Lyme disease

Lyme Disease 

Definition

Lyme disease is an infection transmitted by the bite of ticks carrying the spiral-shaped bacterium Borrelia burgdorferi. The disease was named for Lyme, Connecticut, the town where it was first diagnosed in 1975 after a puzzling outbreak of arthritis. The organism was named for its discoverer, Willy Burgdorfer. The effects of this disease can be long-term and disabling unless it is recognized and treated properly with antibiotics.

Description

Lyme disease, which is also called Lyme borreliosis, is a vector-borne disease. This term means that it is delivered from one host to another. It is also classified as a zoonosis, which means that it is a disease of animals that can be transmitted to humans under natural conditions. In this case, a tick bearing the Borrelia burgdorferi organism literally inserts it into a host's bloodstream when it bites the host to feed on its blood. It is important to note that neither Borrelia burgdorferi nor Lyme disease can be transmitted directly from one person to another, or from pets to humans.

Controversy clouds the true incidence of Lyme disease because no test is definitively diagnostic for the disease, and many of its symptoms mimic those of so many other diseases. Cases of Lyme disease have been reported in 49 of the 50 states; however, 92% of the 17,730 cases reported to the Centers for Disease Control and Prevention (CDC) in 2000 were from only nine states (Connecticut, Rhode Island, New York, Pennsylvania, Delaware, New Jersey, Maryland, Massachusetts, and Wisconsin). The disease is also found in Scandinavia, continental Europe, the countries of the former Soviet Union, Japan, and China; in addition, it is possible that it has spread to Australia.

In the United States, Lyme disease accounts for more than 90% of all reported vector-borne illnesses. It is a significant public health problem and continues to be diagnosed in increasing numbers. The Centers for Disease Control and Prevention (CDC) attributes this increase to the growing size of the deer herd and the geographical spread of infected ticks rather than to improved diagnosis. In addition, some epidemiologists believe that the actual incidence of Lyme disease in the United States may be 5-10 times greater than that reported by the CDC. The reasons for this difference include the narrowness of the CDC's case definition as well as frequent misdiagnoses of the disease.

The risk for acquiring Lyme disease varies, depending on what stage in its life cycle a tick has reached. A tick passes through three stages of development—larva, nymph, and adult—each of which is dependent on a live host for food. In the United States, Borrelia burgdorferi is borne by ticks of several species in the genus Ixodes, which usually feed on the white-footed mouse and deer (and are often called deer ticks). In the summer, the larval ticks hatch from eggs laid in the ground and feed by attaching themselves to small animals and birds. At this stage they are not a problem for humans. It is the next stage—the nymph—that causes most cases of Lyme disease. Nymphs are very active from spring through early summer, at the height of outdoor activity for most people. Because they are still quite small (less than 2 mm), they are difficult to spot, giving them ample opportunity to transmit Borrelia burgdorferi while feeding. Although far more adult ticks than nymphs carry Borrelia burgdorferi, the adult ticks are much larger, more easily noticed, and more likely to be removed before the 24 hours or more of continuous feeding needed to transmit Borrelia burgdorferi.

Causes and symptoms

Lyme disease is caused by Borrelia burgdorferi. Once Borrelia burgdorferi gains entry to the body through a tick bite, it can move through the bloodstream quickly. Only 12 hours after entering the bloodstream, Borrelia burgdorferi can be found in cerebrospinal fluid (which means it can affect the nervous system). Treating Lyme disease early and thoroughly is important because Lyme disease can hide for long periods within the body in a clinically latent state. That ability explains why symptoms can recur in cycles and can flare up after months or years, even over decades. It is important to note, however, that not many people who are exposed to Borrelia burgdorferi develops the disease.

Lyme disease is usually described in terms of length of infection (time since the person was bitten by a tick infected with Lyme disease) and whether Borrelia burgdorferi is localized or disseminated (spread through the body by fluids and cells carrying Borrelia burgdorferi). Furthermore, when and how symptoms of Lyme disease appear can vary widely from patient to patient. People who experience recurrent bouts of symptoms over time are said to have chronic Lyme disease.

Early localized lyme disease

The most recognizable indicator of Lyme disease is a rash around the site of the tick bite. Often, the tick exposure has not been recognized. The eruption might be warm or itch. The rash—erythema migrans (EM)-generally develops within 3-30 days and usually begins as a round, red patch that expands outward. About 75% of patients with Lyme disease develop EM. Clearing may take place from the center out, leaving a bull's-eye effect; in some cases, the center gets redder instead of clearing. The rash may look like a bruise on people with dark skin. Of those who develop Lyme disease, about 50% notice flu-like symptoms, including fatigue, headache, chills and fever, muscle and joint pain, and lymph node swelling. However, a rash at the site can also be an allergic reaction to the tick saliva rather than an indicator of Lyme disease, particularly if the rash appears in less than three days and disappears only days later.

Late disseminated disease and chronic lyme disease

Weeks, months, or even years after an untreated tick bite, symptoms can appear in several forms, including:

• Fatigue, forgetfulness, confusion, mood swings, irritability, numbness.
• Neurologic problems, such as pain (unexplained and not triggered by an injury), Bell's palsy (facial paralysis, usually one-sided but may be on both sides), and a mimicking of the inflammation of brain membranes known as meningitis; (fever, severe headache).
• Arthritis (short episodes of pain and swelling in joints) and other musculoskeletal complaints. Arthritis eventually develops in about 60% of patients with untreated Lyme disease.

Less common effects of Lyme disease are heart abnormalities (such as irregular rhythm or cardiac block) and eye abnormalities (such as swelling of the cornea, tissue, or eye muscles and nerves).

Lyme disease accounts for more than 90% of all reported vector-borne illnesses in the United States. It is caused by an infection transmitted by the bite of ticks carrying the Borrelia burgdorferi bacterium.

(Data taken from the Centers for Disease Control. Illustration by Electronic Illustrators Group.)

Diagnosis

A clear diagnosis of Lyme disease can be difficult, and relies on information the patient provides and the doctor's clinical judgment, particularly through elimination of other possible causes of the symptoms. Lyme disease may mimic other conditions, including chronic fatigue syndrome (CFS), multiple sclerosis (MS), and other diseases with many symptoms involving multiple body systems. Differential diagnosis (distinguishing kyme disease from other diseases) is based on clinical evaluation with laboratory tests used for clarification when necessary. A two-test approach is common to confirm the results. Because of the potential for misleading results (false-positive and false-negative), laboratory tests alone cannot establish the diagnosis.

In February 1999 the Food and Drug Administration (FDA) approved a new blood test for Lyme disease called PreVue. The test, which searches for antigens (substances that stimulate the production of antibodies) produced by Borrelia burgdorferi, gives results within one hour in the doctor's office. A positive result from the PreVue test is confirmed by a second blood test known as the Western blot, which must be done in a laboratory.

Doctors generally know which disease-causing organisms are common in their geographic area. The most helpful piece of information is whether a tick bite or rash was noticed and whether it happened locally or while traveling. Doctors may not consider Lyme disease if it is rare locally, but will take it into account if a patient mentions vacationing in an area where the disease is commonly found.

