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  • 2. Species• B.recurrentis –Relapsing fever• B.vincentii –Vincents angina• B.burgdorferi-Lyme disease DEEPA BABIN 2
  • 3. Epidemiology of Borrelia Infections Pediculus humanus Borreliarecurrentis Ornithodoros spp.Borrelia spp. Ixodes spp. Borreliaburgdorferi DEEPA BABIN 3
  • 4. Borrelia is a Spirochete• Larger, Irregular, wide and open coils• Motile• GRAM NEGATIVE• Some commensals- Buccal /genital mucosa DEEPA BABIN 4
  • 5. Borrelia burgdorferi• Cause –LYME DISEASE• Spirochete: slender helical shaped bacteria• Gram negative• Motile• Extracellular pathogen• Aerobic or microaerophilic DEEPA BABIN 5
  • 6. What is Lyme Disease?• Lyme disease is caused by Borrelia burgdorferi and is transmitted to humans by the bite of infected Ixoid ticks.• *Normally lives in mice, squirrels and other small animals • Blacklegged (deer) ticks • Lone star ticks • American dog ticks DEEPA BABIN 6
  • 7. EPIDEMIOLOGY• Transmitted by Ixodes ticks• Nymph-stage ticks feed on humans- transmit spirochete• Endemic areas – Northeastern coastal states – Wisconsin & Minnesota – Coast of Oregon & northern California DEEPA BABIN 7
  • 8. Methods of Transmission• Vector-borne disease• Vector is deer or black-legged tick (Ixodes scapularis) or by the western black-legged tick (Ixodes pacificus) on the Pacific Coast.• Transmits B. burgdorferi while feeding on an uninfected host – the spirochetes are present in the midgut and migrate during blood feeding to the salivary glands, from which they are transmitted to the host via saliva. DEEPA BABIN 8
  • 9. Larva, nymph, and adult female and male Ixodes dammini ticks They are smaller than we think DEEPA BABIN 9
  • 10. Symptoms• The early symptoms are mild.IP- 3-30 DAYS• The first symptom is usually an expanding rash.• Called Erythema Migrans.• a central spot surrounded by clear skin that in ringed by an expanding red rash looks like bull’s eye. DEEPA BABIN 10
  • 11. Common presenting symptoms in lyme disease• Symptoms of early localized Lyme disease (Stage 1) begin days or weeks after infection. They are similar to the flu and may include:• Body-wide itching• Chills• Fever• General ill-feeling• Headache• Light-headedness or fainting• Muscle pain• Stiff neck• There may be a "bulls eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be quite large and expanding in size. DEEPA BABIN 11
  • 12. Classic Bull’s Eye Rash DEEPA BABIN 12
  • 13. Arthritis DEEPA BABIN 13
  • 14. Disseminated and Persistant• Paralysis or weakness in the muscles of the face• Muscle pain and pain or swelling in the knees and other large joints• Heart problems, such as skipped heartbeats (palpitations)• Symptoms of late disseminated Lyme disease (Stage 3) can occur months or years after the initial infection. The most common symptoms are muscle and joint pain.• Persistant- months or years later with chronic arthritis,polyneuropathy,encephalopathy• DEEPA BABIN 14
  • 15. Prevention of lyme disease• Take precautions to avoid direct contact with ticks. Be extra careful during warmer months. Whenever possible:• Avoid wooded or bushy areas, or areas with high grasses and leaf litter..• Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Shower soon after coming indoors to wash off any unseen ticks. DEEPA BABIN 15
  • 16. Borrelia recurrentis- Relapsing fever• Relapsing fever borreliosis often occurs with severe bacteraemia.• Borrelia recurrentis is transmitted by the human body louse; no other animal reservoir• Lice that feed on infected humans acquire the Borrelia organisms then multiply in the gut of the louse. DEEPA BABIN 16
  • 17. DEEPA BABIN 17
  • 19. Tick-borne = Endemic Relapsing Fever Sporadic cases Transmitted by soft body ticks (vectors) from small mammal reservoir Ticks can multiply and infect new human hosts DEEPA BABIN 19
  • 20. Louse-borne = Epidemic Relapsing Fever Transmitted person-to-person by human body lice (vectors) from infected human reservoir Infect host only when louse is injured, e.g during scratching Therefore, a single louse can only infect a single person Lice leave host that develops a fever and seek normal temperature host DEEPA BABIN 20
  • 21. Relapse Of Fever DEEPA BABIN 21
  • 22. Morphology /Diagnosis• Gram Negative Irregular Spirals With Pointed Ends• 0.2 to 0.5 microns in width and 5 to 20 microns in length. visible with light microscopy and have the cork-screw shape• Culture-Noguchi s MEDIUM, CAM• Vector-Pediculus Humanus Corporis• Ip-2-10 Days• Febrile Onset Of Sudden Onset, fever Subsides After 3-5 Days And It Lasts For 4-10 Days• Then Another Bout Of Fever Starts…relapse (3-10 Times) For Months Or Years DEEPA BABIN 22
  • 23. B.VINCENTII• Mouth commensel• Associated with fusiform bacilli• Malnourished or viral infection it cause ulcers - Gingivostomatitis DEEPA BABIN 23
  • 24. Diagnosis• There are number of blood test available• Antibody test :ELISA and western blot tests.Although there is false positive and negative results• Antigen detection tests• Polymerase chain reaction: this test multiplies the of Bb DNA to detectable measurable level DEEPA BABIN 24
  • 25. Diagnosis• Serologic data by IFA, ELISA and imunoblotting techniques. – Detect presence of IgM or IgG antibodies in patient’s serum against Borrelia burgdorferi – Tests are insensitive the first several weeks of infection – Western blot is more accurate and is used 6-12 weeks after infection to confirm results• Direct Isolation – Biopsies of the skinDEEPA BABIN may yield the lesions 25
  • 26. DEEPA BABIN 26
  • 27. Treatment• Antibiotic therapy• Doxycycline and amoxicillin are used for two to four weeks in early cases• Doxycycline is also effective• Cefuroxime axetil or erythromycin can be used for patients who are allergic to penicillin or who cannot take tetracyclines.• More developed cases, may require treatment with intravenous ceftriaxone or penicillin for 4 weeks or more DEEPA BABIN 27
  • 28. Prevention• Avoid tick habitats• Wear appropriate barrier clothing that follow personal protection procedures• Apply insect repellent containing DEET to skin• Apply permethrin to clothes• Perform regular body checks for ticks• Remove ticks promptly with tweezers and clean area with antiseptic• Education of the general public DEEPA BABIN 28
  • 29. How to remove ticks DEEPA BABIN 29
  • 30. Control• Habitat modification for ticks -Clear trees and brush• Chemical control of tick populations -Apply pesticides to residential properties• Habitat modification for deer and rodents -Keep rodents and deer away from houses and gardens• Host management -Deer feeding stations equipped with pesticide applicators -Baited devices to kill ticks on rodents DEEPA BABIN 30