WEBVTT 00:00:09.083 --> 00:00:10.583 Hello, everyone. 00:00:10.583 --> 00:00:13.583 Today's presentation is going to be on Lyme disease. 00:00:13.666 --> 00:00:16.066 A little introduction for myself. My name is Ben Barter. 00:00:16.066 --> 00:00:18.150 I'm a medical laboratory scientist 00:00:18.150 --> 00:00:21.800 certified through the American Society of Clinical Pathology, or ACP. Is. 00:00:22.100 --> 00:00:25.050 Hopefully you all be all soon. 00:00:25.050 --> 00:00:27.416 I work at EPI laboratories in the Microbial 00:00:27.416 --> 00:00:30.900 Immunology department, and I'm currently the education specialist. 00:00:31.550 --> 00:00:34.133 And this presentation kind of hits home to me. 00:00:34.133 --> 00:00:37.550 I'm an avid outdoorsman, and I have a lot of friends that also enjoy the outdoors. 00:00:37.550 --> 00:00:40.250 And I've had some friends actually contract Lyme disease. 00:00:40.250 --> 00:00:43.283 And so as we're going through this, this is kind of a a topic that hits 00:00:43.283 --> 00:00:46.733 home to me in maybe I'll be able to relate some of those personal stories as well. 00:00:47.633 --> 00:00:50.333 Let's start with the objectives for this presentation. 00:00:51.716 --> 00:00:51.900 So the 00:00:51.900 --> 00:00:55.100 objectives are to identify how Lyme disease is transmitted. 00:00:55.800 --> 00:00:58.650 Locate Lyme hotspots and the increasing prevalence 00:00:58.650 --> 00:01:01.883 in the United States, specifically the eastern United States. 00:01:02.633 --> 00:01:05.083 Interpret Lyme disease signs and symptoms. 00:01:05.083 --> 00:01:08.900 Discuss the diagnosis of lab and laboratory testings associated 00:01:08.900 --> 00:01:11.300 with Lyme, and 00:01:11.300 --> 00:01:14.400 outline the updated testing protocols that have recently come out. 00:01:14.400 --> 00:01:17.400 In July of 2019. 00:01:17.783 --> 00:01:20.783 So what is Lyme disease? 00:01:21.766 --> 00:01:23.750 Lyme disease is a bacterial infection 00:01:23.750 --> 00:01:27.866 specifically caused by the spider Borrelia burgdorferi. 00:01:28.316 --> 00:01:29.066 But really, Dr. 00:01:29.066 --> 00:01:32.216 Frye, is this kind of corkscrew shaped bacteria. 00:01:32.700 --> 00:01:35.000 It's going to cause an array of clinical symptoms, 00:01:35.000 --> 00:01:38.000 which can make it really hard for diagnosis later. 00:01:38.100 --> 00:01:41.100 That can mimic a lot of different things fever, chills, 00:01:41.666 --> 00:01:45.800 body aches, swollen joints, swollen lymph nodes, stuff like that. 00:01:45.800 --> 00:01:47.666 So it can be kind of hard to diagnose later. 00:01:49.066 --> 00:01:49.433 It is a 00:01:49.433 --> 00:01:53.300 vector borne disease, meaning that it is spread by insects specifically, 00:01:53.750 --> 00:01:56.750 in this case the deer tick and the black legged tick. 00:01:57.800 --> 00:01:58.966 Our reservoir is usually 00:01:58.966 --> 00:02:02.516 small rodents, such as mice or the white footed mouse. 00:02:02.866 --> 00:02:05.866 However, there are other ones as well, such as the American robin. 00:02:06.300 --> 00:02:07.250 The red breasted bird 00:02:07.250 --> 00:02:10.250 that you probably see flying around in your garden, in your neighborhood. 00:02:10.350 --> 00:02:13.350 And some other small rodents, squirrels, 00:02:13.350 --> 00:02:16.350 rabbits, things like that as well. 00:02:16.433 --> 00:02:18.433 So let's start with the history of Lyme disease. 00:02:18.433 --> 00:02:19.650 Ticks and evidence of Lyme 00:02:19.650 --> 00:02:22.650 disease have been around for hundreds, if not thousands of years. 00:02:22.766 --> 00:02:26.366 That classic bull's eye rash has been recorded before, and ticks 00:02:26.366 --> 00:02:29.516 have been found for a long time in the past 00:02:31.050 --> 00:02:34.216 and didn't really come into light until in about the 1970s 00:02:34.216 --> 00:02:35.866 in Lyme, Connecticut, 00:02:35.866 --> 00:02:38.866 there was a bunch of children that started presenting with a bunch of, 00:02:38.866 --> 00:02:42.016 puzzling symptoms such as rash, swollen knees, 00:02:42.016 --> 00:02:45.016 paralysis, headache, and severe chronic fatigue. 00:02:45.450 --> 00:02:47.300 Originally, they were starting to think that this was 00:02:47.300 --> 00:02:51.383 maybe from an environmental pollutant or, some sort of poisoning going on. 00:02:51.983 --> 00:02:57.083 However, it wasn't until, 1981 where Willy Bergdorf for, 00:02:57.800 --> 00:03:01.066 a Swiss scientists, specializing in entomology, 00:03:01.400 --> 00:03:04.400 which is the study of insects, came on the case. 00:03:04.516 --> 00:03:08.700 And in 1982 he found this cork shaped screwed 00:03:08.700 --> 00:03:12.900 spider queen or beryllium or Durfee, and they named after him in his honor. 00:03:14.266 --> 00:03:16.550 Which brings us up today, 00:03:16.550 --> 00:03:20.250 where it is the most common vector borne disease in the United States. 00:03:20.550 --> 00:03:23.783 Primarily, this is affecting the eastern U.S.. 00:03:25.166 --> 00:03:27.300 Lyme disease globally does have 00:03:27.300 --> 00:03:30.300 several different species of Borrelia that are going to cause this. 00:03:30.650 --> 00:03:33.533 The main one we're going to focus on today is Bergdorf Rye. 00:03:33.533 --> 00:03:36.866 However, also in North America, in Europe, we have Mahoney. 00:03:37.100 --> 00:03:40.100 And that's discovered by the Mayo Clinic in 2013. 00:03:40.350 --> 00:03:42.800 These other two are mostly in Europe and Asia. 00:03:42.800 --> 00:03:45.383 So we're not going to really focus on those. 00:03:45.383 --> 00:03:47.666 So now let's talk about prevalence 00:03:47.666 --> 00:03:50.900 starting with prevalence by state in the United States. 00:03:51.866 --> 00:03:53.416 So here we have a map. 00:03:53.416 --> 00:03:55.016 And this is from 2019. 00:03:55.016 --> 00:03:58.950 And each one of these dots is a confirmed case of Lyme disease. 00:04:00.616 --> 00:04:02.900 Kind of randomly placed within that county. 00:04:02.900 --> 00:04:04.850 This map changes from year to year. 00:04:04.850 --> 00:04:07.850 And you can see all this information on the CDC website. 00:04:08.216 --> 00:04:11.266 So if you're thinking like me, your geography may not be the best. 00:04:11.266 --> 00:04:14.266 And you're like, where exactly is Lyme, Connecticut. 00:04:14.666 --> 00:04:15.800 Here we have it. 00:04:15.800 --> 00:04:17.666 And if you're like, I still don't know where that is. 00:04:17.666 --> 00:04:20.666 For reference, here's Boston and here's New York. 00:04:21.233 --> 00:04:23.966 You can see here that Massachusetts in this picture 00:04:23.966 --> 00:04:27.616 doesn't have a lot of cases presented, but it's surrounded heavily 00:04:27.616 --> 00:04:29.116 with lots of other cases. 00:04:29.116 --> 00:04:31.800 This is most likely due to a reporting issue. 00:04:31.800 --> 00:04:33.050 And we'll go into those later 00:04:33.050 --> 00:04:36.050 as we talk about some of the statistics for Lyme as well. 00:04:36.450 --> 00:04:38.250 So we have some other interesting statistics. 00:04:38.250 --> 00:04:39.950 This is cases by age 00:04:39.950 --> 00:04:43.500 really a spike in that 5 to 9 decline can into your teenage years. 