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IDSA-Lyme-Guideline-Supplements Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease Supplement Materials Literature search strategy and PRISMA flow diagrams Tick bites prevention and prophylaxis of Lyme disease Early localized Lyme disease (erythema migrans) Neurologic Lyme disease Lyme carditis Lyme arthritis Prolonged symptoms following treatment of Lyme disease Cutaneous manifestations of Eurasian Lyme disease Lyme disease coinfections 1 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines Literature Search Strategy 1. borrelial lymphocytoma$.mp. 2. acrodermatitis chronicum atrophicans.mp. 3. STARI.mp. 4. southern tick-associated rash illness.mp. 5. exp Borrelia Infections/ 6. post lyme disease syndrome.mp. 7. erythema migrans.mp. 8. exp Borrelia/ 9. borrel$.mp. 10. lyme disease$.mp. 11. neuroborreliosis.mp. 12. neuro$.mp. 13. acrodermatitis.mp. 14. exp Acrodermatitis/ 15. carditis.mp. 16. arthrit$.mp. 17. meningitis.mp. 18. exp Meningitis/ 19. radiculoneuropath$.mp. 20. cranial neuropath$.mp. 21. exp Cranial Nerve Diseases/ 22. lyme.mp. 23. (11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21) and 22 24. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 23 25. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 22 or 23 26. limit 25 to humans 27. limit 25 to animals 28. 26 or 27 29. 25 not 28 30. 26 or 29 31. remove duplicates from 30 2 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 3 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 4 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 5 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 6 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 7 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 9 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 10 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 11 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines 12 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines Tick bites prevention and prophylaxis of Lyme disease I. Which measures should be used to prevent tick bites and tick-borne infections? A) Personal protective measures Protective clothing, tick checks, bathing, drying clothing, and limiting pet exposure Bibliography: 1. Stjernberg, et al. Scand J Infect Dis. 2005;37(5):361-4; 2. Ley, et al. Am J Epidemiol. 1995 Nov 1;142(9 Suppl):S39-47; 3. Klein, et al. Clin Pediatr. 1996 Jul;35(7):359-63; 4. Orloski, et al. Am J Epidemiol. 1998 Feb 15;147(4):391-7; 5. Vazquez, et al. Emerg Infect Dis. 2008 Feb;14(2):210-6 ; 6. Connally, et al. Am J Prev Med. 2009 Sep;37(3):201-6; 7. Carroll, et al. J Med Entomol. 2003 Sep;40(5):732-6; 8. Nelson, et al. Ticks Tick Borne Dis. 2016 Jul;7(5):958-963. Study; Study Risk of Tick Type Population Interventions and Comparisons Outcomes Results and Conclusions Location Design bias* Characteristics Stjernberg, Randomized Unclear I. ricinus 10 participants (5M, 5F), 1. The participants wore 1. Mean N of adult and 1. Participants had significantly more 2005 study with risk of exposed by walking in tick alternately light clothing or dark nymphal ticks collected from ticks on light than on dark clothing. cross-over bias endemic areas. clothing before every new each type of clothing after Mean N of ticks was 54.7 (SD 18.1) Sweden design exposure (6 exposures for each exposure; vs. 33.9 (SD 9.2) for light vs. dark clothing type per participant; 3.5 2. Differences in tick groups, P = 0.003 minutes per exposure). detection (% of ticks 2. There was no difference in tick 2. Differences in tick detection detected on each type of detection on light (91%) vs. dark were tested by placing random N clothing) (93%) clothing of ticks (unknown by both the exposed participant and the Thus, dark clothing seemed to searchers) on the participant attract fewer ticks with no wearing light vs. dark clothing disadvantage with regard to tick detection Ley, 1995 Case-control 6 NA 101 cases with Lyme Questionnaire evaluated: location Odds ratios of acquiring The only activity associated with study of risk disease (EM). Each case of home; presence of wildlife Lyme disease (identified as a Lyme disease was the use for more CA, USA factors for was age-, sex-, and around the house; hours of case of Erythema migrans) than 5 hours per week of wide incident location-matched with a outdoor work and outdoor leisure for each risk factor. maintained trails (OR = 11.33,95% CI Lyme control. activities; knowledge about Lyme 1.33-123.5); this association occurred disease Subjects were disease; pet ownership; and only in persons with other outdoor interviewed by telephone personal protective measures leisure