Lyme Disease

Question 1

Name of the skin lesion that associated with tick’s bite

Answer 1

Erythema Migrans

Question 2

What directly cause the Lyme disease?

Answer 2

The cause was found to be a spirochete, Borrelia burgdorferi.

Question 3

T/F
Arthropod-transmitted viruses in the patients with “Lyme arthritis” associated with the same bacteria from the Lyme disease

Answer 3

False
Steere looked for antibodies against 38 known tick-transmitted infections and 178 other arthropod-transmitted viruses in the patients with “Lyme arthritis”, but no one was positive.

Question 4

Name of the bacteria causes Lyme disease

Answer 4

Borrelia burgdorferi

Question 5

Borrelia burgdorferi

Answer 5

Borrelia burgdorferi in the United States

Borrelia mayonii in the upper midwestern U.S.

Borrelia afzelii, B. burgdorferi, B. garinii in Europe and Asia

Question 6

Borrelia mayonii

Answer 6

the upper midwestern U.S.

Question 7

Borrelia afzelii, B. burgdorferi, B. garinii

Answer 7

in Europe and Asia

Question 8

Ixodes ticks

Answer 8

hard ticks. Hard ticks have a plate called a scutum on the dorsum and mouth parts visible when viewed from above.

Question 9

Ixodes scapularis

Answer 9

in the eastern and north central North America

Question 10

Ixodes pacificus

Answer 10

in northern California and Oregon

Question 11

Ixodes persulcatus

Answer 11

in Asia and Eastern Europe

Question 12

Ixodes ricinus

Answer 12

in Europe and Western Asia

Question 13

Reservoirs of Borrelia Spirochetes Causing Lyme Disease

Answer 13

In the northeastern U.S it is mainly the white-footed mouse, but chipmunks, voles, shrews, and birds can also serve as reservoirs.

Question 14

T/F
The mouse maintains a spirochetemia with no symptoms.

Answer 14

True

Question 15

T/F
In Europe songbirds are the reservoir of B. garinii, in Japan, rodents are the reservoir.

Answer 15

True

Question 16

Deer and Lyme disease (Exam)

Answer 16

Deer are important for the tick survival (adults feed and winter over on deer), but the deer do not support the survival of the spirochete, as complement in the deer is lytic.

Question 17

T/F
In the southern U.S., lizards can be hosts for ticks, but lizards are relatively refractory to Borrelia burgdorferi (zoo-prophylactic host)

Answer 17

True

Question 18

Birds and Lyme disease

Answer 18

Birds are phoretic hosts, carrying the ticks and spirochetes to Canada where the spirochete enzootic cycle is not well established.

Question 19

% of recall a tick bite in early lyme disease

Answer 19

Only 25% of patients recall a tick bite

Question 20

T/F
Lyme disease -Erythema migrans progression less than 2 weeks

Answer 20

False
Over 2 weeks

Question 21

Early Disseminated Lyme Disease occurs within ( ) weeks of the illness

Answer 21

Occurs within 2-3 weeks of the illness

Question 22

Manifestations from Early Disseminated Lyme Disease
(Exam)

Answer 22

1) Multiple skin lesions of erythema migrans (bacteremic spread back to the skin)
2) Carditis manifested by heart block (first, second, and third degree), at times with myopericarditis
3) Lymphocytic meningitis, cranial nerve palsy(ies), cerebellar ataxia, encephalomyelitis
4) Ocular abnormalities-conjunctivitis (common) with keratitis, iridocyclitis, retinal vasculitis, choroiditis, and/or optic neuropathy possible but not common

Question 23

T/F Early Lyme disease can cause the 7th cranial nerve palsy

Answer 23

True

Question 24

T/F Early Lyme disease can cause the carditis

Answer 24

True

Question 25

Late Lyme Disease

Answer 25

Occurs months to even years after the onset of infection.

Question 26

Adult, Nymph ,and female only

Question 27

Late Lyme disease associated with (Exam)

Answer 27

1) Arthritis 2) Peripheral neuropathy, encephalopathy 3) Acrodermatitis chronica atrophicans

Question 28

Late lyme disease and arthritis

Answer 28

Arthritis Intermittent swelling (effusion) of one or a few joints, often the knee Without treatment can be relapsing and resolve over a long period or become chronic

Question 29

Late lyme disease and Acrodermatitis chronica atrophicans

Answer 29

Acrodermatitis chronica atrophicans Occurs 6 months to 8 years after onset, in Europe, due to B. afzelii Extensor surfaces of the hands and feet; bluish-red, edema, then atrophy

Question 30

T/F Lyme disease during pregnancy can cause congenital issues

Answer 30

False There is no definable congenital Lyme disease syndrome. Pregnant women are treated as are other patients, but doxycycline or tetracycline are not used.

Question 31

Coinfections seen with Lyme Diseas

Answer 31

Babesia microti (the cause of babesiosis) and Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis) may each be seen in patients with Lyme disease, as the Ixodes ticks can transmit each of the three pathogens.

Question 32

Coinfections seen with Lyme disease

Answer 32

1) Babesia microti (the cause of babesiosis) 2) Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis)

Question 33

T/F The diagnosis of lyme disease is based on serology, with antibody taking at least two weeks to develop.

Answer 33

True

Question 34

T/F A positive ELISA screen must be confirmed with a Western blot to diagnose the Lyme disease

Answer 34

True

Question 35

T/F There are many false positive IgG test results, making IgG of limited value

Answer 35

Flase There are many false positive IgM test results, making IgM of limited value

Question 36

T/F Once a patient has Lyme, the IgM bands may persist for many years.

Answer 36

False Once a patient has Lyme, the IgG bands may persist for many years.

Question 37

T/F A positive IgG Western blot only indicates infection at some point in time, not necessarily active.

Answer 37

True

Question 38

Always rule out concomitant ( ) and () infections

Answer 38

Always rule out concomitant Anaplasma and Babesia infections

Question 39

T/F Culture of Borrelia burgdorferi culture is not available in most clinical labs.

Answer 39

True

Question 40

How do you isolate spirochete?

Answer 40

In research studies, the spirochete has been isolated from blood, CSF, and skin biopsies.

Question 41

How to treat early lyme disease?

Answer 41

Doxycycline, amoxicillin, or cefuroxime

Question 42

How to treat Carditis associated with early lyme disease?

Answer 42

Doxycycline or IV ceftriaxone or IV penicillin with an anti-inflammatory medication

Question 43

How to treat late lyme disease

Answer 43

Doxycycline, amoxicillin, IV ceftriaxone, or IV penicillin for arthritis IV ceftriaxone or IV penicillin for peripheral neuropathy

Question 44

Erythema migrans develops ( ) days after the tick bite, usually within ( ) days; seen in ( ) of patients.

Answer 44

Erythema migrans develops 1-31 days after the tick bite, usually within 7-14 days; seen in 80% of patients.

Question 45

Locations of erythema migrans

Answer 45

Often near axilla, inguinal region, popliteal fossa, belt line

Question 46

Features of EM

Answer 46

Expands in size over days Central clearing, targetoid appearance are common; central blistering can be seen Border is clearly demarcated Multiple lesions indicate early dissemination, not multiple bites

Question 47

Systemic symptoms associated with Early lyme disease

Answer 47

Fatigue, fever, chills, headache, stiff neck, myalgias, arthralgias are commonly seen.

Question 48

Coinfections seen with Lyme disease

Answer 48

1) Babesia microti (the cause of babesiosis) 2) Anaplasma phagocytophilum (the cause of human granulocytic anaplasmosis) 3)