Lyme disease is another bacterial infection transmitted indirectly from rodent reservoirs to humans through tick bites. This disease occurs worldwide and has become endemic throughout the United States. The symptoms are flu-like and can become chronic. Rodents, especially the white-footed mouse (Peromyscus leucopus), act as reservoirs by supporting the larval and nymphal stages of tick species known to transmit the disease. In the northeastern United States, the cycle of Lyme disease involves a rodent intermediate host followed by the adult stage of the tick infesting white-tailed deer. Humans catch the disease through incidental bites from infected ticks.
Diseases appearing on only one list (not included in the table) Nipah virus (CDC C list) coccidiomycosis and dengue (NATO) Machupo (USAMRIID) acquired immunodeficiency syndrome (AIDS), amebiasis, Campylobacter, carbon monoxide poisoning, Chlamydia trachomatis, congenital rubella syndrome, food poisoning, giardiasis, Haemophilus influenza type B (HIB), hepatitis A, hepatitis B, hepatitis C, Kawasaki syndrome, Legionnaires' disease, leptospirosis, Lyme disease, lymphogranuloma venereum, malaria, measles, meningitis, mumps, neisseria gonorrhea, neisseria meningitis in blood or cerebrospinal fluid, pertussis, poliomyelitis, rabies, Reye syndrome, rheumatic fever, rubella, syphilis, tetanus, toxic shock syndrome, toxoplasmosis, and trichinosis (Reportable List).
Uveitis occurs in a wide variety of systemic diseases including those described herein and in other chapters of this book. Several associated diseases are of primary clinical interest, although individually they are relatively uncommon or even rare in the usual practice of a head and neck specialist. Sarcoidosis is a common cause of anterior, intermediate, and posterior uveitis, which is covered in more detail later in this chapter. Other diseases causing uveitis are described in other chapters of this book and include Behcet's disease, relapsing polychondritis, syphilis, Lyme disease, cat-scratch disease, tuberculosis, fungal infection, and infection with the human immunodeficiency virus, cytomegalovirus, and herpes viruses.
Chapters 2 and 3 described biosurveillance as the world has practiced it for the latter half of the 20th century. During that time, the basic methods for detecting cases, detecting outbreaks, and characterizing outbreaks changed little. The methods used to detect and characterize the 1975 Lyme disease outbreak and the 2003 severe acute respiratory syndrome (SARS) pandemic differed primarily in microbiological techniques (e.g., the increasing use of genetic analysis) and the speed at which outbreaks were investigated.
Since Gram-positive skin-infecting bacteria such as Staphylococcus aureus (S. aureus) or Borrelia burgdorferi (B. burgdorferi) are known to be rich sources of LTA and lipoproteins, which are well-known ligands of TLR2 homodi-mers (Table 13.1), the abundant and constitutive expression of TLR2 in the epidermis is not surprising 36, 49, 59 . TLR2 homodimers are also involved in the recognition of lipoarabino-mannan of mycobacteria and atypical lipopoly-saccharides of Leptospira and Porphyromonas species 68 . TLR2 also forms heterodimer complexes with other members of the TLR family, namely with TLR1 and TLR6 49 . These complexes are characterized by different ligand specificity, thus recognition of microorganisms through different complexes gives specificity to the immune response. The TLR2 TLR6 heterodimer is necessary for the recognition of dia-cyl lipopeptide, a common cell wall compound of all Gram-positive bacteria, but it is also involved in the recognition of PAMPs of fungal...
Differential Diagnosis Idiopathic pericarditis, infectious pericarditis (viral, bacterial, mycoplasmal, mycobacterial), Lyme disease, uremia, neoplasm, connective tissue disease, lupus, rheumatic fever, polymyositis, myxedema, sarcoidosis, post myocardial infarction pericarditis (Dressler's syndrome), drugs (penicillin, isoniazid, procainamide, hydralazine).
The source and route of transmission as each biological agent has propensities and limitations in the environments in which it can reside and the mechanisms by which it can be transmitted. The investigators of Legionnaire's disease, AIDS, mad cow disease, Lyme disease, and Nipah virus did not know the causative biological agent and had great difficulty finding the sources and routes of transmission. A significant amount of laboratory work may be required to identify the biological agent. As in the case of Legionnaire's disease, Lyme disease, and Nipah virus in which the organism was previously unknown, it may take considerable time to isolate the organism. Identification of a difficult-to-identify organism is largely a process of elimination. Laboratories use cultures, serological tests, immunohistochemistry, and nucleic acid probes to search for known organisms that are most
The drought-induced migration of wildlife to areas inhabited by man can also result in exposure to a number of diseases. In this case, either the animal is a vector, or parasites on the host animal serve as a vector for the illness. Tick-borne diseases such as Rocky Mountain Spotted Fever, Tularemia, and Lyme Disease are common examples. Flea-borne diseases include the Plague and Hantavirus Pulmonary Syndrome.
