University Health Services

LYME DISEASE

Cause

Lyme disease is caused by a bacterium that can be transmitted to humans by the bite of an infected deer tick. You cannot catch the disease from a human. More than 16,000 cases of Lyme disease are reported each year from all over the country, but mostly from the northeast, which means living in Princeton is particularly dangerous. In fact, the disease is named after Lyme, Connecticut, where the first cases were documented in the 1970s. A group of children in the town who exhibited symptoms of rheumatoid arthritis were found to be infected with the bacterium that causes the illness now known as Lyme disease. Ixodes ticks transmit the infection after feeding for at least 36 hours, but not all ticks in high-risk areas carry the bacterium that causes Lyme disease. Only a small percentage of people bitten by ticks develop the illness.

Because ticks that transmit Lyme disease live in wooded and/or grassy environments, you should be careful when spending time outdoors in rural areas, or even suburban areas where there is overgrown grass and brush. When participating in activities like hiking, camping, gardening, fishing, and hunting, be sure to take preventative measures.

Symptoms

Lyme disease has several stages with increasingly severe symptoms. The first stage is characterized by the well known “bull’s eye” rash, medically referred to as erythema migrans, which may appear as soon as 3 days after infection, or as late as 30 days after. The growing red ring appears in 80% of cases, and surrounds the site of infection, which is usually around the waist, armpits, groin, buttocks, or behind the knee – warm, moist areas of the body. Other warning signs that may accompany the rash are more general symptoms, often leading to misdiagnosis. These include chills, fever, fatigue, headache, muscles aches, and joint aches.

The second stage of the disease can occur several weeks to months after the tick bite. Symptoms can affect the skin, the nervous system, and the heart. Fatigue, muscles aches, joint pain, and fever are common.

The last stage of Lyme disease can occur months to years after exposure. The most common symptom of the third stage is arthritis of the large, weight-bearing joints, primarily the knees. Less common are symptoms of neurological involvement, sleep disturbances, memory loss, and difficulties with concentration. Lyme disease is rarely fatal.

Treatment

Without treatment, patients with Lyme disease may develop the more serious symptoms, but fortunately, almost all cases of Lyme disease can be cured by antibiotics. The sooner antibiotic treatment is begun, the faster and more complete the recovery. Consult a health care provider to discuss which antibiotic is appropriate for your situation.

There was a vaccine for Lyme disease produced by GlaxoSmithKline and approved by the Food and Drug Administration (FDA) in 1998, but it was pulled off the market in 2002.

Prevention
 

• Avoid tick-infested areas. Wooded, brushy, and grassy areas are particularly dangerous in the spring and summer when ticks feed.
• Wear light-colored clothing so that ticks can be seen more easily and removed before they bite. Keep in mind that deer ticks aren’t much bigger than the tip of a pencil.
• Cover as much skin as possible by wearing long pants and long sleeves. Wear boots or tuck your pants into the tops of your socks to prevent ticks from gaining access to your skin.
• Apply insect repellents containing DEET to clothes and exposed skin. Permethrin, a stronger chemical, can only be applied to clothes, but will kill ticks on contact.
• Shower as soon as you come indoors because ticks can remain on your skin for hours without biting.
• Check for ticks daily, especially around your waist, armpits, buttocks, scalp, and groin.
• Remove ticks using tweezers to grab the tick and gently pull it out. Once the tick has been removed, swab the area with alcohol. Do not use petroleum jelly, matches, or nail polish to kill the tick. [top]

MENINGITIS

Imagine this picture: it's Friday night, the weekend stretches out in front of you, and you're out enjoying yourself with some friends over pizza and a game of pool. You make your way home and fall into bed, only to wake up the next morning with a raging headache and sick-to-your-stomach feeling. Now what if these seemingly ordinary symptoms turned out to signify not just another bad cold or flu but a serious, potentially deadly disease, an infection that comes on quickly and can progress to paralysis and even death within a matter of hours?

Sound like the makings of some far-fetched Hollywood drama? Perhaps, but unfortunately this is a story that has played out on all too many college campuses in recent years.

