A Rash Decision - A case study on Lyme Disease


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Rebecca Dew, Medical Laboratory Scientist at Canterbury Health Laboratories presented this case study on Lyme Disease at the NZIMLS South Island Seminar in Hokitika in April 2013

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A Rash Decision - A case study on Lyme Disease

  1. 1. A RASH DECISION Canterbury Health LaboratoriesRebecca Dew BSc, Grad Dip SciSerology/Virology
  2. 2. Presenting Complaint Canterbury Health Laboratories• 60 year old man• Originally from Scotland• 5-6 year history of a slowly extending rash• No foreign travel
  3. 3. Presenting Complaint Canterbury Health Laboratories• Right arm• Thickening over elbow
  4. 4. Early Infection Canterbury Health Laboratories• Bluish/red discolouration with swelling• Extensor surfaces hands and feet• Unilateral
  5. 5. Over the Years Canterbury Health Laboratories• Extends over months to years• Oedema resolves as atrophy develops• Prominent underlying veins
  6. 6. Late Infection Canterbury Health Laboratories• Fibrous induration/ nodules over bony prominences• Sclerotic lesions can cause peripheral nerve or joint damage
  7. 7. Histology Canterbury Health Laboratories• Acrodermatitis chronica atrophicans
  8. 8. To Recap…… Canterbury Health Laboratories• Deer farmer in the Highlands of Scotland• What’s your answer?
  9. 9. Lyme Disease Canterbury Health Laboratories• Positive Lyme serology• Western Blot – 3 bands to Borrelia burgdorferi – 7 bands to B. afzelii• No identified tick bite• Known cases among co-workers
  10. 10. Castor Bean Tick Canterbury Health Laboratories• Ixodes ricinus – B. burgdorferi – B. afzelii – B. garinii
  11. 11. Symptoms and ClinicalFeatures Canterbury Health Laboratories• Tick bite• “Bulls-eye” rash• Multiple and chronic multisystem complications – Arthritis• Neuroboreliosis
  12. 12. Canterbury Health LaboratoriesReported Cases of Lyme Disease by Year,United States, 2002-2011 Centre for Disease Control and Prevention
  13. 13. Treatment Canterbury Health Laboratories• Antibiotics - Generally, recovery will be quicker and more complete the sooner treatment begins• Oral antibiotics - early-stage Lyme disease – Doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women• Intravenous antibiotics - CNS involvement.
  14. 14. Prevention Canterbury Health Laboratories• Long sleeves and long pants• DEET• Check, check and check again…….• Vaccination???
  15. 15. And to finish…. Canterbury Health Laboratories• Dr Richard Clinghan• Dr Sophie Wen