Treatment

The treatment for Lyme disease is antibiotic therapy; however, overprescribing of antibiotics can lead to serious problems, so the decision to treat must be made with care. Disease organisms can develop resistance to families of medications over time, rendering the drugs useless. Furthermore, testing and treatments can be expensive. If a patient has strong indications of Lyme disease (symptoms and medical history), the doctor will probably begin treatment on the presumption of this disease. The American College of Physicians recommends treatment for a patient with a rash resembling EM or who has arthritis, a history of an EM-type rash, and a previous tick bite.

The benefits of treating early must be weighed against the risks of over treatment. The longer a patient is ill with Lyme disease before treatment, the longer the course of therapy must be, and the more aggressive the treatment. The development of opportunistic organisms may produce other symptoms. For example, after long-term antibiotic therapy, patients can become more susceptible to yeast infections. Treatment may also be associated with adverse drug reactions.

For most patients, oral antibiotics (doxycycline or amoxicillin) are prescribed for 21 days. When symptoms indicate nervous system involvement or a severe episode of Lyme disease, intravenous antibiotic (ceftriaxone) may be given for 14-30 days. Some physicians consider intravenous ceftriaxone the best therapy for any late manifestation of disease, but treatments for late Lyme disease are still controversial as of 2003. Corticosteroids (oral) may be prescribed if eye abnormalities occur, but they should not be used without first consulting an eye doctor.

The doctor may have to adjust the treatment regimen or change medications based on the patient's response. Treatment can be difficult because Borrelia burgdorferi comes in several strains (some may react to different antibiotics than others) and may even have the ability to switch forms during the course of infection. Also, Borrelia burgdorferi can shut itself up in cell niches, allowing it to hide from antibiotics. Finally, antibiotics can kill Borrelia burgdorferi only while it is active rather than dormant.

Alternative treatment

Supportive therapies may minimize symptoms of LD or improve the immune response. These include vitamin and nutritional supplements, mostly for chronic fatigue and increased susceptibility to infection. For example, yogurt and Lactobacillus acidophilus preparations help fight yeast infections, which are common in people on long-term antibiotic therapy. In addition, botanical medicine and homeopathy can be considered to help bring the body's systems back to a state of health and well being. A Western herb, spilanthes (Spilanthes spp.), may be effective in treating diseases like LD that are caused by spirochetes (spiral-shaped bacteria).

Prognosis

If aggressive antibiotic therapy is given early, and the patient cooperates fully and sticks to the medication schedule, recovery should be complete. Only a small percentage of Lyme disease patients fail to respond or relapse (have recurring episodes). Most long-term effects of the disease result when diagnosis and treatment is delayed or missed. Co-infection with other infectious organisms spread by ticks in the same areas as Borrelia burgdorferi (babesiosis and ehrlichiosis, for instance) may be responsible for treatment failures or more severe symptoms. Most fatalities reported with Lyme disease involved patients coinfected with babesiosis.

Prevention

Update on vaccination

A vaccine for Lyme disease known as LYMErix was available from 1998 to 2002, when it was removed from the United States market. The decision was influenced by reports that LYMErix may be responsible for neurologic complications in vaccinated patients. Researchers from Cornell-New York Hospital presented a paper at the annual meeting of the American Neurological Association in October 2002 that identified nine patients with neuropathies linked to vaccination with LYMErix. In April 2003, the National Institute of Allergy and Infectious Diseases (NIAID) awarded a federal grant to researchers at Yale University School of Medicine to develop a new vaccine against Lyme disease. As of late 2003, the best prevention strategy is through minimizing risk of exposure to ticks and using personal protection precautions.

Minimizing risk of exposure

Precautions to avoid contact with ticks include moving leaves and brush away from living quarters. Most important are personal protection techniques when outdoors, such as:

• Spraying tick repellent on clothing and exposed skin.
• Wearing light-colored clothing to maximize ability to see ticks.
• Tucking pant legs into socks or boot top.
• Checking children and pets frequently for ticks.

In highly tick-populated areas, each individual should be inspected at the end of the day to look for ticks.

Minimizing risk of disease

The two most important factors are removing the tick quickly and carefully, and seeking a doctor's evaluation at the first sign of symptoms of Lyme disease. When in an area that may be tick-populated:

• Check for ticks, particularly in the area of the groin, underarm, behind ears, and on the scalp.
• Stay calm and grasp the tick as near to the skin as possible, using a tweezer.
• To minimize the risk of squeezing more bacteria into the bite, pull straight back steadily and slowly.
• Do not try to remove the tick by using petroleum jelly, alcohol, or a lit match.
• Place the tick in a closed container (for species identification later, should symptoms develop) or dispose of it by flushing.
• See a physician for any sort of rash or patchy discoloration that appears three to 30 days after a tick bite.

Key terms

Babesiosis — A disease caused by protozoa of the genus Babesia characterized by a malaria-like fever, anemia, vomiting, muscle pain, and enlargement of the spleen. Babesiosis, like Lyme disease, is carried by a tick.

Bell's palsy — Facial paralysis or weakness with a sudden onset, caused by swelling or inflammation of the seventh cranial nerve, which controls the facial muscles. Disseminated Lyme disease sometimes causes Bell's palsy.

Blood-brain barrier — A blockade of cells separating the circulating blood from elements of the central nervous system (CNS); it acts as a filter, preventing many substances from entering the central nervous system.

Cerebrospinal fluid — Clear fluid found around the brain and spinal cord and in the ventricles of the brain.

Disseminated — Scattered or distributed throughout the body. Lyme disease that has progressed beyond the stage of localized EM is said to be disseminated.

Erythema migrans (EM) — A red skin rash that is one of the first signs of Lyme disease in about 75% of patients.

Lyme borreliosis — Another name for Lyme disease.

Spirochete — A spiral-shaped bacterium. The bacteria that cause Lyme disease and syphilis, for example, are spirochetes.

Vector — An animal carrier that transfers an infectious organism from one host to another. The vector that transmits Lyme disease from wildlife to humans is the deer tick or black-legged tick.

Zoonosis (plural, zoonoses) — Any disease of animals that can be transmitted to humans under natural conditions. Lyme disease and babesiosis are examples of zoonoses.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Bacterial Diseases Caused by Spirochetes: Lyme Disease (Lyme Borreliosis)." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Edlow, Jonathan A., MD. "Tick-Borne Diseases, Lyme." eMedicine December 13, 2002. http://www.emedicine.com/emerg/topic588.htm.

Krupp, L. B., L. G. Hyman, R. Grimson, et al. "Study and Treatment of Post Lyme Disease (STOP-LD): A Randomized Double Masked Clinical Trial." Neurology 60 (June 24, 2003): 1923-1930.

Nachman, S. A., and L. Pontrelli. "Central Nervous System Lyme Disease." Seminars in Pediatric Infectious Diseases 14 (April 2003): 123-130.

Pavia, C. S. "Current and Novel Therapies for Lyme Disease." Expert Opinion on Investigational Drugs 12 (June 2003): 1003-1016.

Susman, Ed. "ANA: Neurological Impairment Seen in Patients Given LYMErix Lyme Disease Vaccine." Doctor's Guide October 16, 2002. 〈http://www.plsgroup.com/dg/220652.htm〉.