activities. using a questionnaire on such as protective clothing (e.g. No other behaviors or activities activities during the light-colored clothing, long pants were identified as risk factors for 13 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines month prior to the case and sleeves, and tucking socks into acquisition of Lyme disease in onset of EM. pants), tick checks, and tick California. removal methods Klein, 1996 Case-control 6 NA 44 pediatric cases with LD Questionnaire evaluated: the Odds ratios of acquiring Significant associations with Lyme study of risk from the Lyme Clinic amount of time children spent Lyme disease were disease were found for deer ticks in CT, DE, MD, factors for population were age- and outdoors, play activities and calculated the home environment, ground NJ, PA incident sex-matched 1:1 to household chores engaged in by cover containing moist humus, and states; USA Lyme controls from the same the child, the animals identified on leaf litter in the yard. disease in neighborhood. the families' property, owning There was no correlation with Lyme children Site visits were performed pets, frequency of bathing, etc., disease for the use of any anti-tick to assess environmental and the use of personal protective measures or for any childhood variables; parents were measures such as tick checks and activities. interviewed using a protective clothing (long pants questionnaire. and shirts, socks) Controls were tested for Lyme disease (EIA and Western immunoblot). Orloski, 1998 Case-control 6 NA 51 cases with Questionnaire evaluated: clinical Odds ratios of acquiring Rural residence; clearing peri- study of risk documented EM in 1993 details of the illness (cases only); Lyme disease (identified as a residential brush during spring and NJ, USA factors for in Hunterdon County, NJ the characteristics of residential case of erythema migrans); summer months; and the presence incident were age-matched with property; the frequency of univariate and multivariate of rock walls, woods, deer, or a bird Lyme 51 controls. observing deer on the residential (for variables with p ≤ 0.10) feeder on residential property were disease Subjects were property; outdoor activities; cat conditional logistic associated with incident Lyme interviewed by telephone ownership; and personal regressions were performed disease. using a questionnaire on protective measures, such as use Higher proportion of controls than activities during the of repellent; use of protective of cases performed regular tick summer of 1993 and on clothing (long pants; tucking pants checks, but the difference was not other possible risk factors. into socks, light-colored clothing), significant. None of the other Blood samples were and tick checks. personal protective measures tested for Lyme disease showed a statistically significant (EIA and Western effect on incident Lyme disease. immunoblot). Cat ownership also had no effect on the incidence of Lyme disease. Vazquez, Case-control 7 NA 709 cases with LD Questionnaire evaluated: clinical Odds ratios of acquiring Definite and possible case-patients 2008 study of risk reported to Connecticut’s features of LD (cases); Lyme disease (adjusted for were less likely than controls to factors for Dep. of Public Health and demographics; occupational possible confounders, i.e. report using protective clothing CT, USA incident classified as having (forestry or landscaping) and sex, race, receipt of Lyme outdoors (OR 0.6, effectiveness 40%, 14 Supplement Materials for the IDSA/AAN/ACR 2020 Draft Lyme Disease Guidelines Lyme definite (66%), possible recreational risk factors (camping vaccine, and use of other p<0.0001) and to use tick repellents disease (15%), or unlikely (19%) or other outdoor activities); and personal protective on their skin or clothing (OR 0.8, LD. Each case was age- personal protective measures: measures); effectiveness 20%, p = 0.05). and location-matched use of tick repellents on the skin or Effectiveness was calculated Checking one’s body for ticks was with 2 controls. clothing while outdoors; spraying as [1 - the matched OR] not effective. one’s property with acaricides; use Subjects were of protective clothing such as long interviewed by telephone pants, long-sleeved shirts, and using a questionnaire. light-colored clothing; and tick checks. Connally, Case-control 7 NA 349 cases with Lyme Personal protective measures: Odds ratios of acquiring Checking for ticks within 36 hours of 2009 study of risk disease (EM) reported to Lyme disease (identified as a spending time in the yard at home factors for Connecticut’s Dep.
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