This 12-year-old girl developed a fever and rash on her back after walking through tall grass where she had horseback riding lessons. She was diagnosed with Lyme disease caused by the Borrelia burgdorferi bacteria. Her history of being in an area with ticks and exposure to horses suggested she was infected through a tick bite. Lyme disease is transmitted through the bite of infected blacklegged ticks and causes a characteristic rash and flu-like symptoms in its early stage.

1. CASE 2
PARICHAYA WONGSA 60483
EMILYN KETUDAT-CAIRNS 60484

2. This 12-year-old girl was in her
normal state of good health when
she developed a fever of several
days duration. She had no
localizing symptoms, except for
the development of a large rash
on her back (Fig. 1). Her history
was notable in that she lived in
Connecticut near the New York
State border and had recently
been walking through a tall grass
where her sister was taking a
horseback riding lesions.

3. WHICH MICROORGANISM WAS SHE INFECTED?
WHAT DISEASE DID SHE HAVE?
• She was infected by Borrelia burgdorferi
• Lyme Disease
 Borrelia burgdorferi causes Lyme disease (named after a town in
Connecticut).
 Lyme disease is also known as Lyme borreliosis
 Lyme disease is the most common tick-borne disease in the United
States. It is also the most common vector-borne disease in the United
States.

4. WHAT IN HER HISTORY WAS SUGGESTIVE OF THIS
DISEASE?
HOW IS THE DISEASE TRANSMITTED?
• It was mentioned from her history that she walks through tall grass
where she did horseback ride lessons. It is transmitted through
vectors transmission by the ticks from the horse.

5. THE PATHOGEN’S MORPHOLOGY

6. THE PATHOGEN’S MORPHOLOGY

7. THE PATHOGEN’S MORPHOLOGY

9. BORRELIA
BURGDORFERI MICROGRAPHS

10. PATHOGENESIS OF LYME DISEASE
CAUSED BY BORRELIA BURGDORFERI

11. Stage 1 (early localized stage),
Erythema chronicum migrans (also called erythema migrans), an expanding, erythematous,
macular rash that often has a “target” or “bull’s eye” appearance.
The rash appears between 3 and 30 days after the tick bite.
Both the tick bite and the rash are painless and nonpruritic.
The rash may sometimes be accompanied by nonspecific “flulike” symptoms such as fever,
chills, fatigue, and headache. Secondary skin lesions frequently occur.
Arthralgias, but not arthritis, are another common finding in this early stage. In approximately
25% of cases of Lyme disease, no rash is seen.

12. tage 2 (early disseminated stage),
• Occurs weeks to months later,
• Cardiac and neurologic involvement predominates. Myocarditis, accompanied by various
forms of heart block, occurs. Acute (aseptic) meningitis and cranial neuropathies, such as
facial nerve palsy (Bell’s palsy), are prominent during this stage.
• Bilateral facial nerve palsy is highly suggestive of Lyme disease.
• Peripheral neuropathies also occur.

13. latent phase lasting weeks to months typically ensues.
Stage 3 (late disseminated stage)
• Arthritis, usually of the large joints (e.g., knees), is a characteristic finding. It
develops in almost two-thirds of untreated patients.
• Lyme arthritis is thought to be autoimmune in origin.
• Encephalopathy also occurs in stage 3.
• Some patients treated for Lyme infection continue to have prolonged subjective
symptoms of fatigue, joint pains, or mental status changes after objective findings
have disappeared.

14. • Culture of the organism is rarely positive, usually not performed.
• The diagnosis in later stages of disease usually rests on the
demonstration of circulating antibodies to B burgdorferi.
• Recommended diagnosis procedure is to first perform a sensitive
screening test (enzyme immunoassay) followed by an
immunoblot (Western blot), which detects specific antigens of the
organism.

15. • Diagnosis of early Lyme disease is based on exposure and typical
clinical findings. (most common is erythema migrant
(3 stages, early localized stage, early disseminated stage(cardiac &
neurologic), late disseminated stagearthritis) )

16. • Detecting either IgM antibody or detect rising of IgG antibody
with ELISA or with an indirect immunofluorescence test.
• IgM is detectable after 2 weeks after infections, peaks at 3-6
weeks. Test for IgG more reliable after 30 days of infection.
• Can be problematic because of presence of cross-reacting
antibodies against spirochetes in normal flora. Should perform
western blots test after.

17. • Dr. Burrascano stats bands 18, 23-25, 31, 34, 37, 39, 83, 93.(no
other disease can cause these to be positive.

18. • Nucleic acid amplication(PCR) procedures able to detect
B.burgdorferi- specific DNA sequences in body fluids (joint,
CSF) is available.

19. • Stage 1 and mild manifestations similar to stage 1
Treated with Doxycycline, amoxicilin, and cefuroxime axetil via
oral treatment, patient usually recover rapidly and completely.
In more complicated cases treatment may take anywhere from 3
weeks to a little bit more than a month before complete recovery
Caution! Should the patient have illness related to either neurological
or cardiac form, Intravenous treatment using drugs ceftriaxone or
penicillin

20.  For some unfortunate patient,
 the symptom of the disease may last more than six months!
 This is called Chronic Lyme Disease or Post-treatment Lyme
Disease Syndrome (short PTLDS)
 As of now there is no guaranteed treatment for the lingering effects.
 In fact, long-term antibiotic
 treatment may be harmful to health.

21.  Patient suffering from lingering effects of PTLDS will recover but
with time.
 There are medicines aimed to relieve the patients from pain and
discomfort from PTLDS and it is case-by-base.
 Continuation usage of antibiotics is not recommended

23. Prophylactic antibiotics should be given in regard to
2 main factors
• The percentage of infected tick in the area
• The length of time the tick has fed on the person
If the risk is high patient should be given doxycycline to
prevent the disease

24. Any person bitten by a tick should watch carefully to rash or
flu-like symptoms for the next 3 weeks
The vaccine containing outer surface protein as the
immunogen is no longer recommended

25. THANK YOU