00:04:43.883 --> 00:04:47.116 This could be that the kids are out playing in tall grass or this habitat 00:04:47.116 --> 00:04:50.000 where they might pick up tit, ticks pretty easily, 00:04:51.000 --> 00:04:52.016 and then not again 00:04:52.016 --> 00:04:56.266 until people are kind of in their late 50s, early 60s, carrying on. 00:04:56.266 --> 00:04:58.466 And this might be that they're getting ready for retirement, 00:04:58.466 --> 00:05:01.133 maybe playing a little more golf and exposed a lot more as well. 00:05:01.133 --> 00:05:01.800 I don't really know. 00:05:01.800 --> 00:05:04.100 I looked into that, but I couldn't find a ton of information 00:05:04.100 --> 00:05:06.683 as to why, specifically those two age groups. 00:05:06.683 --> 00:05:08.850 But that's my guess, is that they're probably playing 00:05:08.850 --> 00:05:11.850 a little more golf or in their yards a little more. 00:05:12.166 --> 00:05:15.166 CDC cases by week as we move in. 00:05:15.350 --> 00:05:19.916 Really are spike here is the late spring into the summer, early summer. 00:05:20.216 --> 00:05:22.966 And that has to do with the phase or the life cycle. 00:05:22.966 --> 00:05:25.816 And we'll talk about that as well. 00:05:25.816 --> 00:05:28.500 And then these statistics I found really interesting. 00:05:28.500 --> 00:05:29.550 It's estimated, 00:05:31.200 --> 00:05:33.716 that about 476,000 00:05:33.716 --> 00:05:36.766 cases of Lyme are diagnosed and treated every year. 00:05:37.666 --> 00:05:41.100 Now, the other estimate is that 300,000 of these 00:05:41.100 --> 00:05:43.316 actually have contracted the disease. 00:05:43.316 --> 00:05:46.516 Part of this is due to presumptive treatment that they just suspect, 00:05:47.450 --> 00:05:50.000 after they've been bit by a tick or something like that, 00:05:50.000 --> 00:05:52.550 they may not have actually been infected. 00:05:52.550 --> 00:05:55.550 And most of this is based on these insurance reports. 00:05:55.616 --> 00:05:57.766 So then we go back to this other statistic of 00:05:57.766 --> 00:06:01.250 35,000 actual reported confirmed cases. 00:06:02.516 --> 00:06:06.083 This has to do with the passive reporting process is that it's not mandatory. 00:06:06.383 --> 00:06:09.650 And because of that, sometimes if we have a busy 00:06:09.650 --> 00:06:12.750 healthcare system or they're overloaded, they're not able to report that. 00:06:12.750 --> 00:06:15.750 And if it's not mandatory, they're not going to take the time to do so. 00:06:15.900 --> 00:06:17.566 And so there's statistics. 00:06:17.566 --> 00:06:18.900 There are a little interesting. 00:06:20.850 --> 00:06:22.733 So we have these high numbers and they're climbing. 00:06:22.733 --> 00:06:24.166 And why is that. 00:06:24.166 --> 00:06:28.283 It's the most common vector borne disease specifically in the United States. 00:06:29.850 --> 00:06:31.966 Cases continue to rise each year. 00:06:31.966 --> 00:06:33.500 And this geographic location 00:06:33.500 --> 00:06:36.500 of where we're finding these cases continues to expand. 00:06:36.616 --> 00:06:39.616 And a lot of that has to do with the vector. 00:06:39.650 --> 00:06:42.500 So as we're talking about the vector, what is it specifically? 00:06:42.500 --> 00:06:43.916 It's a tick. 00:06:43.916 --> 00:06:44.666 In the United States, 00:06:44.666 --> 00:06:48.616 we focus on two of the main species that are going to transmit. 00:06:48.616 --> 00:06:50.750 This is the iris capillaries. 00:06:50.750 --> 00:06:53.416 And our specific case, they're, 00:06:53.416 --> 00:06:56.900 pretty uniquely named the black like a tick or the Western black 00:06:56.900 --> 00:06:58.800 like a tick for where you're going to find them. 00:06:58.800 --> 00:07:01.216 Also might be known as the deer tick. 00:07:01.216 --> 00:07:03.750 So we're going to see these in the northeastern, 00:07:03.750 --> 00:07:06.650 north central United States, maybe the Mid-Atlantic. 00:07:06.650 --> 00:07:08.000 And then I have a specific case 00:07:08.000 --> 00:07:11.000 we're going to see specifically along the Pacific Coast. 00:07:11.300 --> 00:07:12.383 Ticks are the vector. 00:07:12.383 --> 00:07:15.016 And so here we have a picture of these blacklegged ticks. 00:07:16.583 --> 00:07:19.166 Specifically on the left here we have the adult female 00:07:19.166 --> 00:07:22.350 and the adult male adult female being slightly larger than the adult male. 00:07:22.666 --> 00:07:24.316 We have the nymph and larval phase. 00:07:24.316 --> 00:07:26.150 And we'll talk about those as well, but pretty small 00:07:26.150 --> 00:07:27.866 if you're comparing them to the time here. 00:07:27.866 --> 00:07:30.866 The nymph is about the size of a Diana Darwin. 00:07:31.366 --> 00:07:32.750 So where do we find these? 00:07:32.750 --> 00:07:37.550 The iris capillaries we're mostly going to find, on the eastern end of the country. 00:07:38.033 --> 00:07:39.300 It's really interesting to me 00:07:39.300 --> 00:07:43.100 when we look at this line here, if we divide it by longitude, 00:07:43.466 --> 00:07:46.583 this would divide almost exactly along the 100th meridian. 00:07:47.183 --> 00:07:49.816 What's unique about that is that kind of divides 00:07:49.816 --> 00:07:53.716 the country into higher rainfall and lower rainfall. 00:07:54.233 --> 00:07:57.416 West of the hundredth meridian, we typically find deserts. 00:07:57.416 --> 00:08:01.016 Utah, Wyoming, Colorado, New Mexico, Arizona, Nevada, 00:08:01.250 --> 00:08:03.683 some of the dry states in the country. 00:08:03.683 --> 00:08:06.466 However, east of those, we're going to have quite a bit 00:08:06.466 --> 00:08:09.950 more rainfall, making for more vegetation and more habitat. 00:08:11.783 --> 00:08:12.133 Here's what 00:08:12.133 --> 00:08:15.200 would find the oldest specifics, mostly along the course. 00:08:15.450 --> 00:08:18.450 The coast here, the Pacific coast, 00:08:18.983 --> 00:08:20.633 a lot in Washington 00:08:20.633 --> 00:08:23.783 and Oregon as they have all the rain coming in off the ocean there. 00:08:24.100 --> 00:08:25.350 We have a couple of hotspots. 00:08:25.350 --> 00:08:27.383 One here is, Utah as well. 00:08:27.383 --> 00:08:30.533 Most of the state of Utah is a hotspot for our specific ice. 00:08:31.433 --> 00:08:34.516 So if you go back to prevalence, these prevalence cases 00:08:34.516 --> 00:08:36.600 kind of match up with that map. 00:08:36.600 --> 00:08:38.150 We have a lot of low incidence state. 00:08:38.150 --> 00:08:40.950 Most of the West is going to be low incidence. 00:08:40.950 --> 00:08:44.333 And a lot of the South Texas, Louisiana, those areas all the way 00:08:44.333 --> 00:08:48.416 across from Florida, the Carolinas, those are also going to be low incidence. 00:08:49.250 --> 00:08:53.066 And there are high incidence centering around Lyme, Connecticut. 00:08:54.283 --> 00:08:54.833 Again, this 00:08:54.833 --> 00:08:59.416 476,000 diagnosed and treated cases a year. 00:09:00.566 --> 00:09:03.566 And that's as of 2019. 00:09:03.983 --> 00:09:06.150 So here we have our life cycle. 00:09:06.150 --> 00:09:08.450 I was really surprised to know that this life cycle takes 00:09:08.450 --> 00:09:11.966 two years to complete, and a new host is needed. 00:09:12.283 --> 00:09:15.283 Almost every phase. 00:09:15.916 --> 00:09:19.366 So the greatest risk of infection is this late spring, 00:09:19.366 --> 00:09:22.666 moving into the summer, and it's mostly by this nymph phase. 