Why does University Health Services recommend the meningococcal vaccine?

Since the early 1990's, there has been an increase in meningococcal meningitis outbreaks in the United States. About one-third of all outbreaks from 1991 to 1996 occurred in schools, universities, and other organization-based settings. This is why University Health Services and the American College Health Association recommend that students consider vaccination to reduce their risk for potentially fatal meningococcal disease. New Jersey Department of Health and Senior Services requires that each new student entering a four-year college or university after September 1, 2001 and prior to matriculation, be provided information on meningococcal disease.

University Health Services (UHS) is pleased to offer the meningitis vaccine as part of their preventive health program to encourage all students to immunize themselves against meningitis. The cost of the visit and the vaccine will be charged directly to your student account.

This safe, effective vaccine can provide protection against four of the five most prevalent strains of meningococcal disease (serogroups A, C, Y and W-135), which together account for nearly 70% of the meningococcal cases on campus. Side effects are mild and infrequent, consisting primarily of redness and swelling at the injection site and lasting up to two days. However, meningococcal immunization should be deferred during any acute illness, and the vaccine should not be administered to individuals sensitive to thimerosal or any other component of the vaccine. If students received the vaccine in the last 3 years, they do not need re-immunization.

What is meningitis?

Meningitis is an inflammation of the meninges, the lining that surrounds the spinal cord and brain. Meningococcal bacteria cross from the blood into the tissue surrounding the brain, and the bacterial toxins cause the membranes around the brain to swell, resulting in increasing intracranial pressure. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether a virus or bacterium causes meningitis is important because the severity of illness and the treatments differ. The more common form of meningitis – viral meningitis – is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. Unlike other cells in the body, brain cells cannot regenerate after being killed, so damage to the brain caused by inflammation is often permanent. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people.

What are the signs and symptoms of meningitis?

High fever, headache, stiff neck, vomiting, and extreme sensitivity to light are common symptoms of meningitis in anyone over several hours, or they may take 1 to 2 days. A rash may also develop anywhere on the body. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. The infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

How is meningitis diagnosed?

Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal is readily accessible. Identification of the type of bacteria responsible is important for selection of correct antibiotics.

Can meningitis be treated?

Bacterial meningitis can be treated with a number of effective antibiotics. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.

Is meningitis contagious?

Yes, some forms are bacterial meningitis are contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). About 1 in 10 people carry the bacteria at some time in their lives, but are not harmed unless the bacteria enters the bloodstream. Fortunately, none of the bacteria that cause meningitis are as contagious as infections like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been. Viral meningitis can be the result of polluted water or poor hygiene.

Who is at risk for developing meningitis?

It is recommended that college freshman get vaccinated for meningitis because the number of cases increased on college campuses in the 90s. Studies suggest that college students are more susceptible because they live and work in close proximity to each other in dormitories and classrooms. Lifestyle appears to be a risk factor as well, with exposure to active and passive smoking, alcohol consumption, and bar patronage all increasing the chance that one will contract meningitis from an infected individual.

People in the same household or day-care center, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of acquiring the infection.

Meningitis cases should be reported to state or local health departments to assure follow-up of close contacts and recognize outbreaks. Although large epidemics of meningococcal meningitis do not occur in the United States, some countries experience large, periodic epidemics. Therefore, overseas travelers should check to see if meningococcal vaccine is recommended for their destination. Travelers should receive the vaccine at least 1 week before departure, if possible. Information on areas for which meningococcal vaccine is recommended can be obtained by calling the [top]

WEST NILE VIRUS

Cause

West Nile virus is a mosquito-borne virus that can cause encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord). A mosquito becomes infected by biting a bird that carries the virus. You cannot get West Nile virus from a person who has the disease. West Nile virus is not spread by person-to-person contact such as touching, kissing, or caring for someone who is infected.
Outbreaks of the West Nile virus have occurred before in Egypt, Asia, Israel, South Africa, parts of Europe and Australia. Before 1999, the West Nile virus had never before been found in the United States. The most likely explanation for the sudden appearance of West Nile in the US is that the virus was introduced by an infected bird that was imported or an infected human returning from a country where the virus is common.
West Nile virus cannot spread directly from birds to people. However, dead birds should not be handled with bare hands. Please contact the Department of Public Safety, and, if necessary, use gloves to carefully place dead birds in a double plastic bag.