Tick-borne relapsing fever is a spirochete disease caused by at least 13 different Borrelia species and is present worldwide. The vector is the soft tick Ornithodoros, and rodents are commonly infected. The soft tick bite is usually painless. The incubation period is 4-18 days. Relapsing fever presents as a viral-like illness with high fever, myalgias, chills, and headache, and many patients have an eschar at the bite site. The clinical course will usually involve the initial syndrome for 3 days followed by an asymptomatic period of 7 days then another relapse. Neurologic symptoms are common. Diagnosis is made by demonstration of borreliae in peripheral blood during a febrile episode (thick and thin smear preparation, Wright or Giemsa stain can be used). Treatment is with Doxycycline, Penicillin, Erythromycin, or Ceftriaxone.
Lyme Disease (1975) affected children in their community (American Museum of Natural History, 1998) and notified the local health department about this unusual circumstance. The local health department, suspecting the emergence of a new infectious disease, asked Dr. Allen Steere to investigate. His study of the children of Lyme produced several clues the disease did not appear to spread from one person to another, it occurred most often in the summer when insect-borne disease was more common, and a rash often appeared before children developed arthritic symptoms, suggesting a tick-borne disease. In 1981, entomologist Willy Burgdorfer found the cause by looking at the digestive tracts of Ixodes ticks under a microscope.The bacterium he found, Borrelia burgdorferi, was named in his honor. Lyme disease in humans is an example of a vector-borne disease. Malaria, the most prevalent of the vector-borne diseases, causes 1.5 to 2.7 million deaths annually, mostly in third world...
Diagnosis is similar to that of bacterial meningitis, though other CSF studies such as India ink stain, VDRL, Lyme titer, stain for acid-fast bacteria, PCR for herpes, cryp-tococcal antigen, or cultures for anaerobic bacteria, viruses, mycoplasma, and fungi may be required. A PPD should be placed on all patients with meningitis from areas where TB is endemic, or if history or symptoms suggest TB infection. Lyme disease may be suggested by history or characteristic rash, and should be considered in endemic areas. Management is supportive for viral infections, though antibiotics should be started until bacterial culture results are obtained if the diagnosis is not clear. Treatment for tuberculosis, fungi, parasites, or Lyme disease should be instituted if appropriate. Some experienced clinicians may choose not to hospitalize clinically stable patients with a clear diagnosis of aseptic meningitis, but hospitalization is necessary for more ill patients or those in whom the diagnosis is...
Zoonoses are those diseases and infections that are naturally transmitted between vertebrate animals and humans (see Table 26.1 ). Zoonotic diseases (which are not restricted to farming communities) can present as a mild illness but are prolonged in duration and can have debilitating sequelae. 10 There is a long list of diseases, which vary from country to country, and includes plague, rabies, scrub typhus, Lyme disease, tularaemia, hydatid disease, orf, anthrax, erysipeloid, listeriosis, campylobacteriosis and ornithosis (psittacosis).
From the clinical perspective, viral infection is often implicated as the cause of CFS due to the onset of symptoms with a flu-like episode, waxing and waning clinical course, history of geographic outbreaks, and effectiveness of some antiviral therapies. Approximately 50 of patients with CFS report the onset of their illness after a viral-like infection. Worldwide, CFS has been reported following acute infectious mononucleosis, Lyme disease, Q-fever, and enteroviral infections. Additionally, patients more frequently report the onset of CFS in winter months when viral infections are prevalent (Jason et al., 2005). However, no study has established one virus or agent as a specific cause of CFS (Ablashi et al., 2000).
Etiology and Systemic Associations Acquired sixth nerve palsies, whether isolated or not, are usually caused by tumors (especially glioma and medulloblastoma) and trauma (47 -62 )3,24,191,269,287,405 A significant number of cases are also due to inflammatory causes such as meningitis (including from Lyme disease), Gradenigo's syndrome,117 cerebellitis, and postviral sixth nerve palsy. The clinician is also faced with numerous other possible etiologies (Table 5-4).
The outbreaks of Lyme disease, hepatitis A, AIDS, cryp-tosporidium, SARS (2003), and Legionnaire's disease were detected by an astute observer who noticed a cluster of illness and reported its existence to a health department. Outbreaks caused by contamination of food are often discovered when affected individuals who have dined together phone each other upon waking up sick the next day, and one of them calls the health department.
After an incubation period of 1 to 4 weeks the clinical presentation is with nonspecific flu-like symptoms, including fever, chills, headache, fatigue, and anorexia. Other less common symptoms are nausea, diaphoresis, depression, photophobia, myalgias, arthralgias, dark urine, emotional lability, and hyperesthesias. Unlike Lyme disease, rash is not a feature of the illness. Splenomegaly is present on exam in patients. More severe disease occurs in splenectomized patients. The diagnosis is established by examination of thick and thin Giemsa-stained blood smears. Characteristic intra-ery-throcytic forms may be present.