00:09:23.150 --> 00:09:26.300 So what happens is winter ticks can stay active on a host. 00:09:26.600 --> 00:09:29.600 Or if they drop off, sometimes they can survive and go dormant 00:09:29.700 --> 00:09:30.833 depending on how cold it is. 00:09:30.833 --> 00:09:31.700 If it's mild winter, 00:09:31.700 --> 00:09:35.816 they might be able to crawl or some leaves or a log and, survive the winter. 00:09:35.816 --> 00:09:37.366 There. 00:09:37.366 --> 00:09:39.350 Again, this nymph stays is the most, 00:09:39.350 --> 00:09:43.216 this nymph stage is the most likely stage for human infection. 00:09:43.950 --> 00:09:45.716 And why is that? Right. 00:09:45.716 --> 00:09:48.833 And if we're looking at this picture here of the different phases 00:09:49.050 --> 00:09:52.133 on the far right, we have that tiny little larva phase. 00:09:52.133 --> 00:09:55.200 It's about the size of a poppy seed from a poppy seed muffin or something 00:09:55.200 --> 00:09:56.000 like that. 00:09:56.000 --> 00:09:59.550 Next would be the nymph, and that would be about the size of a sesame seed. 00:09:59.550 --> 00:10:01.883 So pretty small and hard to find. 00:10:01.883 --> 00:10:04.733 And the adult male and the adult female are a little bit 00:10:04.733 --> 00:10:07.733 smaller than maybe the kernel of a sunflower. 00:10:07.733 --> 00:10:08.183 Kernel. 00:10:10.100 --> 00:10:13.100 So here's that nymph phase. 00:10:13.466 --> 00:10:14.450 So why the in phase? 00:10:14.450 --> 00:10:16.466 Again, they're small and hard to see. 00:10:16.466 --> 00:10:19.466 They may be really hard to feel in your hairline. 00:10:19.766 --> 00:10:22.733 So we're unlikely to discover these within 36 hours. 00:10:22.733 --> 00:10:25.883 That 36 hours is kind of the magic window or timeline 00:10:26.216 --> 00:10:29.900 most of the time, if we can remove a tick within 36 hours of the attaching, 00:10:30.450 --> 00:10:33.450 we have a low incidence of infection for Borrelia. 00:10:35.333 --> 00:10:37.516 There's a lot of nymphs at this phase questing, 00:10:37.516 --> 00:10:40.516 which is how they attach to us in the spring and summer. 00:10:41.250 --> 00:10:44.783 Rather than having to go through a full another year of the life cycle. 00:10:45.266 --> 00:10:46.650 They don't have to survive another winter. 00:10:46.650 --> 00:10:49.650 They don't have to survive any predation from, 00:10:49.950 --> 00:10:52.883 birds or, small little predators. 00:10:52.883 --> 00:10:54.683 They would eat these ticks. 00:10:54.683 --> 00:10:56.933 So there's a lot more nymphs in this questing phase 00:10:56.933 --> 00:11:00.000 in the spring and summer, in that first year of their life cycle. 00:11:01.800 --> 00:11:03.266 And, an easy way to 00:11:03.266 --> 00:11:06.266 prevent this is, tick checks and showers. 00:11:06.416 --> 00:11:07.466 And with that, 00:11:07.466 --> 00:11:11.000 it takes about ten hours for a tick to select a site and attach itself. 00:11:11.216 --> 00:11:15.150 So if we can shower and use a washcloth or even just some soap to kind of scrub 00:11:15.150 --> 00:11:18.233 those off before they can attach, a lot of times will prevent them 00:11:18.233 --> 00:11:21.233 from fully attaching. 00:11:21.750 --> 00:11:24.333 And there again is the nymph phase on his hand. 00:11:24.333 --> 00:11:27.316 So you can see these are quite small, especially in your hairline, 00:11:27.316 --> 00:11:30.166 behind your ears, behind a knee, maybe in an armpit or 00:11:30.166 --> 00:11:33.600 on the back of your neck, your collar line where you don't check and see a lot. 00:11:33.800 --> 00:11:35.850 You may not feel or see these, 00:11:35.850 --> 00:11:38.750 until they've started to engorged with blood from that blood meal 00:11:38.750 --> 00:11:40.800 so they can be pretty hard to find and see. 00:11:40.800 --> 00:11:42.800 And that's why people have them for a while. 00:11:44.333 --> 00:11:44.933 So when we're talking 00:11:44.933 --> 00:11:47.933 about why more Lyme disease, there's a couple theories on this. 00:11:48.116 --> 00:11:51.983 One of them has to do with reforestation and the conservation of habitat, 00:11:52.283 --> 00:11:55.850 specifically the conservation of habitat for deer populations. 00:11:55.850 --> 00:11:58.850 And within that habitat comes more mice. 00:11:58.916 --> 00:12:00.533 Therefore, the ticks have more food. 00:12:00.533 --> 00:12:02.450 So we're going to get more ticks as well. 00:12:02.450 --> 00:12:06.383 They have an easier time wintering over with more deer and mice populations. 00:12:06.900 --> 00:12:08.216 We have some slight climate change 00:12:08.216 --> 00:12:11.600 considerations that, winters are becoming slightly milder. 00:12:11.966 --> 00:12:14.700 So that might be, extending the range. 00:12:14.700 --> 00:12:17.366 And we have this outdoor recreation boom. 00:12:17.366 --> 00:12:20.716 In the past few years, outdoor recreation has become very popular, 00:12:20.966 --> 00:12:24.350 especially this last year with this social distancing initiative, 00:12:24.900 --> 00:12:27.900 tons of people flocked to the outdoors to 00:12:28.200 --> 00:12:31.200 kind of recreate in ways that they hadn't in the past. 00:12:31.433 --> 00:12:35.416 And so we'll expect that hopefully, we don't see a huge increase, 00:12:35.416 --> 00:12:39.000 but maybe we will with more people being outside and being bit by ticks. 00:12:39.466 --> 00:12:40.766 And the other is urban expansion. 00:12:40.766 --> 00:12:44.366 We continue to grow and move into other areas and other habitat 00:12:44.550 --> 00:12:48.116 where we're exposing people to ticks where they weren't previously exposed. 00:12:49.950 --> 00:12:52.100 Now let's talk about the transmission. 00:12:52.100 --> 00:12:54.150 And this starts with a tick bite. 00:12:54.150 --> 00:12:56.566 This picture to me is just ew, gross. 00:12:56.566 --> 00:12:57.533 You see him in there? 00:12:57.533 --> 00:13:00.716 The little inflamed, guy kind of digging in there. 00:13:01.966 --> 00:13:04.250 And so, again, we have a low infection rate. 00:13:04.250 --> 00:13:07.250 If they're attached for less than this 36 hours. 00:13:08.866 --> 00:13:09.866 This is the nymph phase. 00:13:09.866 --> 00:13:12.833 As you can see, he's pretty small. Again, less than two millimeters. 00:13:12.833 --> 00:13:13.966 That's why they're hard to detect. 00:13:13.966 --> 00:13:17.550 And that's why most people are going to be infected at this phase. 00:13:18.166 --> 00:13:21.533 Their saliva has an anesthetic property so that you don't feel them, 00:13:21.533 --> 00:13:24.500 or they maybe can get away a little bit longer. 00:13:24.500 --> 00:13:27.500 And then when you think of or variety noticed areas that I o 00:13:27.500 --> 00:13:31.316 this term is coming from a glue or cement like root word. 00:13:31.550 --> 00:13:35.483 And so they're going to secrete this glue like bonding agent in their saliva 00:13:35.483 --> 00:13:38.216 as well. It's going to kind of lock them in place. 00:13:38.216 --> 00:13:39.950 So they're really hard to remove. 00:13:39.950 --> 00:13:44.150 Anyone that's ever had a tick knows that as you use the specific tweezers or the 00:13:44.150 --> 00:13:49.500 the tick puller that you start to notice, how much your skin will stretch. 00:13:49.500 --> 00:13:50.266 And that's because they've kind of 00:13:50.266 --> 00:13:54.616 superglued themselves in there so they can't be pulled or, scraped off naturally. 00:13:56.750 --> 00:13:58.883 So how do we pick up ticks? 