Wormser, G. P., R. Ramanathan, J. Nowakowski, et al. "Duration of Antibiotic Therapy for Early Lyme Disease. A Randomized, Double-Blind, Placebo-Controlled Trial." Annals of Internal Medicine 138 (May 6, 2003): 697-704.

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Lyme Disease Foundation. One Financial Plaza, Hartford, CT, 06103. (800) 886-LYME. http://www.lyme.org.

Lyme Disease Network of NJ, Inc. 43 Winton Road, East Brunswick, NJ 08816. http://www.lymenet.org.

National Institute of Allergy and Infectious Diseases (NIAID). 31 Center Drive, Room 7A50 MSC 2520, Bethesda, MD, 20892. (301) 496-5717. http://www.niaid.nih.gov.

Other

Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases. CDC Lyme Disease Home Page. http://www.cdc.gov/ncidod/dvbid/lyme/.

National Institute of Neurological Disorders and Stroke (NINDS) Fact Sheet. Bell's Palsy. Bethesda, MD: NINDS, 2003.

NINDS Information Page. Neurological Complications of Lyme Disease. Bethesda, MD: NINDS, 2003.

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disease /dis·ease/ (dĭ-zēz´) any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. See also entries under syndrome.

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acquired cystic disease of kidney  the development of cysts in the formerly noncystic failing kidney in end-stage renal disease.

Addison's disease  bronzelike pigmentation of the skin, severe prostration, progressive anemia, low blood pressure, diarrhea, and digestive disturbance, due to adrenal hypofunction.

Albers-Schönberg disease  osteopetrosis.

allogeneic disease  graft-versus-host reaction occurring in immunosuppressed animals receiving injections of allogeneic lymphocytes.

Alpers' disease  a rare disease of young children, characterized by neuronal deterioration of the cerebral cortex and elsewhere, progressive mental deterioration, motor disturbances, seizures, and early death.

alpha chain disease  heavy chain disease characterized by plasma cell infiltration of the lamina propria of the small intestine resulting in malabsorption with diarrhea, abdominal pain, and weight loss, possibly accompanied by pulmonary involvement.

Alzheimer's disease  progressive degenerative disease of the brain, of unknown cause; characterized by diffuse atrophy throughout the cerebral cortex with distinctive histopathological changes.

Andersen's disease  glycogen storage d., type IV.

apatite deposition disease  a connective tissue disorder marked by deposition of hydroxyapatite crystals in one or more joints or bursae.

Aran-Duchenne disease  spinal muscular atrophy.

arteriosclerotic cardiovascular disease  (ASCVD) atherosclerotic involvement of arteries to the heart and to other organs, resulting in debility or death; sometimes used specifically for ischemic heart disease.

arteriosclerotic heart disease  (ASHD) ischemic heart d.

autoimmune disease  any of a group of disorders in which tissue injury is associated with humoral or cell-mediated responses to the body's own constituents; they may be systemic or organ-specific.

Ayerza's disease  polycythemia vera with chronic cyanosis, dyspnea, bronchitis, bronchiectasis, hepatosplenomegaly, bone marrow hyperplasia, and pulmonary artery sclerosis.

Banti's disease  congestive splenomegaly.

Barlow disease  scurvy in infants.

Barraquer's disease  partial lipodystrophy.

Basedow's disease  Graves' d.

Batten disease , Batten-Mayou disease

1. Vogt-Spielmeyer d.

2. more generally, any or all of the group of disorders constituting neuronal ceroid lipofuscinosis.

Bayle's disease  general paresis.

Bazin's disease  erythema induratum.

Bekhterev's (Bechterew's) disease  ankylosing spondylitis.

Benson's disease  asteroid hyalosis.

Berger's disease  IgA glomerulonephritis.

Bernhardt's disease , Bernhardt-Roth disease meralgia paresthetica.

Besnier-Boeck disease  sarcoidosis.

Best's disease  congenital macular degeneration.

Bielschowsky-Janský disease  Janský-Bielschowsky d.

Binswanger's disease  a degenerative dementia of presenile onset caused by demyelination of the subcortical white matter of the brain.

black disease  a fatal disease of sheep, and sometimes of humans, in the United States and Australia, due to Clostridium novyi, marked by necrotic areas in the liver.

Blocq's disease  astasia-abasia.

Blount disease  tibia vara.

Boeck's disease  sarcoidosis.

Bornholm disease  epidemic pleurodynia.

Bowen's disease  a squamous cell carcinoma in situ, often due to prolonged exposure to arsenic; usually occurring on sun-exposed areas of skin. The corresponding lesion on the glans penis is termed erythroplasia of Queyrat.

Brill's disease  Brill-Zinsser d.

Brill-Symmers disease  giant follicular lymphoma.

Brill-Zinsser disease  mild recrudescence of epidemic typhus years after the initial infection, because Rickettsia prowazekii has persisted in body tissue in an inactive state, with humans as the reservoir.

broad beta disease  familial dysbetalipoproteinemia; named for the electrophoretic mobility of the abnormal chylomicron and very-low-density lipoprotein remnants produced.

Busse-Buschke disease  cryptococcosis.

Caffey's disease  infantile cortical hyperostosis.

calcium hydroxyapatite deposition disease  apatite deposition d.

calcium pyrophosphate deposition disease  (CPDD) an acute or chronic inflammatory arthropathy caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the joints, chondrocalcinosis, and crystals in the synovial fluid. Acute attacks are sometimes called pseudogout.

Calvé-Perthes disease  osteochondrosis of capitular epiphysis of femur.

Camurati-Engelmann disease  diaphyseal dysplasia.

Canavan disease , Canavan-van Bogaert-Bertrand disease spongy degeneration of the central nervous system.

Carrión's disease  bartonellosis.

Castleman disease  a benign or premalignant condition resembling lymphoma but without recognizable malignant cells; there are isolated masses of lymphoid tissue and lymph node hyperplasia, usually in the abdominal or mediastinal area.

cat-scratch disease  a usually benign, self-limited disease of the regional lymph nodes, caused by Bartonella henselae and characterized by a papule or pustule at the site of a cat scratch, subacute painful regional lymphadenitis, and mild fever.

celiac disease  a malabsorption syndrome precipitated by ingestion of gluten-containing foods, with loss of villous structure of the proximal intestinal mucosa, bulky, frothy diarrhea, abdominal distention, flatulence, weight loss, and vitamin and electrolyte depletion.

Chagas disease  trypanosomiasis due to Trypanosoma cruzi; its course may be acute, subacute, or chronic.

Charcot-Marie-Tooth disease  muscular atrophy of variable inheritance, beginning in the muscles supplied by the peroneal nerves and progressing to those of the hands and arms.

cholesteryl ester storage disease  (CESD) a lysosomal storage disease due to deficiency of lysosomal cholesterol esterase, variably characterized by some combination of hepatomegaly, hyperbetalipoproteinemia, and premature atherosclerosis.

Christmas disease  hemophilia B.

chronic granulomatous disease  frequent, severe infections of the skin, oral and intestinal mucosa, reticuloendothelial system, bones, lungs, and genitourinary tract associated with a genetically determined defect in the intracellular bactericidal function of leukocytes.

chronic obstructive pulmonary disease  (COPD) any disorder marked by persistent obstruction of bronchial air flow.

