Lyme disease?

Re: Lyme disease?

Nicola Lawlor — Fri, 09 Nov 2012 22:08:13 GMT

Thanks Tania - sorry for the late response. Update - the dog became pyrexic again whilst still on Potentiated Amoxycillin so I switched her onto Doxycyline and within 24hrs she was doing a lot better. Meanwhile I took another blood sample for IFA and this result showed the same level of antibody response (1/64) as approx 3 weeks previously. The dog did not become lame or stiff again with this flare up so for now no PCR from joint fluid. We are using a working diagnosis of Lymes given the clinical signs and obvious difficulty in being accurate with diagnosis. It seems the PCR can prove the disease but can still not discount the disease if negative. So far so good since then, spoke to the owner today and the dog has stayed well after nearly a week of the doxycycline.

Re: Lyme disease?

Tanya Leslie — Wed, 31 Oct 2012 16:33:22 GMT

Hi Nicola,

Diagnosing Lyme disease in dogs can be quite frustrating for a variety of reasons. A presumptive diagnosis can be made based on a history of tick exposure, fatigue, anorexia and pyrexia followed by recurrent lameness with the exclusion of other differentials. Unfortunately the clinical signs are not pathognomic and there isn't a specific clinical marker (unlike in people). While a single antibody test can provide a good indication of exposure and high titres in a dog showing clinical signs do support a clinical diagnosis, this should be supported by PCR where possible. Asymptomatic dogs showing a raised antibody titre ideally need a paired sample to indicate active infection as persistent antibody production without manifestation of disease can occur. Borrelia DNA can be determined using PCR and its presence in samples more than 90 days after a tick bite confirms persistent infection. If accompanied by clinical signs, this is supportive of chronic Borreliosis.

While doxycycline is not licensed for use to treat Borrelia in the UK, it is considered the antibiotic of choice due to its high intracelluar penetration and concurrent efficacy on Anaplasma and Ehrlichia (these are often found to co-infect ticks and consequently dogs. Dogs with a mixed infections are more likely to show clinical signs of Borreliosis).

With regards to being able to PCR test after using antibiotics, it is best to discuss this with the lab concerned. It can be quite difficult to rid a dog of the spirochaete completely even when using antibiotics, especially if they are not treated at the optimal time, and in some instances, spircohaetes have been detected for up to 500 days post treatment (Arthropod-borne infectious diseases of the dog and cat; Susan Shaw and Michael Day) which means that PCR may still be effective in some cases.

I hope this helps a bit! If you would like a bit more information on Lyme disease (or tick-borne disease in general), please give the Merial Technical Center a call on 0870 6000 123 or email us at ukcompanionanimal@merial.com.

Regards,

Tanya

Re: Lyme disease?

Virginia Campbell — Sat, 27 Oct 2012 09:34:58 GMT

Try www.bada-uk.org

I had a good chat with these people at the Midlands Game Fair last month. They mostly deal with humans affected by Lyme dz but a recurring theme seemed to be duration of treatment - need at least 6 weeks antibiotics, possibly more.

Also had a lengthy chat with an owner lately whose daughter got Lyme dz from a tick bite in Texas (different species tick, same disease). She has been on doxy for months. The Texan doctors seem to know a lot about it she said - think one of the Texan unis was directing treatment and advising even after she came back to the UK. She said that the Texans were frustrated that the northeastern US academics didn't seem to take Lyme seriously enough even though it is prevalent there too.

One UK GP with a special interest in Lyme that her daughter is travelling to Wales to see is Dr David Owen in Cardiff.

I know this is all human related but maybe interesting to think about.

Wonder if anyone at Moredun or any of the VLAs know much about Lyme?

Re: Lyme disease?

Gerry Henry — Sat, 27 Oct 2012 08:42:43 GMT

Had /have a very similar case, young whippet, tick in July, intermittant pyrexia, dull, stiff; borrelia negative but toxoplasma gondii positive.

Re: Lyme disease?

Prabhakar Ghorpade — Sat, 27 Oct 2012 06:46:42 GMT

Do not know how PCR affected after antibiotic treatment. But as your are using bactericidal antibiotic actively multiplying bacteria should be killed by it.

I guess how much PCR will be affected by antibiotics rests with antibiotics your are using and host immune status (Convalescence & carrier stage of host). you may or may not able to detect organisms presence during later stage of antibiotic treatment.

Re: Lyme disease?