00:13:58.883 --> 00:14:01.516 And this is done by what they call questing. 00:14:01.516 --> 00:14:04.250 If you look at this tick here up on his legs, 00:14:04.250 --> 00:14:06.150 you can see these little barbs. 00:14:06.150 --> 00:14:08.666 So he's this is a female actually. 00:14:08.666 --> 00:14:12.350 She's out there just kind of putting out her legs with these barbed hooks, hoping, 00:14:12.650 --> 00:14:13.733 some clothing will come by 00:14:13.733 --> 00:14:17.233 or some fur of an animal will come by and she can, hitch a ride. 00:14:17.250 --> 00:14:18.950 So they're like little hitchhikers. 00:14:18.950 --> 00:14:22.216 We pick them up as we walk through, shrubs and grass 00:14:22.433 --> 00:14:26.116 while we're hiking, doing yard work, visiting a park. 00:14:26.633 --> 00:14:29.566 Or perhaps that your pets bring them into your house. 00:14:29.566 --> 00:14:32.150 Maybe you have a cat or a dog, and they jump up on the couch after 00:14:32.150 --> 00:14:35.150 they've been out rolling in the grass or playing in the field. 00:14:35.333 --> 00:14:38.933 And, as they come into your house, they have all of these questing bugs, 00:14:38.933 --> 00:14:41.716 and maybe they shake and send a bunch of them all over. 00:14:41.716 --> 00:14:44.483 They could be on your couch, in your bed or something like that, 00:14:44.483 --> 00:14:46.816 and then they're going to attach to you while you're not suspecting it. 00:14:48.750 --> 00:14:51.483 So here's an adult female after she's had a blood meal 00:14:51.483 --> 00:14:54.900 and she's gorge and kind of stretched out for this blood meal. 00:14:55.800 --> 00:14:59.566 Usually at this point they fed for 7 to 10 days to get to this size, 00:15:00.266 --> 00:15:03.166 and they're preparing to complete their life cycle, 00:15:03.166 --> 00:15:05.550 at which point they'll detach from the blood meal 00:15:05.550 --> 00:15:08.333 and prepare to go lay their eggs, finding a selection, 00:15:08.333 --> 00:15:11.333 kind of completing that life cycle and starting it over with eggs. 00:15:14.700 --> 00:15:17.216 So how do we prevent being bit by ticks? 00:15:17.216 --> 00:15:20.300 And the easiest way to do this is use insect repellents. 00:15:21.533 --> 00:15:23.000 We can do that in a couple of different ways. 00:15:23.000 --> 00:15:26.150 We can use pest controls in our yards and gardens via spray. 00:15:26.150 --> 00:15:28.916 Pest control companies can come spray for ticks, 00:15:28.916 --> 00:15:31.216 reducing the numbers of them in your area. 00:15:31.216 --> 00:15:33.866 You can wear light colored clothing. 00:15:33.866 --> 00:15:37.216 A lot of people don't understand why the light colored clothing would help, 00:15:37.433 --> 00:15:38.483 but what that is, is 00:15:38.483 --> 00:15:39.683 they're dark little bodies 00:15:39.683 --> 00:15:42.766 against the light colored clothing make them stand out easily 00:15:42.766 --> 00:15:45.833 so you can see them and remove them before they have a chance to adhere. 00:15:46.283 --> 00:15:50.100 You can tuck your pants into your socks, and tick checks, right? 00:15:50.400 --> 00:15:54.050 This tick check can be part of a shower, and that's within ten hours after being 00:15:54.050 --> 00:15:54.983 in a tick area. 00:15:56.416 --> 00:15:58.133 They're very hard or very small 00:15:58.133 --> 00:16:01.250 and hard to see again when, especially in that nymph phase or that larva phase. 00:16:01.650 --> 00:16:05.783 And so simply just toweling off or using a loofah or a washcloth 00:16:06.000 --> 00:16:07.066 to take a shower 00:16:07.066 --> 00:16:10.916 can scrub a lot of these little guys off and, prevent them from attaching. 00:16:11.716 --> 00:16:15.450 And the last thing is, if we are bit knowing those early signs 00:16:15.450 --> 00:16:18.983 and symptoms so we can get treatment quickly is important. 00:16:20.700 --> 00:16:23.516 So what are the symptoms of Lyme? 00:16:23.516 --> 00:16:26.350 Typically we have the symptoms of Lyme showing up within 3 00:16:26.350 --> 00:16:30.616 to 30 days, most people developing symptoms within seven days. 00:16:30.950 --> 00:16:35.333 And the main symptoms they're going to develop are going to be fever, chills 00:16:35.333 --> 00:16:38.600 and kind of a headache of this fatigue feeling setting in. 00:16:38.816 --> 00:16:42.083 They may have some muscle and joint aches, swollen lymph nodes. 00:16:42.350 --> 00:16:47.400 And then this really common, kind of the hallmark for Lyme disease 00:16:47.400 --> 00:16:51.316 is this bullseye rash or your thema migrants rash. 00:16:52.616 --> 00:16:54.983 And here's a picture of that erythema migraines. 00:16:54.983 --> 00:16:57.983 And you can see that classic bullseye pattern. 00:16:58.100 --> 00:17:01.216 This is going to appear in 70 to 80% of infected persons. 00:17:01.800 --> 00:17:04.800 Beginning about seven days after that initial bite. 00:17:04.833 --> 00:17:07.766 It could be warm to the touch, slightly raised. 00:17:07.766 --> 00:17:09.800 Expand into this bullseye appearance. 00:17:09.800 --> 00:17:12.116 That's really hallmark for that. 00:17:12.116 --> 00:17:14.966 And it can appear on any part of the body. 00:17:14.966 --> 00:17:16.550 So again, we talked about some of those areas. 00:17:16.550 --> 00:17:19.550 You might find this this one here was behind the knee where they didn't see it. 00:17:19.800 --> 00:17:22.583 And this bullseye rash is started here on this foot on the left. 00:17:22.583 --> 00:17:25.583 And then this raised one here kind of on the right. 00:17:27.050 --> 00:17:28.250 If this goes untreated 00:17:28.250 --> 00:17:31.733 at this phase, we'll move into the later signs and symptoms. 00:17:32.900 --> 00:17:35.900 And these are going to get slightly more, 00:17:36.200 --> 00:17:37.050 serious. 00:17:37.050 --> 00:17:40.050 This is going to be headaches and stiff neck, 00:17:40.250 --> 00:17:43.066 nerve pain, numbness, shooting pain, 00:17:43.066 --> 00:17:46.366 facial palsy or kind of a drooping of one side of your face. 00:17:46.766 --> 00:17:50.150 You could have some heart palpitations caused by Lyme colitis. 00:17:50.400 --> 00:17:53.933 As the line gets into the heart muscle and tissues, it can, interfere 00:17:53.933 --> 00:17:56.933 with the electrical signals in the heart, causing issues there. 00:17:57.800 --> 00:18:00.750 Moving into dizziness, dizziness, shortness of breath, 00:18:00.750 --> 00:18:03.716 arthritis, severe joint pain, swollen joints, 00:18:03.716 --> 00:18:07.616 and then lastly, inflammation of the brain and spinal cord and encephalitis. 00:18:08.866 --> 00:18:11.866 Getting pretty serious there as we go on. 00:18:12.016 --> 00:18:14.700 So now as we move into diagnosis and testing, we're going to talk about 00:18:14.700 --> 00:18:19.133 the laboratory testing and to keep things kind of on a base level and simple. 00:18:19.133 --> 00:18:20.550 We're going to talk about a few definitions 00:18:20.550 --> 00:18:23.033 and how we're going to use them for this presentation. 00:18:23.033 --> 00:18:25.733 So first off is indirect testing. 00:18:25.733 --> 00:18:29.516 This is where we are testing for the antibodies or something that our 00:18:29.516 --> 00:18:34.400 body makes to the antigen, the antigen being Borrelia or the spider kit itself 00:18:35.150 --> 00:18:39.616 versus direct testing which is looking for the antigen itself. 