Management Of Lyme Disease Research Articles

Incidence and management of Lyme disease: a Scottish general practice retrospective study.

The true burden of Lyme disease in primary care in Scotland is unknown. Epidemiological data are currently based on laboratory-confirmed reports as there is no mandatory reporting of clinical cases. To analyse data from general practice in NHS Highland (North) over a 6-year period to assess the incidence and management of Lyme disease in primary care. This was a retrospective descriptive study. Study data from 2017 to 2022 were extracted from all 63 general practices within NHS Highland (North). Consultations for Lyme disease were identified via Lyme-related clinical Read codes, requests for borrelia tests , free text, 'tags' and/or Lyme disease antibiotic scripts. Using Read codes to identify patients with Lyme disease or suspected Lyme disease gave an estimated average annual incidence of 124/100 000 population, which was 2.1 times more than estimates based solely on laboratory-confirmed reports. The incidence figures increased 5.2 times (362/100 000 population) when patients with Lyme disease or suspected Lyme disease (identified via Read codes, laboratory test requests, and free text tags) who were given antibiotic treatment were taken into account. Local 'hot spots' of infection were identified. Analysis of the antibiotic data indicates that antibiotic prescribing in NHS Highland largely follows the National Institute for Health and Care Excellence (NICE) guidelines. This data analysis pathway can, and should, be rolled out across the whole of Scotland to assess the incidence and management of Lyme disease in primary care and allow appropriate allocation of resources.

Consultation in out-of-hours practice: a clinical review of Lyme disease

In this article Sharon Brydon and Dr Sonya MacVicar highlight the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

An ecological approach to predict areas with established populations of Ixodes scapularis in Quebec, Canada

Public health management of Lyme disease (LD) is a dynamic challenge in Canada. Climate warming is driving the northward expansion of suitable habitat for the tick vector, Ixodes scapularis. Information about tick population establishment is used to inform the risk of LD but is challenged by sampling biases from surveillance data. Misclassifying areas as having no established tick population underestimates the LD risk classification.We used a logistic regression model at the municipal level to predict the probability of I. scapularis population establishment based on passive tick surveillance data during the period of 2010-2017 in southern Quebec. We tested for the effect of abiotic and biotic factors hypothesized to influence tick biology and ecology. Additional variables controlled for sampling biases in the passive surveillance data.In our final selected model, tick population establishment was positively associated with annual cumulative degree-days > 0°C, precipitation and deer density, and negatively associated with coniferous and mixed forest types. Sampling biases from passive tick surveillance were controlled for using municipal population size and public health instructions on tick submissions. The model performed well as indicated by an area under the curve (AUC) of 0.92, sensitivity of 86% and specificity of 81%.Our model enables prediction of I. scapularis population establishment in areas which lack data from passive tick surveillance and may improve the sensitivity of LD risk categorization in these areas. A more sensitive system of LD risk classification is important for increasing awareness and use of protective measures employed against ticks, and decreasing the morbidity associated with LD.

Consultation in out-of-hours practice: a clinical review of Lyme disease

In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding of the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.

Management of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines.

Management of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines.

A Computer Vision Approach to Identifying Ticks Related to Lyme Disease.

Background: Lyme disease (caused by Borrelia burgdorferi) is an infectious disease transmitted to humans by a bite from infected blacklegged ticks (Ixodes scapularis) in eastern North America. Lyme disease can be prevented if antibiotic prophylaxis is given to a patient within 72 hours of a blacklegged tick bite. Therefore, recognizing a blacklegged tick could facilitate the management of Lyme disease. Methods: In this work, we build an automated detection tool that can differentiate blacklegged ticks from other tick species using advanced computer vision approaches in real-time. Specially, we use convolution neural network models, trained end-to-end, to classify tick species. Also, advanced knowledge transfer techniques are adopted to improve the performance of convolution neural network models. Results: Our best convolution neural network model achieves 92% accuracy on unseen tick species. Conclusion: Our proposed vision-based approach simplifies tick identification and contributes to the emerging work on public health surveillance of ticks and tick-borne diseases. In addition, it can be integrated with the geography of exposure and potentially be leveraged to inform the risk of Lyme disease infection. This is the first report of using deep learning technologies to classify ticks, providing the basis for automation of tick surveillance, and advancing tick-borne disease ecology and risk management.