Coats' disease  exudative retinopathy.

collagen disease  any of a group of diseases characterized by widespread pathologic changes in connective tissue; they include lupus erythematosus, dermatomyositis, scleroderma, polyarteritis nodosa, thrombotic purpura, rheumatic fever, and rheumatoid arthritis. Cf. collagen disorder.

communicable disease  a disease the causative agents of which may pass or be carried from one person to another directly or indirectly.

Concato's disease  progressive malignant polyserositis with large effusions into the pericardium, pleura, and peritoneum.

constitutional disease  one involving a system of organs or one with widespread symptoms.

Cori's disease  glycogen storage d., type III.

coronary artery disease  (CAD) atherosclerosis of the coronary arteries, which may cause angina pectoris, myocardial infarction, and sudden death; risk factors include hypercholesterolemia, hypertension, smoking, diabetes mellitus, and low levels of high-density lipoproteins.

coronary heart disease  (CHD) ischemic heart d.

Cowden disease  a hereditary disease marked by multiple ectodermal, mesodermal, and endodermal nevoid and neoplastic anomalies.

Creutzfeldt-Jakob disease  a rare prion disease existing in sporadic, familial, and infectious forms, with onset usually in middle life, and having a wide variety of clinical and pathological features. The most commonly seen are spongiform degeneration of neurons, neuronal loss, gliosis, and amyloid plaque formation, accompanied by rapidly progressive dementia, myoclonus, motor disturbances, and encephalographic changes, with death occurring usually within a year of onset.

Crigler-Najjar disease  see under syndrome.

Crohn's disease  regional enteritis; a chronic granulomatous inflammatory disease usually in the terminal ileum with scarring and thickening of the wall, often leading to intestinal obstruction and formation of fistulas and abscesses.

Crouzon's disease  craniofacial dysostosis.

Cruveilhier's disease  spinal muscular atrophy.

Cushing's disease  Cushing's syndrome in which the hyperadrenocorticism is secondary to excessive pituitary secretion of adrenocorticotropic hormone.

cystic disease of breast  mammary dysplasia with formation of blue dome cysts.

cytomegalic inclusion disease , cytomegalovirus disease an infection due to cytomegalovirus and marked by nuclear inclusion bodies in enlarged infected cells. In the congenital form, there is hepatosplenomegaly with cirrhosis, and microcephaly with mental or motor retardation. Acquired disease may cause a clinical state similar to infectious mononucleosis. When acquired by blood transfusion, postperfusion syndrome results.

deficiency disease  a condition caused by dietary or metabolic deficiency, including all diseases due to an insufficient supply of essential nutrients.

degenerative joint disease  osteoarthritis.

Dejerine's disease , Dejerine-Sottas disease progressive hypertrophic neuropathy.

demyelinating disease  any condition characterized by destruction of the myelin sheaths of nerves.

disappearing bone disease  gradual resorption of a bone or group of bones, sometimes associated with multiple hemangiomas, usually in children or young adults and following trauma.

diverticular disease  a general term including the prediverticular state, diverticulosis, and diverticulitis.

Duchenne's disease 

1. spinal muscular atrophy.

2. progressive bulbar paralysis.

3. tabes dorsalis.

4. Duchenne's muscular dystrophy.

Duchenne-Aran disease  spinal muscular atrophy.

Duhring's disease  dermatitis herpetiformis.

Dukes' disease  a febrile disease of childhood marked by an exanthematous eruption, probably due to a virus of the Coxsackie-ECHO group.

Durand-Nicolas-Favre disease  lymphogranuloma venereum.

Duroziez's disease  congenital mitral stenosis.

Ebola virus disease  fatal acute hemorrhagic fever resembling Marburg virus disease but caused by Ebola virus, seen in the Sudan and Zaire.

Ebstein's disease  see under anomaly.

end-stage renal disease  chronic irreversible renal failure.

Erb's disease  Duchenne's muscular dystrophy.

Erb-Goldflam disease  myasthenia gravis.

Eulenburg's disease  paramyotonia congenita.

extrapyramidal disease  any of a group of clinical disorders marked by abnormal involuntary movements, alterations in muscle tone, and postural disturbances; they include parkinsonism, chorea, athetosis, etc.

Fabry's disease  an X-linked lysosomal storage disease of glycosphingolipid catabolism resulting from deficiency of α-galactosidase A and leading to accumulation of ceramide trihexoside in the cardiovascular and renal systems.

Farber's disease  a lysosomal storage disease due to defective ceramidase and characterized by hoarseness, aphonia, dermatitis, bone and joint deformities, granulomatous reaction, and psychomotor retardation.

Fazio-Londe disease  a rare type of progressive bulbar palsy occurring in childhood.

Feer disease  acrodynia.

fibrocystic disease of breast  a form of mammary dysplasia with formation of cysts of various size containing a semitransparent, turbid fluid that imparts a brown to blue color to the unopened cysts; believed due to abnormal hyperplasia of the ductal epithelium and dilatation of the ducts of the mammary gland, resulting from exaggeration and distortion of normal menstrual cycle–related breast changes.

fibrocystic disease of the pancreas  cystic fibrosis.

fifth disease  erythema infectiosum.

flint disease  chalicosis.

floating beta disease  familial dysbetalipoproteinemia.

focal disease  a localized disease.

foot-and-mouth disease  an acute, contagious viral disease of wild and domestic cloven-footed animals and occasionally humans, marked by vesicular eruption on the lips, buccal cavity, pharynx, legs, and feet.

Forbes' disease  glycogen storage d., type III.

fourth disease  Dukes' d.

fourth venereal disease  granuloma inguinale.

Fox-Fordyce disease  a persistent and recalcitrant, itchy, papular eruption, chiefly of the axillae and pubes, due to inflammation of apocrine sweat glands.

Freiberg's disease  osteochondrosis of the head of the second metatarsal bone.

Friedländer's disease  endarteritis obliterans.

Friedreich's disease  paramyoclonus multiplex.

functional disease  see under disorder.

Garré's disease  sclerosing nonsuppurative osteomyelitis.

gastroesophageal reflux disease  (GERD) any condition resulting from gastroesophageal reflux, characterized by heartburn and regurgitation; see also reflux esophagitis.

Gaucher's disease  a hereditary disorder of glucocerebroside metabolism, marked by the presence of Gaucher's cells in the marrow, and by hepatosplenomegaly and erosion of the cortices of long bones and pelvis. The adult form is associated with moderate anemia and thrombocytopenia, and yellowish pigmentation of the skin; in the infantile form there is, in addition, marked central nervous system impairment; in the juvenile form there are rapidly progressive systemic manifestations but moderate central nervous system involvement.

genetic disease  a general term for any disorder caused by a genetic mechanism, comprising chromosome aberrations (or anomalies), mendelian (or monogenic or single-gene) disorders, and multifactorial disorders.

gestational trophoblastic disease  see under neoplasia.

Gilbert disease  a familial, benign elevation of bilirubin levels without evidence of liver damage or hematologic abnormalities.