00:18:39.900 --> 00:18:42.316 You could compare this to drug testing. 00:18:42.316 --> 00:18:45.716 Kind of if we're doing a drug test, we're looking for the active drug 00:18:45.800 --> 00:18:49.733 or the metabolite of that drug in the system versus indirect. 00:18:49.733 --> 00:18:53.816 We're looking for the body's response, in this case, antibodies. 00:18:54.466 --> 00:18:57.350 Then as we talk about sensitivity and specificity, 00:18:57.350 --> 00:19:00.600 sensitivity is where we're going to cast kind of a broad net 00:19:00.600 --> 00:19:03.616 to try and catch anyone that could possibly have the disease. 00:19:03.900 --> 00:19:07.200 This is used as a screening, or we consider it like a true positive. 00:19:07.650 --> 00:19:11.300 It's identifying those that have or possibly have the disease 00:19:11.933 --> 00:19:15.616 versus specificity is identifying those without the disease. 00:19:15.616 --> 00:19:17.666 We're going to use this as a confirmatory. 00:19:17.666 --> 00:19:20.150 So we're kind of sorting out that broad net. 00:19:20.150 --> 00:19:21.566 And we've got a lot of things. 00:19:21.566 --> 00:19:24.383 And now we're going to say okay this one's actually a true negative. 00:19:24.383 --> 00:19:25.650 It's not a positive. 00:19:25.650 --> 00:19:28.016 And it's very specific to Lyme. 00:19:28.016 --> 00:19:30.766 When we talk about sensitivity and specificity really we're 00:19:30.766 --> 00:19:33.766 talking also about our cross reactivity. 00:19:33.900 --> 00:19:37.133 Other spirt kits such as syphilis for example. 00:19:38.250 --> 00:19:39.716 May cross-reactivity of 00:19:39.716 --> 00:19:42.600 cross-reactive, be cross-reactive 00:19:42.600 --> 00:19:46.516 as they have same and similar structures as other spider kids. 00:19:46.516 --> 00:19:49.516 So those antigens are similar. 00:19:49.650 --> 00:19:52.950 So some of the types of testing that we could use and maybe we don't. 00:19:53.316 --> 00:19:58.166 And we'll talk about why is a culture this can this is a direct method of testing. 00:19:58.400 --> 00:20:01.466 It would come from blood CSF or a skin scraping 00:20:01.466 --> 00:20:04.466 near that rash. 00:20:04.500 --> 00:20:07.700 And the reason we don't use this is they tend to be transient. 00:20:07.700 --> 00:20:10.766 After that initial infection, we're no longer finding 00:20:10.766 --> 00:20:14.483 the Borrelia circulating around in the peripheral blood or in the CSF. 00:20:14.483 --> 00:20:17.483 Maybe they've burrowed in and they're kind of hiding from our immune system. 00:20:17.483 --> 00:20:19.966 So it's an unreliable method. 00:20:19.966 --> 00:20:22.466 It requires complicated growth and media 00:20:22.466 --> 00:20:25.500 requirements, specialized training for technologists 00:20:25.850 --> 00:20:29.816 as well as they can be pretty slow waiting for these bacteria to grow out. 00:20:30.450 --> 00:20:32.100 Another option is some PCR. 00:20:32.100 --> 00:20:33.116 This another direct. 00:20:33.116 --> 00:20:36.800 We're looking for the DNA of Borrelia in these samples. 00:20:37.700 --> 00:20:41.333 Again unreliable because it's transient after that initial infection infection 00:20:41.816 --> 00:20:45.750 transient meaning that it can go away or disappear and then reappear. 00:20:45.750 --> 00:20:47.550 So it's an unreliable mess. 00:20:47.550 --> 00:20:51.166 Method and PCR can tend to be a little bit more expensive. 00:20:52.700 --> 00:20:55.583 So then we have an EIA or an enzyme immunoassay. 00:20:55.583 --> 00:20:59.000 This is an indirect test specifically when we're talking about Lyme 00:20:59.333 --> 00:21:02.333 that is looking for the antibody response. 00:21:03.350 --> 00:21:05.216 This measures total antibodies 00:21:05.216 --> 00:21:08.216 created by your immune system. 00:21:08.550 --> 00:21:11.266 Another version of that would be a Western blot 00:21:11.266 --> 00:21:13.166 which tends to be a little more specific. 00:21:13.166 --> 00:21:15.916 In this case the EIA would use as a screening. 00:21:15.916 --> 00:21:19.950 And then the Western blot would use as the follow up in the old method. 00:21:19.950 --> 00:21:21.083 And we'll talk about the old 00:21:21.083 --> 00:21:24.833 and the new method, which is the standard two tier and the modified two tier. 00:21:25.216 --> 00:21:29.150 So the EIA is typically going to be that sensitive one that we're screening 00:21:29.450 --> 00:21:32.516 and then move to the confirmatory for the western blot. 00:21:32.516 --> 00:21:35.566 And that's going to differentiate between IgG and IgG. 00:21:35.566 --> 00:21:41.000 And antibodies IgG being kind of that long term immunity or a long term antibody. 00:21:41.000 --> 00:21:44.783 And I kind of having that initial spike with infection and going away in 00:21:44.783 --> 00:21:46.350 that after that acute phase. 00:21:48.566 --> 00:21:50.033 So as we talk about standard two tier 00:21:50.033 --> 00:21:53.816 testing versus the modified two tier two, two tier testing system, 00:21:54.083 --> 00:21:56.933 and that was recommended as of July 29th, 00:21:56.933 --> 00:21:59.933 2019 by the CDC. 00:22:00.200 --> 00:22:02.750 The standard two tier is going to use an EIA 00:22:02.750 --> 00:22:06.016 for a sensitive screening test or the first tier of testing. 00:22:06.316 --> 00:22:08.450 The second test is going to be the Western blot, 00:22:08.450 --> 00:22:11.566 and it's going to be a little bit more specific, confirming or weeding out 00:22:11.566 --> 00:22:14.566 some of those false positives. 00:22:14.966 --> 00:22:16.850 The modified two tier testing system, 00:22:16.850 --> 00:22:22.066 it's going to use, only EIA testing and use a very, sensitive EIA 00:22:22.066 --> 00:22:25.250 for the first here and a very specific EIA 00:22:25.250 --> 00:22:28.250 for the second tier, tier, 00:22:28.583 --> 00:22:32.033 it requires that they be FDA approved for this two tier system. 00:22:32.450 --> 00:22:34.100 So if we're looking at the testing, here's 00:22:34.100 --> 00:22:37.133 what the two tier just testing systems look like for Lyme. 00:22:38.033 --> 00:22:42.466 This first tier, this is the standard or the the older method which is still valid. 00:22:43.016 --> 00:22:47.750 So our initial testing is going to be that EIA or enzyme immunoassay. 00:22:48.150 --> 00:22:51.166 Or you can use them immunofluorescence assay. 00:22:51.166 --> 00:22:51.650 Or if 00:22:52.966 --> 00:22:53.483 if initial 00:22:53.483 --> 00:22:58.166 testing it's negative then we're going to consider this a negative test. 00:22:58.616 --> 00:23:01.916 However we can do a convalescent and follow up within 30 days 00:23:01.916 --> 00:23:04.650 to see if we've developed antibodies. 00:23:04.650 --> 00:23:07.366 Again, this testing is using your immune system's 00:23:07.366 --> 00:23:09.616 production of antibodies to detect. 00:23:09.616 --> 00:23:13.583 So an early disease or late, early disease, we may not have 00:23:13.583 --> 00:23:18.450 detectable levels of antibody if it's positive or if equivocal. 00:23:18.450 --> 00:23:21.900 We'll move into this next portion greater than 30 days. 00:23:21.900 --> 00:23:27.016 We're thinking we want to use an exam and IgG for that acute and chronic phase. 00:23:27.316 --> 00:23:29.116 And then, 00:23:29.116 --> 00:23:31.133 greater than 30 days, we're only going to perform 00:23:31.133 --> 00:23:34.133 the IgG western blot 00:23:34.350 --> 00:23:35.900 versus here's the modern 00:23:35.900 --> 00:23:38.750 or the modified two tier system. 