A brief look at tips for preventing and diagnosing Lyme disease, with perspective on why Lyme disease can manifest as a persistent infection and why additional research is need to guide physicians on how best to treat it.

1. Lyme Disease
Prevention, Diagnosis, and Treatment
Keith Berndtson, MD

2. Preventing Tick Bites
On People
1. Avoid direct contact with ticks by avoiding wooded or bushy areas and
walking in the center of trails.
2. Repel ticks with DEET >20% placed on skin (avoid hands, eyes, and
mouth) and use permethrin-treated clothing.
3. Find and properly remove ticks from your body, gear, and pets.
a. Inspect clothes, dryer-tumble in high heat for 10 minutes.
b. Inspect children, gear, and pets before entering house.
c. Bathe or shower within 2 hours.
d. After shower use two mirrors to do a full body check with special
attention to hair, ears, armpits, and groins.
www.travelreadymd.com/how-to-make-your-clothing-insect-repellent/
DEET Lemon Eucalyptus

3. Preventing Tick Bites
On Pets
1. Check pets for ticks daily, best right after being outside.
2. If a tick is found, remove it right away.
3. Ask the vet to do a tick check with each exam.
4. Consult your vet about tick repellents for your pet.
5. Reduce tick habitat in your yard.
6. Use tick collars* for dogs and cats.
*(contain propoxur, S-methoprene so consult your vet)

4. Preventing Tick Bites
1. Use landscaping principles to
create tick-safe zones.
2. Mow frequently and keep leaves
raked.
3. Clear tall grasses and brush from
around the home.
4. Place a 3-ft. gravel barrier between
lawns and wooded areas.
5. Keep playgrounds and furniture
away from wooded edges.
6. Stack wood, keep it dry, and
reduce habitat for rodents.
In the Yard

5. How to Remove a Tick
1. Use fine or special tweezers to grasp tick as close to the skin as possible.
2. Pull upward with steady pressure to avoid leaving mouth in the the skin.
3. If mouth remains in skin, remove it. If buried, leave it and monitor.
4. Clean the bite zone and your hands with alcohol, then soap and water.
5. Do not use nail polish or intense heat to remove ticks.
6. Save the tick in a baggie or under clear tape on white paper.

6. Identifying a Tick
Embedded Deer Tick larva
Deer Tick mouth parts
Lyme disease
Babesia
Bartonella
Ehrlichia
Anaplasma
Powassan
virus
Rocky mtn.
spotted fever
B. americana
B. andersonii
Ehrlichia
Borrelia?

7. July 2012 Illinois Tick survey
56.4% of over 1,067 ticks collected from 17 sites in Cook,
Lake, McHenry, and DuPage counties were deer ticks.

8. Dispersal of Borrelia burgdorferi
by songbirds can help account
for the dramatic increase in the
incidence of tick-borne diseases
in North America and Europe
over the past 16 years.
Bloated tick on a Cedar Waxwing

9. The Deer Tick Life Cycle
Year 1:
1. 100 Adult Ticks Lay Eggs
Assume: 2500 Eggs per Tick
2. 250,000 Eggs Total
Assume: 80% Hatch
3. 200,000 Larvae
Assume: 10% Find a Host, Feed, and Molt
Year 2:
4. 20,000 Nymphs
Assume: 10% Find a Host, Feed, and Molt
5. 2000 Adult Ticks
Assume: 10% Mate, and Lay Eggs
6. 200 Adults Lay Eggs, Complete the Cycle
RESULT:
Double the starting population in two years.
A Crude Model for Deer Tick
Population Expansion

10. Signs of Lyme Disease
Lyme Arthritis
•Migrating oligoarthritis (one or a few larger joints
at a time, changing over time).
•Occurs in > 60% of untreated Lyme patients.
•Variable response to antibiotics and anti-
inflammatories. Best results with early treatment.Classic Bull’s Eye Classic Bell’s Palsy

11. Symptoms of
Lyme Disease
1. CDC website woefully inadequate
on this subject.
2. Over 50 symptoms documented for
acute and persistent Lyme.
3. Early dissemination: days to weeks.
4. Late dissemination: weeks to
months.
5. Main destination: matrix tissue
a. Joints
b. Heart
c. Brain and nervous systems
d.Various other organs
6. Common with late dissemination:
a. Severe fatigue
b. Joint and muscle aches
c. Depression, anxiety
d. Memory loss, brain fog
e. Poor sleep

12. Diagnosis and Testing
1. CDC website woefully inadequate on this subject.
2. Two-step method averages a 50% false negative rate.
3. Virginia and Maine passed laws requiring MDs to
inform patients that a negative two-step test does not
rule out Lyme disease.
3. To avoid persistent Lyme, early detection is essential.
4. IgX method misses fewer cases than 2-step method.
5. iSpot Lyme test: only 16% false negatives and only
6% false positives.
7. The search is on for tests with better abilities to rule
in (sensitivity) and rule out (specificity) cases of Lyme
and associated diseases.
ILADS

13. Treatment
Patients Caught in the Crossfire
Given the lack of reliable biomarkers for use in monitoring responses
to therapy for chronic Lyme disease, outcomes evaluation must rely
on methods for assessing the subjective dimensions of the patient’s
experience with therapy.
Physical Symptoms
Social
Mental
Overall
Function
Outlook
ILADS
??
Who will help me?
The Rationalists The Empiricists
Finding reasons
to treat
Finding reasons
not to treat

14. What are doctors to supposed to do?

15. Evidence for Immune Evasion and
Persistent Infection in Lyme Disease
2. Bb uses host proteins, antigen masking and variation, elite motility
skills, strategic niche-seeking, horizontal gene transfer, atypical forms,
biofilm-like behavior, and antibiotic tolerance to help it persist within
mammalian hosts.
1. Bb has an unusually adaptive combined genome that encodes for a
powerful set of immune evasion capabilities.
3. In mice and primates, Bb subsets are proven to remain viable and
infective despite culture negativity following antibiotic challenge.
4. Immune suppressed mice are more susceptible to the reactivation of
viable Bb that persist despite antibiotic challenge.
5. Solid evidence supports the existence of persistent Lyme disease. Health
care policy needs to accommodate efforts to prevent, detect, and treat it.

16. “The question is no longer whether Lyme disease can survive
antibiotic challenge in order to become a persistent infection.
Our task in the new era is to determine which patients suffer
from persistent Lyme disease, and to keep pressing for
evidence-based wisdom to guide the physicians called upon
to treat them.”
- Keith Berndtson, MD
Conclusion

17. 15 N. Prospect
Park Ridge, IL 60068
847-232-9800
www.parkridgemultimed.com
Patient-centered
systems medicine.