Gilles de la Tourette's disease  see under syndrome.

Glanzmann disease  see thrombasthenia.

glycogen storage disease  any of a number of rare inborn errors of metabolism caused by defects in specific enzymes or transporters involved in the metabolism of glycogen.

type I glucose-6-phosphatase deficiency: a severe hepatorenal form due to deficiency of the hepatic enzyme glucose-6-phosphatase, resulting in liver and kidney involvement, with hepatomegaly, hypoglycemia, hyperuricemia, and gout

type IA glycogen storage d., type I.

type IB a form resembling type I but additionally predisposing to infection due to neutropenia and to chronic inflammatory bowel disease; due to a defect in the transport system for glucose 6-phosphate.

type II a disorder due to deficiency of the lysosomal enzyme α-1,4,-glucosidase, the severe infant form resulting in generalized glycogen accumulation, with cardiomegaly, cardiorespiratory failure, and death, and a milder adult form being a gradual skeletal myopathy that sometimes causes respiratory problems.

type III a form due to deficiency of debrancher enzyme (amylo-1,6-glucosidase) in muscle, liver, or both; defects in the liver enzyme are characterized by hepatomegaly and hypoglycemia while defects in the muscle enzyme are characterized by progressive muscle wasting and weakness.

type IV brancher enzyme deficiency; cirrhosis of the liver, hepatosplenomegaly, progressive hepatic failure, and death due to deficiency of the glycogen brancher enzyme (1,4-α-glucan branching enzyme).

type V muscle cramps and fatigue during exercise due to a defect in the skeletal muscle isozyme of glycogen phosphorylase (muscle phosphorylase).

type VI hepatomegaly, mild to moderate hypoglycemia and mild ketosis, due to deficiency of the liver isozyme of glycogen phosphorylase (hepatic phosphorylase).

type VII muscle weakness and cramping after exercise due to deficiency of the muscle isozyme of 6-phosphofructokinase.

type VIII phosphorylase .

graft-versus-host (GVH) disease  disease caused by the immune response of histoincompatible, immunocompetent donor cells against the tissue of immunocompromised host, as a complication of bone marrow transplantation, or as a result of maternal-fetal blood transfusion, or therapeutic transfusion to an immunocompromised recipient.

Graves' disease  an association of hyperthyroidism, goiter, and exophthalmos, with accelerated pulse rate, profuse sweating, nervous symptoms, psychic disturbances, emaciation, and elevated basal metabolism.

Greenfield's disease  former name for the late infantile form of metachromatic leukodystrophy.

Gull's disease  atrophy of the thyroid gland with myxedema.

Günther disease  congenital erythropoietic porphyria.

H disease  Hartnup d.

Hailey-Hailey disease  benign familial pemphigus.

Hallervorden-Spatz disease  an autosomal recessive disorder caused by decreased numbers of myelin sheaths of the globus pallidus and substantia nigra, with accumulation of iron pigment, progressive rigidity beginning in the legs, choreoathetoid movements, dysarthria, and mental deterioration.

Hand's disease  Hand-Schüller-Christian d.

hand-foot-and-mouth disease  a mild, highly infectious viral disease of children, with vesicular lesions in the mouth and on the hands and feet.

Hand-Schüller-Christian disease  a chronic, progressive form of multifocal Langerhans cell histiocytosis, sometimes with accumulation of cholesterol, characterized by the triad of calvarial bone defects, exophthalmos, and diabetes insipidus.

Hansen's disease  leprosy.

Hartnup disease  a hereditary disorder of intestinal and renal transport of neutral α-amino acids, marked by a pellagra-like skin rash, with transient cerebellar ataxia, constant renal aminoaciduria, and other biochemical abnormalities.

Hashimoto's disease  a progressive disease of the thyroid gland with degeneration of its epithelial elements and replacement by lymphoid and fibrous tissue.

heavy chain diseases  a group of malignant neoplasms of lymphoplasmacytic cells marked by the presence of immunoglobulin heavy chains or heavy chain fragments; they are classified according to heavy chain type, e.g., alpha chain disease.

Heine-Medin disease  the major form of poliomyelitis.

hemoglobin disease  any of various hereditary molecular diseases characterized by abnormal hemoglobins in the red blood cells; the homozygous form is manifested by hemolytic anemia.

hemolytic disease of the newborn  erythroblastosis fetalis.

hemorrhagic disease of the newborn  a self-limited hemorrhagic disorder of the first few days of life, due to deficiency of vitamin K–dependent coagulation factors II, VII, IX, and X.

Hers' disease  glycogen storage d., type VI.

Heubner-Herter disease  the infantile form of celiac disease.

hip-joint disease  tuberculosis of the hip joint.

Hippel's disease  von Hippel's d.

Hirschsprung's disease  congenital megacolon.

His disease , His-Werner disease trench fever.

Hodgkin's disease  a form of malignant lymphoma marked clinically by painless, progressive enlargement of lymph nodes, spleen, and general lymphoid tissue; other symptoms may include anorexia, lassitude, weight loss, fever, pruritus, night sweats, and anemia. Reed-Sternberg cells are characteristically present. Four types have been distinguished on the basis of histopathologic criteria.

hoof-and-mouth disease  foot-and-mouth d.

hookworm disease  infection with the hookworm Ancylostoma duodenale or Necator americanus, whose larvae enter the body through the skin or in contaminated food or water and migrate to the small intestine where, as adults, they attach to the mucosa and ingest blood; symptoms may include abdominal pain, diarrhea, colic or nausea, and anemia.

hyaline membrane disease  a type of respiratory distress syndrome of the newborn in which there is formation of a hyaline-like membrane lining the terminal respiratory passages; extensive atelectasis is attributed to lack of surfactant.

hydatid disease  an infection, usually of the liver, due to larval forms of tapeworms of the genus Echinococcus, marked by development of expanding cysts.

hypophosphatemic bone disease  an inherited disorder resembling a mild form of X-linked hypophosphatemia, similarly due to a defect in renal tubular function but usually showing osteomalacia without radiographic evidence of rickets.

immune complex disease  local or systemic disease caused by the formation of circulating immune complexes and their deposition in tissue, due to activation of complement and to recruitment and activation of leukocytes in type III hypersensitivity reactions.

infectious disease  one due to organisms ranging in size from viruses to parasitic worms; it may be contagious in origin, result from nosocomial organisms, or be due to endogenous microflora from the nose and throat, skin, or bowel.

inflammatory bowel disease  any idiopathic inflammatory disease of the bowel, such as Crohn's disease and ulcerative colitis.

intercurrent disease  one occurring during the course of another disease with which it has no connection.

iron storage disease  hemochromatosis.

ischemic bowel disease  ischemic colitis.

ischemic heart disease  (IHD) any of a group of acute or chronic cardiac disabilities resulting from insufficient supply of oxygenated blood to the heart.

Janský-Bielschowsky disease  the late infantile form of neuronal ceroid lipofuscinosis, occurring between two and four years of age, characterized by abnormal accumulation of lipofuscin; beginning as myoclonic seizures and progressing to neurologic and retinal deterioration and death by age 8 to 12.

jumping disease  any of several culture-specific disorders characterized by exaggerated responses to small stimuli, muscle tics including jumping, obedience even to dangerous suggestions, and sometimes coprolalia or echolalia.

juvenile Paget disease  hyperostosis corticalis deformans juvenilis.