00:23:38.750 --> 00:23:40.800 This is 00:23:40.800 --> 00:23:42.116 the Elisa to begin with. 00:23:42.116 --> 00:23:44.216 The very sensitive at first kind of the screening. 00:23:44.216 --> 00:23:47.216 If it's negative it's MDT negative 00:23:47.416 --> 00:23:50.966 or if it's positive we're going to move into that secondary more specific. 00:23:50.966 --> 00:23:52.350 Elisa. 00:23:52.350 --> 00:23:52.850 Same thing here. 00:23:52.850 --> 00:23:54.900 If it's negative we're going to consider it negative. 00:23:54.900 --> 00:23:57.900 If it's positive, we'll move into a positive result. 00:23:58.016 --> 00:23:59.333 If we have a negative result. 00:23:59.333 --> 00:24:00.950 But highly suggest Lyme. 00:24:00.950 --> 00:24:02.033 Again, we're going to follow up 00:24:02.033 --> 00:24:06.233 testing in 21 to 30 days to make sure we don't have any changes. 00:24:07.750 --> 00:24:10.666 So as we're talking about enzyme immunoassays, 00:24:10.666 --> 00:24:12.533 here's how one of those works. 00:24:12.533 --> 00:24:14.150 We start with antigen. 00:24:14.150 --> 00:24:18.166 And this is antigen to cell structures on the bacteria itself. 00:24:18.800 --> 00:24:21.150 It can be to the flagellum. 00:24:21.150 --> 00:24:26.300 It can be to the cell wall or lipoproteins, anything like that. 00:24:26.700 --> 00:24:29.116 So we start by having this immuno fixed into the bottom of the. 00:24:29.116 --> 00:24:31.950 Well it comes that way from the manufacturer. 00:24:31.950 --> 00:24:34.583 Then we're going to go ahead and add patient antibody. 00:24:34.583 --> 00:24:37.583 We're going to incubate this for a specified amount of time 00:24:37.733 --> 00:24:39.616 so that this antibody can go ahead and end here. 00:24:39.616 --> 00:24:42.750 Usually this is at body temperature or 37 degrees. 00:24:43.816 --> 00:24:48.916 From here we remove all of that excess antibody or we wash out this plate 00:24:49.216 --> 00:24:53.416 preparing it for conjugate conjugate is an anti-human antibody 00:24:53.416 --> 00:24:57.650 that is made or reagent antibody tagged with an enzyme 00:24:58.650 --> 00:24:59.400 once that has 00:24:59.400 --> 00:25:02.566 had its incubation period as well and it's all adhered, 00:25:02.566 --> 00:25:05.966 we'll go ahead and remove any excess conjugate at this phase. 00:25:05.966 --> 00:25:10.100 If we didn't remove any excess conjugate it could react with the substrate. 00:25:10.283 --> 00:25:13.400 That enzyme specifically is what's going to react with the substrate 00:25:13.766 --> 00:25:16.550 and provide a color or a chrome. 00:25:16.550 --> 00:25:17.300 Again. 00:25:17.300 --> 00:25:20.633 So as that substrate reacts with the enzyme to produce a color, 00:25:21.416 --> 00:25:24.116 we'll start to visibly see that is that enzymatic 00:25:24.116 --> 00:25:27.116 reaction happening for a specified amount of time. 00:25:27.266 --> 00:25:29.300 And then we're going to go ahead and stop it. 00:25:29.300 --> 00:25:31.216 And a stop is usually an acid. 00:25:31.216 --> 00:25:34.700 And that acid is going to cleave enzymatic response 00:25:34.700 --> 00:25:38.450 with that substrate stopping the assay. 00:25:38.866 --> 00:25:40.850 So we have a video of that coming up. 00:25:40.850 --> 00:25:43.283 So you can see the color change there. 00:25:43.283 --> 00:25:46.283 A lot of the time the stop itself will have a 00:25:46.400 --> 00:25:49.400 pH indicator changing from a blue to a yellow. 00:25:49.583 --> 00:25:51.350 Indicating that we've added that. Stop. 00:25:51.350 --> 00:25:53.816 So here's a video of that so you can see what that looks like. 00:26:06.416 --> 00:26:08.000 And it went ahead and changed there. 00:26:08.000 --> 00:26:11.000 So that's how we know that this assay worked. 00:26:11.400 --> 00:26:15.633 That the amount of color is directly proportional to the concentration. 00:26:15.633 --> 00:26:18.600 And we'll use beer's law to, to calculate that. 00:26:18.600 --> 00:26:21.716 If you don't know that you I'm sure you'll learn it later coming on. 00:26:22.100 --> 00:26:24.300 But beer's law is a way to calculate that. 00:26:24.300 --> 00:26:27.083 So for these EIA tests, when we're talking about lime 00:26:27.083 --> 00:26:29.550 specifically, we have sensitive and specific. 00:26:29.550 --> 00:26:34.133 Now, as these assays have gotten better and they've been developing new ones. 00:26:34.433 --> 00:26:37.816 So, we can have IgG and to multiple 00:26:37.816 --> 00:26:40.816 different antigens as a screening or a very sensitive test. 00:26:40.883 --> 00:26:44.633 Or we have very, very specific, eyes as well. 00:26:44.633 --> 00:26:45.866 And that's what kind of drove 00:26:45.866 --> 00:26:50.116 this change to the modified two tier system versus only using, 00:26:50.783 --> 00:26:53.933 the standard two tier, which would be an EIA followed up with a blot. 00:26:54.233 --> 00:26:59.900 Now you can use a sensitive EIA and then a very specific EIA as the second tier. 00:27:00.266 --> 00:27:03.766 So that could be some of these lipoproteins, cell membrane antigens 00:27:03.766 --> 00:27:06.000 or antigens to structure like the flagellum. 00:27:07.283 --> 00:27:07.833 So some of the 00:27:07.833 --> 00:27:11.816 the limitations that specifically with EIA and we talked about a few of these, 00:27:12.083 --> 00:27:16.050 that negative results do not necessarily exclude recent or early infection. 00:27:16.050 --> 00:27:20.250 Again, we're waiting on that immune response to develop antibodies. 00:27:20.516 --> 00:27:23.933 If it's early infection we may be below those detectable levels. 00:27:24.466 --> 00:27:25.966 Giving us a false negative. 00:27:25.966 --> 00:27:27.316 They are actually infected, 00:27:27.316 --> 00:27:30.466 but they don't have enough antibody yet to detect that antibody. 00:27:31.100 --> 00:27:33.900 Or it could cross react with other respire kits, 00:27:33.900 --> 00:27:37.366 such as, syphilis or something that they've had in the past. 00:27:38.300 --> 00:27:41.750 That can give us a false positive, results for an other disease. 00:27:42.266 --> 00:27:45.466 And the issue there is that we may have treatment that, 00:27:47.066 --> 00:27:50.183 with that treatment, it's treating for a disease that maybe not 00:27:50.450 --> 00:27:54.050 the right antibiotic or maybe the not not the right treatment in general. 00:27:55.466 --> 00:27:57.533 So moving into Western blot, 00:27:57.533 --> 00:28:01.133 we're going to show you three types of Western blot or immuno blot. 00:28:01.133 --> 00:28:03.900 And they can be used kind of interchangeably. 00:28:03.900 --> 00:28:07.433 So in this case we're looking at a multiple patients here. 00:28:07.766 --> 00:28:11.150 We have a positive control a negative control and a weak reactive control. 00:28:11.150 --> 00:28:13.400 And then all of these are different patients. 00:28:13.400 --> 00:28:16.250 This patient here has some sort of interfering substance 00:28:16.250 --> 00:28:20.116 that's reacting and binding to the strip, causing it to be unreadable. 00:28:20.600 --> 00:28:24.116 In this case are weak reactive control this band. 00:28:24.116 --> 00:28:26.150 The intensity of this band is important. 00:28:26.150 --> 00:28:29.150 We're comparing this to all the other bands. 