Unwitting Hosts and Resourceful Guests The Lyme Disease Story Modern epidemiology discovers an old disease Old Lyme Connecticut Bul s eye rashes present on victims bitten by the Ixodes tick Lyme Disease Vector and Reservoir Causative agent Borrelia burgdorferi Reservoir white footed deer mouse Vector Tick Ixodes Primary host for tick white tailed deer Rickettsia amblyommii Instead of the Rocky Mountain Spotted Fever caused by Rickettsia rickettisii a less lethal Rickettsia amblyommii is likely at work in NC causing Southern Tick Associated Rash Illness STARI Emerging Waterborne Disease Cryptosporidiosis The value of clean drinking water and the consequence of living in a large population center was demonstrated in Milwaukee Wisconsin March 1993 Unusually heavy rainfall overwhelmed the city s sewage system contaminating the city s water supply with untreated sewage The contaminated drinking water resulted in approximately 400 000 cases of diarrhea 4 400 were hospitalized and 100 people died as a result of the outbreak Cryptosporidium parvum Oocysts in feces of an infected patient Emerging Disease Factors Microbial evolution gene exchange mutation antibiotic misuse Public health infrastructure deterioration wars economic meltdowns Changes in human activity air travel spreads disease faster Advances in technology transplantation pharmacology Human population explosion 7 billion and counting War and civil unrest sub Saharan Africa Middle East Climate change wetter warmer more hurricanes Microbes Evolve Faster Than We Do Bacteria mutate or horizontally transfer genes to evolve resistances to antibiotics Example Multiple Drug Resistant Staphlococcus aureus Neisseria gonorrheae Viruses reshuffle genes and escape the human immune system Example Influenza virus Viruses mutate and resist antiviral drugs Example HIV Overview Lyme disease caused by Borrelia burgdorferi bacteria is an infectious arthritis named after Old Lyme CT Lyme is a vector borne disease spread by Ixodes ticks Vector bornes disease incidence increases during warmer months North Carolina leads the country in cases of Rocky Mountain Spotted Fever a tick borne disease caused by either Rickettsia rickettsii or Rickettsia emblyomii bacteria An outbreak of cryptospordosis caused by the water borne protozoan Cryptosporidium parvum caused 100 deaths in Milwaukee WI in 1993 and sicken people in an Australian outbreak in 2008 9 The cryptosporodosis protozoan is resistant to the chlorination used to produce potable drinking water Emerging infectious diseases can travel long distances warranting world wide surveillance of infectious disease