Management of Lyme Disease: An Update

Sponsoring Organizations: The Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of

Survey of Lyme disease management in primary care in Poland

Survey of Lyme disease management in primary care in Poland

AKT question relating to management of Lyme disease

AKT question relating to management of Lyme disease

AKT answer relating to management of Lyme disease

AKT answer relating to management of Lyme disease

Prevention and management of Lyme disease: On complexity and the need to take into consideration various psycho-social factors

This paper aims to present a psychosocial analysis on the scientific literature concerning Lyme disease prevention and care. We performed a literature review on Lyme disease, especially on prevention and care, both through physicians and patients' perspective. A total of 31 documents were included in our literature review. Literature shows that the acceptability of preventive measures, which is relatively poor, has to be associated with the behavioral nature, and not medical one, of these interventions. Moreover, the Lyme disease care is characterized by a condition of uncertainty - especially because of the controversy about the existence of the chronical form and the treatment to adopt - provoking important consequences on patient's quality of life. That is why the acknowledgment of profane knowledge's legitimacy is strongly demanded by patients, especially through the research of an empowered condition in the relation with the physicians. In this sense, the construction of a solid relation between caregiver and patient seems to be essential. The invisibility of most symptoms, the patient's subjective experience and the social representations about Lyme disease show the need and the contribution of a psychosocial approach, in order to better understand the life experience of this uncertain condition and, more in general, of this disease.

A Multiple Streams Approach to Understanding the Issues and Challenges of Lyme Disease Management in Canada's Maritime Provinces.

This study examines potential challenges facing Lyme disease patients in Canada’s Maritime provinces—New Brunswick, Nova Scotia, Prince Edward Island—and considers how issues could be addressed. Reviews of both the academic and grey literature are complemented by surveys targeting both medical professionals and decision makers in government. Combined, the literature reviews and surveys demonstrate that there is considerable debate surrounding the effectiveness of testing, treatment options, and the existence of chronic Lyme disease. As the focus on the Maritimes demonstrates, these debates often pit the medical community against patients and patient advocates and, thus far, governments have been unable to produce policy that entirely pleases either side. Moving forward, this study recommends the creation of a discussion forum via a federal Commission of inquiry to review best practise guidelines for Lyme disease. The key is to foster an unbiased probe of central issues surrounding treatment and diagnosis without alienating stakeholders. This course of action will not necessarily solve the issue of Lyme disease, but would foster a greater understanding through dialogue that includes and validates the experiences of stakeholders, which is something that is currently missing.

Diagnosis and management of patients with Lyme disease: NICE guideline.

The National Institute for Health and Care Excellence (NICE) has published a new guideline on diagnosis and management of Lyme disease.1 The guideline aims to increase awareness of Lyme disease and ensure that patients get the correct treatment at an early stage. Lyme disease is a bacterial infection transmitted by the bite of an infected tick. The bacterium Borrelia burgdorferi is a spirochete with many similarities to the syphilis organism. Ticks inject a local anaesthetic to the site of the bite and often attach themselves at the hairline or in the axillae or groin areas, so they can be easy to miss. Ticks are found in grassy and woodland areas, including urban gardens and parks. Not all ticks carry Lyme disease, but infected ticks have been identified in urban and peri-urban areas.2 There is a perception that Lyme disease only occurs in certain areas and, although some areas have a higher prevalence, cases are reported throughout the UK. People in certain occupations, for example, farm workers, are at higher risk but anyone who spends time outside is at risk. Worldwide, higher prevalence is noted in Central, Eastern, and Northern Europe, the US and Canada, and parts of Asia. A good occupational, travel, and lifestyle history is important when assessing patients. Lyme disease is a multisystem illness and can present with a variety of focal and non-focal symptoms and …

Lyme disease: diagnosis and management

Lyme disease (borreliosis) is a tick-borne bacterial infection caused by the spirochaete Borrelia burgdoferi, transmitted by hard-backed Ixodes ticks. Actual numbers of cases are increasing and it appears that the...

Incidence, presentation and management of Lyme disease in Dutch general practice.

Little is known about the presentation and management of Lyme disease in general practice. To investigate the incidence of Lyme disease over a 6-year period, and its presentation and management in Dutch general practice. Observational study using routine data from a practice-based research network in the Netherlands with 7 practices, 24 GPs and 30000 registered patients. From 2009 to 2014, we calculated the incidence of patients presenting with Lyme disease in general practice. We analysed patient characteristics and symptoms that patients presented with at first visit. Furthermore, we analysed General Practitioners' (GPs') diagnostic and therapeutic strategies, and adherence to the national guideline. Over a 6-year period, we found 212 episodes with clinical- or laboratory-based diagnosed Lyme disease, resulting in a mean incidence of 117 cases per 100000 patients per year. We did not identify a significant linear trend over time. The most frequently reported symptoms at first visit were rash (77%) and/or insect bite (58%). In 25% of patients, GPs performed a serological test, in 99% an antibiotic was prescribed and 11% were referred to a medical specialist. Frequently (in 46% of patients), the GP did not adhere to the guideline completely. This study shows that there is no linear trend in the incidence of Lyme disease over a 6-year period and that most patients present to GPs with unspecific symptoms like rash or insect bites. We show that GPs frequently (in 46% of patients) do not fully adhere to recommendations stated in the national guideline.