Kashin-Bek (Kaschin-Beck) disease  a disabling degenerative disease of the peripheral joints and spine, endemic in northeastern Asia; believed to be caused by ingestion of cereal grains infected with the fungus Fusarium sporotrichiella.

Katayama disease  schistosomiasis japonica.

Kawasaki disease  a febrile illness usually affecting infants and young children, with conjunctival injection, changes to the oropharyngeal mucosa, changes to the peripheral extremities including edema, erythema, and desquamation, a primarily truncal polymorphous exanthem, and cervical lymphadenopathy. It is often associated with vasculitis of the large coronary vessels.

Kienböck's disease  slowly progressive osteochondrosis of the lunate bone; it may affect other wrist bones.

kinky hair disease  Menkes' syndrome.

Köhler's bone disease 

1. osteochondrosis of the tarsal navicular bone in children.

2. thickening of the shaft of the second metatarsal bone and changes about its articular head, with pain in the second metatarsophalangeal joint on walking or standing.

Krabbe's disease  a lysosomal storage disease beginning in infancy, due to deficiency of β-galactosidase. Pathologically, there is rapidly progressive cerebral demyelination and large globoid bodies (swollen with accumulated cerebroside) in the white substance.

Kufs' disease  the adult form of neuronal ceroid lipofuscinosis, with onset prior to age 40; characterized by progressive neurologic deterioration but not blindness, excessive storage of lipofuscin, and shortened life expectancy;

Kümmell's disease  compression fracture of vertebra, with symptoms a few weeks after injury, including spinal pain, intercostal neuralgia, lower limb motor disturbances, and kyphosis.

Kyasanur Forest disease  a fatal viral disease of monkeys in the Kyasanur Forest of India, communicable to humans, in whom it produces hemorrhagic symptoms.

Kyrle's disease  a chronic disorder of keratinization marked by keratotic plugs that develop in hair follicles and eccrine ducts, penetrating the epidermis and extending down into the corium, causing foreign-body reaction and pain.

Lafora's disease  see under epilepsy.

Leber's disease 

1. Leber's hereditary optic neuropathy.

2. Leber's congenital amaurosis.

legionnaires' disease  an often fatal bacterial infection caused by Legionella pneumophila, not spread by person-to-person contact, characterized by high fever, gastrointestinal pain, headache, and pneumonia; there may also be involvement of the kidneys, liver, and nervous system.

Leiner's disease  a disorder of infancy characterized by generalized seborrhea-like dermatitis and erythroderma, severe intractable diarrhea, recurrent infections, and failure to thrive.

Leriche disease  post-traumatic osteoporosis.

Letterer-Siwe disease  a Langerhans cell histiocytosis of early childhood, of autosomal recessive inheritance, characterized by cutaneous lesions resembling seborrheic dermatitis, hemorrhagic tendency, hepatosplenomegaly, lymphadenitis, and progressive anemia. If untreated it is rapidly fatal. Called also acute disseminated Langerhans cell histiocytosis.

Libman-Sacks disease  see under endocarditis.

Lindau's disease , Lindau-von Hippel disease von Hippel-Lindau d.

Little's disease  congenital spastic stiffness of the limbs, a form of cerebral palsy due to lack of development of the pyramidal tracts.

Lobstein's disease  see osteogenesis imperfecta.

Lou Gehrig disease  amyotrophic lateral sclerosis.

Lowe disease  oculocerebrorenal syndrome.

Lutz-Splendore-Almeida disease  paracoccidioidomycosis.

Lyme disease  a recurrent multisystemic disorder caused by the spirochete Borrelia burgdorferi, the vectors being the ticks Ixodes scapularis and I. pacificus; usually initially characterized by lesions of erythema chronicum migrans, followed by various manifestations including arthritis of the large joints, myalgia, and neurologic and cardiac abnormalities.

lysosomal storage disease  an inborn error of metabolism with (1) a defect in a specific lysosomal enzyme; (2) intracellular accumulation of an unmetabolized substrate; (3) clinical progression affecting multiple tissues or organs; (4) considerable phenotypic variation within a disease.

MAC disease  complex d.

McArdle disease  glycogen storage d., type V.

mad cow disease  bovine spongiform encephalopathy.

Madelung's disease 

1. see under deformity.

2. see under neck.

maple bark disease  hypersensitivity pneumonitis in logging and sawmill workers due to inhalation of spores of a mold, Cryptostroma corticale, growing under the maple bark.

maple syrup urine disease  (MSUD) a hereditary enzyme defect in metabolism of branched chain amino acids, marked clinically by mental and physical retardation, severe ketoacidosis, feeding difficulties, and a characteristic maple syrup odor in the urine and on the body.

Marburg virus disease  a severe, often fatal, viral hemorrhagic fever first reported in Marburg, Germany, among laboratory workers exposed to African green monkeys.

Marchiafava-Micheli disease  paroxysmal nocturnal hemoglobinuria.

Marie-Bamberger disease  hypertrophic pulmonary osteoarthropathy.

Marie-Strümpell disease  ankylosing spondylitis.

Marie-Tooth disease  Charcot-Marie-Tooth d.

Mediterranean disease  thalassemia major.

medullary cystic disease  familial juvenile nephronophthisis.

Meniere's disease  deafness, tinnitus, and dizziness, in association with nonsuppurative disease of the labyrinth.

mental disease  see under disorder.

Merzbacher-Pelizaeus disease  Pelizaeus-Merzbacher d.

metabolic disease  one caused by a disruption of a normal metabolic pathway because of a genetically determined enzyme defect.

Meyer's disease  adenoid vegetations of the pharynx.

Mikulicz's disease  benign, self-limited lymphocytic infiltration and enlargement of the lacrimal and salivary glands of uncertain etiology.

Milroy disease  hereditary permanent lymphedema of the legs due to lymphatic obstruction.

Minamata disease  a severe neurologic disorder due to alkyl mercury poisoning, with permanent neurologic and mental disabilities or death; once prevalent among those eating contaminated seafood from Minamata Bay, Japan.

minimal change disease  subtle alterations in kidney function demonstrable by clinical albuminuria and the presence of lipid droplets in cells of the proximal tubules, seen primarily in young children.

mixed connective tissue disease  a combination of scleroderma, myositis, systemic lupus erythematosus, and rheumatoid arthritis, and marked serologically by the presence of antibody against extractable nuclear antigen.

Möbius disease  ophthalmoplegic migraine.

molecular disease  any disease in which the pathogenesis can be traced to a single molecule, usually a protein, which is either abnormal in structure or present in reduced amounts.

Mondor's disease  phlebitis affecting the large subcutaneous veins normally crossing the lateral chest wall and breast from the epigastric or hypochondriac region to the axilla.

Monge's disease  chronic mountain sickness.

Morquio's disease , Morquio-Ullrich disease see under syndrome.

motor neuron disease , motor system disease any disease of a motor neuron, including spinal muscular atrophy, progressive bulbar paralysis, amyotrophic lateral sclerosis, and lateral sclerosis.