Symptoms

In the most recent outbreak, most people who were infected with West Nile virus had no symptoms or experienced mild illness such as a fever, headache and body aches before fully recovering. In outbreaks in other parts of the world, some people developed a mild rash or swollen lymph glands. In some individuals, particularly the elderly, West Nile virus can cause serious disease that affects brain tissue. At its most serious, it can cause permanent neurological damage and can be fatal. Encephalitis (inflammation of the brain) symptoms include the rapid onset of severe headache, high fever, stiff neck, confusion, loss of consciousness and muscle weakness.

Being bitten by an infected mosquito will not necessarily make you sick since most people who are infected with West Nile virus have no symptoms or experience mild illness. If illness were to occur, it would occur within 5 to15 days of being bitten by an infected mosquito.

Most mosquitoes are not infected with West Nile virus. However, you should see a doctor immediately if you develop symptoms such as:

• high fever
• confusion
• muscle weakness
• severe headaches
• stiff neck
• extreme sensitivity to light

Patients with mild symptoms should recover completely, and do not require any specific medication or laboratory testing.

Treatment

There is no specific treatment for West Nile virus. In severe cases, intensive supportive therapy is indicated, i.e., hospitalization, intravenous fluids and nutrition, airway management, breathing support if needed, prevention of secondary infections and good nursing care. There is no vaccine against the virus.

Prevention

Preventive measures include spraying insect repellent on clothing and exposed skin; wearing long sleeved shirts and pants when outdoors; curbing outdoor activities at dawn and dusk; installing window screens and keeping them in good repair; and eliminating standing water that can serve as a breeding ground for mosquitoes.

Information was adapted from [top]

EASTERN EQUINE ENCEPHALITIS

Causes

Eastern Equine Encephalitis (EEE) is a rare mosquito-borne virus that kills 30% of infected individuals. As the name implies, horses are susceptible to the virus, as are some birds and dogs. Cases occur most frequently in the eastern United States, though less than five are reported each year. Most infections arise at the end of the summer, when mosquitoes are most active, but could happen year-round in southern states. The EEE virus has been found to replicate in various peripheral sites of the body before it invades the central nervous system.

Symptoms

Many infected individuals develop only mild flu-like symptoms, while others develop none at all. The onset of symptoms generally occurs 4-10 days after the bite of an infected mosquito, and may be sudden or gradual. Often patients experience fever, headache, confusion, dizziness, and malaise. Fortunately, only a small proportion of infected individuals develop full-blown encephalitis, which can cause seizures, coma, and death. Encephalitis (swelling of the brain) is a severe condition that is likely to leave survivors with permanent brain damage. Depending on age, patients may exhibit different symptoms. Adults tend to experience decreasing levels of consciousness and evidence of neurological trauma more than infants and children.

Treatment

The most common way to diagnose encephalitis is to analyze the cerebrospinal fluid surrounding your brain and spinal cord in a procedure called a spinal tap. The EEE virus doesn’t respond to antibiotics or anti-viral medications, so treatment mainly consists of rest and a healthy diet, including plenty of fluids to help your immune system fight off the virus.

Prevention

Although there’s a vaccine for horses, there has not been one approved for humans. Unfortunately, control measures, such as aerial spraying to kill mosquitoes, is expensive and there is frequently limited financial support for preventative measures. Because there’s no vaccine, prevention centers on controlling mosquitoes and avoiding mosquito bites. Here’s what you can do to prevent mosquito-borne viruses:

• wear long sleeves and pants when in mosquito-infested areas
• avoid going outside at dawn or dusk
• repair holes in screens of windows and doors.
• eliminate standing water
• clean the gutters of your house [top]