Multi-Scale Clustering of Lyme Disease Risk at the Expanding Leading Edge of the Range of Ixodes scapularis in Canada

Since its detection in Canada in the early 1990s, Ixodes scapularis, the primary tick vector of Lyme disease in eastern North America, has continued to expand northward. Estimates of the tick’s broad-scale distribution are useful for tracking the extent of the Lyme disease risk zone; however, tick distribution may vary widely within this zone. Here, we investigated I. scapularis nymph distribution at three spatial scales across the Lyme disease emergence zone in southern Quebec, Canada. We collected ticks and compared the nymph densities among different woodlands and different plots and transects within the same woodland. Hot spot analysis highlighted significant nymph clustering at each spatial scale. In regression models, nymph abundance was associated with litter depth, humidity, and elevation, which contribute to a suitable habitat for ticks, but also with the distance from the trail and the type of trail, which could be linked to host distribution and human disturbance. Accounting for this heterogeneous nymph distribution at a fine spatial scale could help improve Lyme disease management strategies but also help people to understand the risk variation around them and to adopt appropriate behaviors, such as staying on the trail in infested parks to limit their exposure to the vector and associated pathogens.

Management of Lyme Disease in European Children: a Review for Practical Purpose.

Lyme disease is a tick-borne zoonosis transmitted through a bite of a tick carrying a spirochete belonging to Borrelia species. In the last 20years, the reported incidence of Lyme disease is increased by three times in Europe. Clinically, the illness develops through a primary stage with a typical skin rash (erythema marginatum), then a secondary stage with possible neurologic or cardiac involvement. The last stage (chronic Lyme disease) is mainly represented by arthritis or late neurological complications but nowadays is rarely seen due to precocious antibiotic use. The diagnosis of Lyme disease is essentially based on history in agreement with tick exposure (living/recent traveling in endemic area or tick bite) and clinical findings compatible with the disease. At present, no laboratory diagnostic tool available can neither establish nor exclude the diagnosis of Lyme disease. The management of Lyme disease should comprise a prophylactic administration of antibiotic in selected population (patients exposed to a tick bite in endemic regions) in which the typical signs of Lyme disease are not yet appeared; conversely, patients with current signs of Lyme disease should undergo a standard therapeutic course. First-line therapy should be oral tetracycline or oral penicillin/cephalosporin (in pediatric populations, beta-lactamic drugs are preferred). In severe courses, intravenous route should be preferred. The aim of this review is to provide an updated guide to the management of pediatric Lyme patients, from prophylaxis to first- and second-line therapy in European setting.

The management of Lyme disease

Prompt treatment is important in order to minimise the risk of multi-system disease, says Sandra Pearson

Gene bb0318 Is Critical for the Oxidative Stress Response and Infectivity of Borrelia burgdorferi.

A greater understanding of the molecular mechanisms that Borrelia burgdorferi uses to survive during mammalian infection is critical for the development of novel diagnostic and therapeutic tools to improve the clinical management of Lyme disease. By use of an in vivo expression technology (IVET)-based approach to identify B. burgdorferi genes expressed in vivo, we discovered the bb0318 gene, which is thought to encode the ATPase component of a putative riboflavin ABC transport system. Riboflavin is a critical metabolite enabling all organisms to maintain redox homeostasis. B. burgdorferi appears to lack the metabolic capacity for de novo synthesis of riboflavin and so likely relies on scavenging riboflavin from the host environment. In this study, we sought to investigate the role of bb0318 in B. burgdorferi pathogenesis. No in vitro growth defect was observed for the Δbb0318 clone. However, the mutant spirochetes displayed reduced levels of survival when exposed to exogenous hydrogen peroxide or murine macrophages. Spirochetes lacking bb0318 were found to have a 100-fold-higher 50% infectious dose than spirochetes containing bb0318 In addition, at a high inoculum dose, bb0318 was found to be important for effective spirochete dissemination to deep tissues for as long as 3 weeks postinoculation and to be critical for B. burgdorferi infection of mouse hearts. Together, these data implicate bb0318 in the oxidative stress response of B. burgdorferi and indicate the contribution of bb0318 to B. burgdorferi mammalian infectivity.