Mycobacterium avium complex disease  MAC disease; systemic disease caused by infection with organisms of the Mycobacterium avium-intracellulare complex in patients with human immunodeficiency virus infection.

Newcastle disease  a viral disease of birds, including domestic fowl, transmissible to humans, characterized by respiratory, gastrointestinal or pulmonary, and encephalitic symptoms.

new variant Creutzfeldt-Jakob disease  (nvCJD) a variant of Creutzfeldt-Jakob disease having a younger age of onset than is seen in Creutzfeldt-Jakob disease, and caused by the same agent that causes bovine spongiform encephalopathy.

Nicolas-Favre disease  lymphogranuloma venereum.

Niemann's disease , Niemann-Pick disease a lysosomal storage disease due to sphingomyelin accumulation in the reticuloendothelial system; there are five types distinguished by age of onset, amount of central nervous system involvement, and degree of enzyme deficiency.

nil disease  minimal change d.

Norrie's disease  an X-linked disorder consisting of bilateral blindness from retinal malformation, mental retardation, and deafness.

notifiable disease  one required to be reported to federal, state, or local health officials when diagnosed, because of infectiousness, severity, or frequency of occurrence.

oasthouse urine disease  methionine malabsorption syndrome.

obstructive small airways disease  chronic bronchitis with irreversible narrowing of the bronchioles and small bronchi with hypoxia and often hypercapnia.

occupational disease  disease due to various factors involved in one's employment.

Oguchi's disease  a form of hereditary night blindness and fundus discoloration following light adaptation.

organic disease  one associated with demonstrable change in a bodily organ or tissue.

Osgood-Schlatter disease  osteochondrosis of the tuberosity of the tibia.

Osler's disease 

1. polycythemia vera.

2. hereditary hemorrhagic telangiectasia.

Owren's disease  parahemophilia.

Paget's disease 

1. (of bone) osteitis deformans.

2. (of breast) an intraductal inflammatory carcinoma of the breast, involving the areola and nipple.

3. an extramammary counterpart of Paget's disease (2), usually involving the vulva, and sometimes other sites, as the perianal and axillary regions.

Parkinson's disease  a slowly progressive form of parkinsonism, usually seen late in life, marked by masklike facies, tremor of resting muscles, slowing of voluntary movements, festinating gait, peculiar posture, muscular weakness, and sometimes excessive sweating and feelings of heat.

Parrot's disease  see under pseudoparalysis.

parrot disease  psittacosis.

Parry's disease  Graves' d.

Pelizaeus-Merzbacher disease  a progressive familial form of leukoencephalopathy, marked by nystagmus, ataxia, tremor, parkinsonian facies, dysarthria, and mental deterioration.

Pellegrini's disease , Pellegrini-Stieda disease calcification of the medial collateral ligament of the knee due to trauma.

pelvic inflammatory disease  (PID) any pelvic infection involving the upper female genital tract beyond the cervix.

periodontal disease  any disease or disorder of the periodontium.

Perthes' disease  osteochondrosis of capitular femoral epiphysis.

Peyronie's disease  induration of the corpora cavernosa of the penis, producing a painful fibrous chordee and penile curvature.

Pfeiffer's disease  infectious mononucleosis.

Pick's disease 

1. progressive atrophy of the cerebral convolutions in a limited area (lobe) of the brain, with clinical manifestations and course similar to Alzheimer's disease.

2. Niemann-Pick d.

polycystic kidney disease , polycystic disease of kidneys either of two unrelated heritable disorders marked by cysts in both kidneys: the autosomal dominant or adult form is more common, appears in adult life, and is marked by loss of renal function that can be either rapid or slow; the autosomal recessive or infantile form is more rare, may be congenital or may appear later in childhood, and almost always progresses to renal failure.

polycystic renal disease  polycystic kidney d..

Pompe's disease  glycogen storage d., type II.

Pott's disease  spinal tuberculosis.

primary electrical disease  serious ventricular tachycardia, and sometimes ventricular fibrillation, in the absence of recognizable structural heart disease.

prion disease  any of a group of fatal, transmissible neurodegenerative diseases, which may be sporadic, familial, or acquired, caused by abnormalities of prion protein metabolism resulting from mutations in the prion protein gene or from infection with pathogenic forms of the protein.

pulseless disease  Takayasu's arteritis.

Raynaud's disease  a primary or idiopathic vascular disorder, most often affecting women, marked by bilateral attacks of Raynaud's phenomenon.

Recklinghausen's disease 

1. neurofibromatosis.

2. (of bone) osteitis fibrosa cystica generalisata.

Refsum's disease  an inherited disorder of lipid metabolism, characterized by accumulation of phytanic acid, chronic polyneuritis, retinitis pigmentosa, cerebellar ataxia, and persistent elevation of protein in cerebrospinal fluid.

remnant removal disease  familial dysbetalipoproteinemia.

reversible obstructive airway disease  a condition characterized by bronchospasm reversible by intervention, as in asthma.

rheumatic heart disease  the most important manifestation and sequel to rheumatic fever, consisting chiefly of valvular deformities.

rheumatoid disease  a systemic condition best known by its articular involvement (rheumatoid arthritis) but emphasizing nonarticular changes, e.g., pulmonary interstitial fibrosis, pleural effusion, and lung nodules.

Ritter's disease  dermatitis exfoliativa neonatorum.

Roger's disease  a ventricular septal defect; the term is usually restricted to small, asymptomatic defects.

runt disease  a graft-versus-host disease produced by immunologically competent cells in a foreign host that is unable to reject them, resulting in gross retardation of host development and in death.

Salla disease  an inherited disorder of sialic acid metabolism characterized by accumulation of sialic acid in lysosomes and excretion in the urine, mental retardation, delayed motor development, and ataxia.

Sandhoff's disease  a type of GM2 gangliosidosis resembling Tay-Sachs disease, seen in non-Jews, marked by a progressively more rapid course, and due to a defect in hexosaminidase, both isozymes A and B.

Schamberg's disease  a slowly progressive purpuric and pigmentary disease of the skin affecting chiefly the shins, ankles, and dorsa of the feet.

Schilder's disease  subacute or chronic leukoencephalopathy in children and adolescents, similar to adrenoleukodystrophy; massive destruction of the white substance of the cerebral hemispheres leads to blindness, deafness, bilateral spasticity, and mental deterioration.

Schönlein's disease  see under purpura.

secondary disease 

1. one subsequent to or as a consequence of another disease.

2. one due to introduction of incompatible, immunologically competent cells into a host rendered incapable of rejecting them by heavy exposure to ionizing radiation.

self-limited disease  one that runs a limited and definite course.

serum disease  see under sickness.

severe combined immunodeficiency disease  (SCID) see under immunodeficiency .

sexually transmitted disease  venereal disease; any of a diverse group of infections transmitted by sexual contact; in some this is the only important mode of transmission, and in others transmission by nonsexual means is possible.

sickle cell disease  any disease associated with the presence of hemoglobin S.

Simmonds' disease  see panhypopituitarism.

sixth disease  exanthema subitum.

small airways disease  chronic obstructive bronchitis with irreversible narrowing of the bronchioles and small bronchi. See also obstructive small airways d.

