford Oscoda Roscommon Ogemaw Alpena Alcona 1 Manistee Mason Lake Gladwin Clare Osceola Huron 2 Oceana Mecosta Muskegon 1 Ottawa Tuscola Van Buren Gratiot Montcalm 1 Saginaw Ionia Kalamazoo 4 Calhoun Ingham 2 Oakland Livingston 2 Washtenaw Jackson Branch Cass St. Joseph 1 Hillsdale Lenawee St. Clair Macomb Shiawassee Clinton Eaton 1 Lapeer Genesee 1 Barry Sanilac 1 3 Kent 1 Allegan 1 Bay Midland Isabella Newaygo 1 Berrien Iosco Arenac Monroe Wayne

Most Common Tick Submissions 1985 -1996 Tick No. Submitted Human No. on: Dog Other D. variabilis 2554 1302 708 542 D. albipictus 824 63 23 737 A. americanum 190 156 17 17 I. cookei 554 103 168 283 I. scapularis 333 121 139 73