Prabhakar Ghorpade — Fri, 26 Oct 2012 20:36:06 GMT

As per this link http://en.wikipedia.org/wiki/Lyme_disease

PCR in case of Lyme disease is suffering from false negative result but for Lyme arthritis good chance is there that you could detect organisms presence using Synovial fluid for PCR.

Re: Lyme disease?

Rajat — Fri, 26 Oct 2012 19:02:27 GMT

Nicola, I'm gonna be really lazy and post a link on a good review on Lyme's- I don't have the answers to your questions I am afraid, but they may be buried in here : ACVIM Lyme's Review

Hope it helps

Cheers

Raj

Re: Lyme disease?

Nicola Lawlor — Fri, 26 Oct 2012 18:13:35 GMT

Thanks for that link James.

Does anyone know how the PCR would be affected by antibiotics? Presumably they are looking presence of the organism with this - which is why I went for the IFA originally as had already been on antibiotics by the time of sampling.

Re: Lyme disease?

Bob Russell — Fri, 26 Oct 2012 18:00:13 GMT

I struggle to diagnose Lyme disease as those cases I am suspicious of always seem to come back negative. We have infected ticks by the bucket load here and I now just treat with amoxycillin/clav wherever I have it high on the differentials list.

A high titre suggests exposure to the parasite. I suspect most of my patients have been exposed to the parasite, many on a regular basis. Very few cases I see would fit the 'typical' pattern.

Re: Lyme disease?

James Laidlaw — Fri, 26 Oct 2012 17:26:39 GMT

http://www.bsava.com/Advice/LymeDisease/tabid/1574/Default.aspx

Also re: low number of cases - this was in the news earlier in the year:

http://www.bbc.co.uk/news/health-16706942

And if you look at the prevalence data in people, cases in the UK seem to be increasing too.

Re: Lyme disease?

Nicola Lawlor — Fri, 26 Oct 2012 17:19:23 GMT

I spoke to the owner today - dog on loxicom and noroclav (synulox) at the moment and doing well. Reviewing in clinic next week at end of meds. Will consider further testing and/or doxycycline. What I had read had suggested penicillin based ABs or tetracycyline based ABs with both effective.

Re: Lyme disease?

Anthony Dennison — Fri, 26 Oct 2012 17:06:17 GMT

I've seen a similar case to this, small terrier cross that had been camping in North Yorkshire and since has been lethargic, pyrexic and lame LH, pain located to hip. radiographs were normal, though at time of radiographs temperature was normal so they didn't do a joint tap. I started it on a short course of steroids first as it doesn't seem like normal Lyme disease and no exposure to ticks, but if this doesn't work I'll be doling out the doxy.

Re: Lyme disease?

Martin Atkinson — Fri, 26 Oct 2012 16:55:53 GMT

I have no experience but I would be treating it with Doxycyline right now if I was you, but you should continue for 4 weeks even if it gets better.

Re: Lyme disease?

James Laidlaw — Fri, 26 Oct 2012 16:14:34 GMT

Are you on ivis.org?

Free to join and some good factsheets on Lyme if you just search "lyme" with aetiology, diagnosis and treatment info. I'd guess it was just previous exposure - have they been outside the UK?

little excerpt:

"The main symptoms in dogs are lameness and arthritis,

particularly in the carpal and tarsal joints. The lameness can

be intermittent or shift from leg to leg. It may or may not

be accompanied by swollen, painful joints. Fever, anorexia,

fatigue or lymphadenitis, particularly in the prescapular or

popliteal nodes, may be seen concurrently. The arthritis is usually

self-limiting but may become chronic or intermittent.

Kidney disease is seen less frequently. This form, which

is generally fatal, is characterized by a severe protein-losing

nephropathy, uremia, hyperphosphatemia and often peripheral

edema.

A rare cardiac form, characterized by conduction abnormalities

with bradycardia, and a neurologic form, with facial

paralysis, seizures or aggression, have also been reported.

The classic skin lesion seen in humans, erythema

migrans, is not seen in dogs; however, in endemic regions

expanding skin lesions on the abdomen or other relatively

hairless regions, may suggest Lyme disease."

Re: Lyme disease?

Thomas Johnson — Fri, 26 Oct 2012 16:08:23 GMT

I don't have much experience of lyme disease, but have you tried talking to the pathologist at the lab?

Re: Lyme disease?

Nicola Lawlor — Fri, 26 Oct 2012 15:35:06 GMT

Anyone?? Pretty please