00:28:30.466 --> 00:28:31.583 Within the strip. 00:28:31.583 --> 00:28:34.616 And if they're darker, we're going to consider that band detected. 00:28:35.100 --> 00:28:38.416 So these are separated out via electrophoresis by Kildonan Wheat. 00:28:38.900 --> 00:28:41.516 Each band is specific 00:28:41.516 --> 00:28:45.116 to an antigen for Lyme or the structure of a spike. 00:28:45.116 --> 00:28:45.450 Acute. 00:28:47.216 --> 00:28:50.483 So this process is very similar to an EIA. 00:28:50.483 --> 00:28:51.500 And the fact that we add 00:28:51.500 --> 00:28:54.766 patient antibody which is going to bind with the antigen in the strip. 00:28:55.666 --> 00:28:57.233 Then we'll wash all of that out. 00:28:57.233 --> 00:28:58.350 Add conjugate. 00:28:58.350 --> 00:29:01.800 This conjugate will bind again to any bound antibody. 00:29:02.450 --> 00:29:04.616 And then from here we'll add a substrate. 00:29:04.616 --> 00:29:08.366 This substrates are just going to collect making this strip visible. 00:29:09.350 --> 00:29:11.933 And then to stop this usually we just stop the reaction 00:29:11.933 --> 00:29:14.933 by removing the substrate and washing with the ionized water. 00:29:16.133 --> 00:29:19.800 So specific bands again are specific for specific antigens. 00:29:21.000 --> 00:29:24.233 Another option here is a different type of western blot 00:29:24.233 --> 00:29:28.166 in which we pre purify or synthesize these antigens. 00:29:28.166 --> 00:29:30.300 And this is just a different manufacturing process. 00:29:30.300 --> 00:29:33.500 Instead of the electrophoresis we're immuno fixing these purified 00:29:33.500 --> 00:29:36.683 or synthesizing antigens onto the strep. 00:29:36.916 --> 00:29:39.916 And they're going to be in a very specific location by doing this 00:29:40.066 --> 00:29:42.766 so that we can read them via dense a trauma tree. 00:29:42.766 --> 00:29:46.766 It's a fancy word that basically means we're going to use a fancy Xerox scanner 00:29:46.966 --> 00:29:49.050 and scan them to compare the densities. 00:29:49.050 --> 00:29:50.666 So what we're doing there when we're comparing 00:29:50.666 --> 00:29:53.666 the densities is looking to see here's the cut off. 00:29:53.750 --> 00:29:57.166 We're comparing this cut off to see if it's darker or lighter than this. 00:29:57.166 --> 00:29:59.000 Cut off is darker than this cut off. 00:29:59.000 --> 00:30:01.500 We're going to consider this strip detected. 00:30:01.500 --> 00:30:04.500 So the 93 here this 93 band is detected. 00:30:04.500 --> 00:30:06.383 The 66 would be detected. 00:30:06.383 --> 00:30:07.583 And this 58 band 00:30:07.583 --> 00:30:11.600 here would be not detected because it is lighter than this band here 00:30:12.800 --> 00:30:15.800 with that standard location that allows us to use a software, 00:30:16.100 --> 00:30:19.100 to aid in the reading and also makes it a little bit faster. 00:30:19.166 --> 00:30:22.166 We can read and have this software interpret and then just, 00:30:22.166 --> 00:30:25.816 do a secondary verification to make sure that everything is good. 00:30:25.816 --> 00:30:29.433 There again, we have the ECG and exam. 00:30:29.783 --> 00:30:33.316 These have kind of a panel, ten significant bands. 00:30:33.316 --> 00:30:36.350 And five of those ten significant bands are significant. 00:30:36.350 --> 00:30:39.683 Antigens have to be present to be considered positive. 00:30:40.666 --> 00:30:44.183 The second would be the AGM, and that's two of the three. 00:30:44.633 --> 00:30:47.700 Again, IBM's not as good of a marker because it is transient. 00:30:47.700 --> 00:30:48.683 We're going to see that 00:30:48.683 --> 00:30:51.833 kind of spike and then disappear usually within that 30 days. 00:30:52.400 --> 00:30:55.733 And it can with only three significant bands, 00:30:55.916 --> 00:30:58.766 it could have some potential for cross-reactivity. 00:30:58.766 --> 00:31:02.566 For example, the 41 band that could be to the anti flagellum structure. 00:31:02.866 --> 00:31:06.233 And so you might have that from other spider kids as well. 00:31:08.066 --> 00:31:11.066 Another option that we have, and we're not really going to talk about it a lot, 00:31:11.416 --> 00:31:13.816 but it's a microarray immuno block. 00:31:13.816 --> 00:31:17.400 This would be a tiny little block kind of placed in the bottom 00:31:17.400 --> 00:31:21.833 of one of those 96 well, plates like you saw in the video of the EIA. 00:31:22.216 --> 00:31:24.833 You'd treat it similar to an EIA. 00:31:24.833 --> 00:31:27.900 And then once it was emptied and dried, you would read it 00:31:27.900 --> 00:31:30.900 with an instrument using specific software. 00:31:31.016 --> 00:31:35.050 It's an automated immuno block process, the microarray immuno block that he uses, 00:31:35.050 --> 00:31:38.050 a specialized instrument and also, 00:31:38.400 --> 00:31:41.400 a reader to interpret those as well. 00:31:41.450 --> 00:31:44.450 They can't be interpreted manually like these other strips. 00:31:44.633 --> 00:31:48.316 So any interference or interfering substance, like if we go 00:31:48.650 --> 00:31:52.016 to those other slides, any interfering substance is going to, 00:31:52.500 --> 00:31:55.200 make those need to be repeated 00:31:55.200 --> 00:31:58.200 as there's no component for manual interpretation on those. 00:31:58.966 --> 00:32:02.416 So again, western blot has also the same limitations. 00:32:03.050 --> 00:32:03.833 Negative results 00:32:03.833 --> 00:32:07.583 do not necessarily exclude a recent or early infection of Lyme disease. 00:32:07.850 --> 00:32:10.766 And again, we're waiting for those, antibodies 00:32:10.766 --> 00:32:14.366 to be secreted by the, immune system so that they can be detected. 00:32:14.783 --> 00:32:16.550 Or there may be some cross-reactivity. 00:32:17.933 --> 00:32:20.933 While the Western blots are more specific, 00:32:21.350 --> 00:32:26.550 they do have, for example, the 41 band, is to an anti flagellum. 00:32:26.716 --> 00:32:29.750 And so other spider kits might cross react 00:32:29.750 --> 00:32:33.083 with that specific banding, which is why you have that profile. 00:32:33.300 --> 00:32:38.300 You need the five of the ten, for IgG or the two of the three 00:32:38.300 --> 00:32:41.300 for the AGM to be considered positive. 00:32:42.350 --> 00:32:45.866 So this all correlates into the diagnosis of Lyme disease. 00:32:46.400 --> 00:32:50.550 First thing we have to have is an, evaluate the relevant exposure. 00:32:51.166 --> 00:32:54.683 You kind of have to have a tick bite to contract Lyme disease, 00:32:55.216 --> 00:32:57.500 or be exposed to an area that might have it. 00:32:57.500 --> 00:32:58.583 However, this is tricky. 00:32:58.583 --> 00:33:00.716 We might not know that we were bit by a tick. 00:33:00.716 --> 00:33:02.966 We might miss this bull's eye rash. 00:33:02.966 --> 00:33:07.516 We may have really mild symptoms and or maybe just kind of things 00:33:07.516 --> 00:33:11.100 that we're having a common cold or a touch of the flu or something like that. 00:33:12.050 --> 00:33:13.066 And so, 00:33:13.066 --> 00:33:15.750 this might be missed in that first, 00:33:15.750 --> 00:33:18.533 signs and symptoms that we might not have. 00:33:18.533 --> 00:33:21.533 Then we have the testing again, we're going to use an indirect testing, 00:33:21.833 --> 00:33:24.683 with serology, we're going to have a two tier system, 00:33:24.683 --> 00:33:27.833 whether that's the standard two tier or the modified two tier. 00:33:28.583 --> 00:33:31.133 One of those is going to be a sensitive test for the screening, 00:33:31.133 --> 00:33:34.133 and the other is a confirmation test, which is very specific. 00:33:36.200 --> 00:33:39.200 And now we move into treatment and prognosis. 00:33:39.566 --> 00:33:43.700 Treatment for Borrelia is mostly going to be antibiotic therapy, 00:33:44.400 --> 00:33:46.966 depending on the patient and if they're allergic to certain 00:33:46.966 --> 00:33:49.966 meds or not, we're going to use ducks or cycling or amoxicillin, 00:33:50.516 --> 00:33:53.716 for 10 to 14 days, usually about a two week treatment. 00:33:53.966 --> 00:33:57.000 There's other drugs as well, depending if, patients 00:33:57.000 --> 00:34:00.000 don't respond well or if they're allergic to other drugs, 00:34:01.400 --> 00:34:02.266 depending on 00:34:02.266 --> 00:34:05.700 how Lyme disease is affecting us, whether we're having neurological effects. 00:34:06.600 --> 00:34:09.433 Usually the treatment is going to be very similar. 00:34:09.433 --> 00:34:13.066 So here's a couple of the other options or other issues. 00:34:13.066 --> 00:34:15.466 We could have complications. 00:34:15.466 --> 00:34:17.366 So we could have cranial nerve involvement. 00:34:17.366 --> 00:34:20.366 This is where you'd get that facial palsy and that drooping 00:34:20.633 --> 00:34:22.883 peripheral nerve involvement numbness tingling. 00:34:22.883 --> 00:34:26.216 You get those shooting pains or you can have central nerve involvement. 00:34:27.016 --> 00:34:30.533 This is where we get into the more serious meningitis, encephalitis, 00:34:31.050 --> 00:34:34.100 severe headaches, light sensitivities, stiff necks. 00:34:35.600 --> 00:34:38.250 If it's not affecting our brain, but it's affecting our heart, 00:34:38.250 --> 00:34:39.983 we could get Lyme colitis. 00:34:39.983 --> 00:34:40.500 And this is where 00:34:40.500 --> 00:34:44.266 the bacteria have entered into the heart tissue, causing inflammation and damage. 00:34:44.783 --> 00:34:48.083 And that will interfere with the normal electrical signals 00:34:48.083 --> 00:34:51.750 within the heart, giving you heart palpitations, maybe making you dizzy, 00:34:51.750 --> 00:34:55.583 feeling like you're going to pass out treatment with this again is oral. 00:34:55.583 --> 00:34:56.933 Or in this case, IV. 00:34:56.933 --> 00:35:01.166 Antibiotics are usually within that, two week period, 00:35:01.166 --> 00:35:05.366 maybe even longer, for an extended period of time with antibiotics. 00:35:05.366 --> 00:35:07.050 Depends on the patient. 00:35:07.050 --> 00:35:10.550 And this may require a temporary pacemaker to keep the heart beating, 00:35:10.550 --> 00:35:15.150 as it should, until the damage and inflammation can go down. 00:35:16.216 --> 00:35:17.600 Most people are going to recover 00:35:17.600 --> 00:35:20.600 from Lyme colitis in 1 to 6 weeks, with treatment. 00:35:22.466 --> 00:35:23.966 Or we could have Lyme arthritis. 00:35:23.966 --> 00:35:27.000 And this is one of the more common, complications that we see. 00:35:27.266 --> 00:35:31.250 You know, obviously you'll have a swelling that's obvious of one of the joints. 00:35:31.250 --> 00:35:33.533 Usually the knees or the elbows are most common. 00:35:33.533 --> 00:35:35.600 You can also have it in the jaw and your hips, 00:35:35.600 --> 00:35:38.850 but they're not as noticeable as we can't easily compare them to each other. 00:35:39.650 --> 00:35:40.516 It isn't treated. 00:35:40.516 --> 00:35:43.516 It can cause permanent damage. 00:35:43.550 --> 00:35:46.550 Again, treatment IV or oral antibiotics. 00:35:47.416 --> 00:35:50.850 Now, even with treatment, some people still have some issues. 00:35:51.083 --> 00:35:54.083 And this is post treatment Lyme disease syndrome. 00:35:54.716 --> 00:35:57.416 This creates some autoimmune like symptoms. 00:35:57.416 --> 00:35:58.933 That can last a really long time. 00:35:58.933 --> 00:36:01.933 Well, after the infection and well after treatment, 00:36:02.250 --> 00:36:07.550 some of these will take, weeks, if not years, two months to recover. 00:36:07.816 --> 00:36:12.433 And they can have some other complications that involve the long term antibiotics. 00:36:13.100 --> 00:36:15.466 Those complications can be liver damage 00:36:15.466 --> 00:36:18.466 due to the drugs or kidney damage due to the drugs. 00:36:18.683 --> 00:36:22.100 And so it's something that to consider as well, that you want to get treatment 00:36:22.100 --> 00:36:23.333 as soon as possible. 00:36:23.333 --> 00:36:26.333 And even then, you can have these long term complications. 00:36:27.050 --> 00:36:29.516 This is one to me that I had a friend, 00:36:29.516 --> 00:36:33.900 that was on a backpacking trip and got bit by a tick, came home, found the tick 00:36:33.900 --> 00:36:37.500 a few days later after it had been feeding and was engorged. 00:36:37.500 --> 00:36:39.266 They didn't find it until then, 00:36:39.266 --> 00:36:42.766 and by the time they came home, they had contracted Lyme disease. 00:36:43.100 --> 00:36:45.150 They got treatment pretty quick. 00:36:45.150 --> 00:36:49.433 But then spent the next year or so with really, really heavy fatigue, 00:36:49.733 --> 00:36:50.683 the brain fog. 00:36:50.683 --> 00:36:54.900 They talk about achy muscles and sore joints, and it took them 00:36:54.900 --> 00:36:59.633 a really long time to get back to normal is a very active, very healthy individual. 00:36:59.633 --> 00:37:00.533 Before this. 00:37:00.533 --> 00:37:04.166 And and just watching them kind of crippled by this was really surprising. 00:37:04.166 --> 00:37:05.516 It really hit home. 00:37:05.516 --> 00:37:10.366 So kind of the takeaway here is there's a lot of ways to prevent Lyme disease. 00:37:10.550 --> 00:37:12.150 And prevention really is the best. 00:37:12.150 --> 00:37:14.716 Yes, there is treatment and treatments pretty effective. 00:37:14.716 --> 00:37:16.550 But we want to avoid this if we can 00:37:17.550 --> 00:37:20.550 if we circle back to our objectives. 00:37:20.933 --> 00:37:23.933 Now you can identify how Lyme disease is transmitted. 00:37:24.166 --> 00:37:27.166 Locate these Lyme hotspots and increase prevalence, 00:37:27.833 --> 00:37:31.650 interpret Lyme disease signs and symptoms, hopefully understand, 00:37:32.450 --> 00:37:35.116 laboratory testing and how the diagnosis is made. 00:37:35.116 --> 00:37:38.866 And outline the updated testing protocols as they continue to get better. 00:37:39.616 --> 00:37:42.233 Hopefully in the future we have better testing as the testing 00:37:42.233 --> 00:37:45.233 continues to get better and better, and more and more tests are developed. 00:37:45.716 --> 00:37:48.716 It's kind of a huge step to have this modified two tier. 00:37:49.133 --> 00:37:52.133 And so hopefully we have better testing in the future. 00:37:53.000 --> 00:37:54.866 Thank you all for joining this presentation. 00:37:54.866 --> 00:37:56.666 I hope you learned something. 00:37:56.666 --> 00:37:58.550 Please let me know if you have any questions 00:37:58.550 --> 00:38:00.566 or you can ask your professors later. 00:38:00.566 --> 00:38:02.100 Here's a list of references. 00:38:02.100 --> 00:38:03.733 And thank you very much for tuning in.