Smith-Strang disease  methionine malabsorption syndrome.

Spielmeyer-Vogt disease  Vogt-Spielmeyer d.

Steinert's disease  myotonic dystrophy.

Still's disease  juvenile rheumatoid arthritis.

storage disease  a metabolic disorder in which a specific substance (a lipid, a protein, etc.) accumulates in certain cells in unusually large amounts.

storage pool disease  a blood coagulation disorder due to failure of the platelets to release adenosine diphosphate (ADP) in response to aggregating agents; characterized by mild bleeding episodes, prolonged bleeding time, and reduced aggregation response to collagen or thrombin.

Strümpell's disease 

1. hereditary lateral sclerosis with the spasticity mainly limited to the legs.

2. cerebral poliomyelitis.

Strümpell-Leichtenstern disease  hemorrhagic encephalitis.

Strümpell-Marie disease  ankylosing spondylitis.

Sutton's disease 

1. halo nevus.

2. periadenitis mucosa necrotica recurrens.

3. granuloma fissuratum.

Swift's disease , Swift-Feer disease acrodynia.

Takayasu's disease  see under arteritis .

Tangier disease  a familial disorder characterized by a deficiency of high-density lipoproteins in the blood serum, with storage of cholesteryl esters in tissues.

Tarui's disease  glycogen storage d., type VII.

Tay-Sachs disease  (TSD) the most common GM2 gangliosidosis, seen almost exclusively in northeastern European Jews, characterized by infantile onset, doll-like facies, cherry-red macular spot, early blindness, hyperacusis, macrocephaly, seizures, hypotonia, and death in early childhood.

Thomsen's disease  myotonia congenita.

thyrotoxic heart disease  heart disease associated with hyperthyroidism, marked by atrial fibrillation, cardiac enlargement, and congestive heart failure.

transmissible neurodegenerative disease  prion d..

trophoblastic disease  gestational trophoblastic neoplasia.

tsutsugamushi disease  scrub typhus.

tunnel disease  decompression sickness.

uremic bone disease  renal osteodystrophy.

venereal disease  sexually transmitted d.

venoocclusive disease of the liver  symptomatic occlusion of the small hepatic venules caused by ingestion of Senecio tea or related substances, by certain chemotherapy agents, or by radiation.

vinyl chloride disease  acro-osteolysis resulting from exposure to vinyl chloride, characterized by Raynaud's phenomenon and skin and bony changes on the limbs.

Vogt-Spielmeyer disease  the juvenile form of neuronal ceroid lipofuscinosis with onset between ages 5 and 10 years; characterized by rapid cerebroretinal degeneration, excessive neuronal storage of lipofuscin, and death within 10 to15 years.

Volkmann's disease  congenital deformity of the foot due to tibiotarsal dislocation.

von Hippel's disease  hemangiomatosis confined principally to the retina; when associated with hemangioblastoma of the cerebellum, it is known as von Hippel-Lindau d.

von Hippel-Lindau disease  a hereditary condition marked by hemangiomas of the retina and hemangioblastomas of the cerebellum, sometimes with similar lesions of the spinal cord and cysts of the viscera; there may be neurologic symptoms such as seizures and mental retardation.

von Willebrand's disease  an autosomal dominant bleeding disorder characterized by prolonged bleeding time, deficiency of von Willebrand's factor, and often impairment of adhesion of platelets on glass beads, associated with epistaxis and increased bleeding after trauma or surgery, menorrhagia, and postpartum bleeding.

Waldenström's disease  osteochondrosis of the capitular femoral epiphysis.

Weber-Christian disease  nodular nonsuppurative panniculitis.

Werlhof's disease  idiopathic thrombocytopenic purpura.

Wernicke's disease  see under encephalopathy.

Westphal-Strümpell disease  hepatolenticular degeneration.

Whipple's disease  a malabsorption syndrome marked by diarrhea, steatorrhea, skin pigmentation, arthralgia and arthritis, lymphadenopathy, central nervous system lesions, and infiltration of the intestinal mucosa with macrophages containing PAS-positive material.

Whitmore's disease  melioidosis.

Wilson's disease  an inherited, progressive disorder of copper metabolism, with accumulation of copper in liver, brain, kidney, cornea, and other tissues; it is characterized by cirrhosis in the liver, degenerative changes in the brain, and a pigmented ring at the outer margin of the cornea.

Wolman's disease  a lysosomal storage disease due to deficiency of the lysosomal sterol esterase, occurring in infants, and associated with hepatosplenomegaly, adrenal steatorrhea, calcification, abdominal distention, anemia, and inanition.

woolsorter's disease  inhalational anthrax.

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Lyme disease

n.

An inflammatory disease caused by the spirochete Borrelia burgdorferi transmitted by ticks and characterized initially by a rash followed by flulike symptoms including fever, joint pain, and headache; if untreated, it can result in chronic arthritis and nerve and heart dysfunction.

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Lyme disease

[līm]

Etymology: Lyme, Connecticut, where originally described

an infection caused by the spirochete, Borrelia burgdorferi, transmitted by the bite of infected Ixodes ticks (which are far smaller than dog ticks). In the northeast and north-central United States, the ticks normally feed on the white-footed mouse, the white-tailed deer, or other mammals and birds. Ticks are most likely to spread infection after 2 or more days of feeding. Most commonly, nymph ticks spread the disease because they are smaller than 2 mm in size and are rarely noticed. In contrast, the larger adult ticks are more likely to be found and removed before they have transmitted infection. See also erythema migrans.

observations The disease first manifests itself as a red skin macule or papule at the bite site with accompanying flulike symptoms, such as headache, fever, chills, muscle aches, and fatigue. These are often missed or ignored by the individual. In about 50% of cases, other lesions develop soon after onset. Lymphadenopathy, neck pains, and hepatosplenomegaly are also often present in early disease. After weeks or months, neurologic abnormalities such as meningitis, meningoencephalitis, neuritis, and radiculopathies appear in about 15% of all cases. Myocardial abnormalities such as atrioventricular block, myopericarditis, and cardiomegaly occur in 8% of cases. Joint inflammation, pain, and arthritis develop in 50% of cases as long as 2 years after transmission. Diagnosis is made through clinical examination with evidence of characteristic lesions and a positive enzyme-linked immunosorbent assay (ELISA). Cultures and biopsy of skin lesions and PCR testing of blood gives a definitive diagnosis. However, the lab tests are available only at reference laboratories.

interventions Current treatment centers around the use of oral or intravenous antibiotics. A single dose of doxycycline within 72 hours of an Ixodes tick bite will prevent development of disease.

nursing considerations Nursing for acute disease is focused on rest and monitoring for complications. Education about preventive practices in endemic areas is needed and includes instruction to wear appropriate clothing (long pants tucked in boots) in wooded or grassy areas; use of bug repellent with DEET; keeping grass mowed; keeping woodpiles away from foot-traffic areas and the house; treating pets with tick and flea repellent and keeping pets off furniture; removal of ticks with tweezers; and thorough washing and application of antiseptic to any tick bite. Education is needed about the identification of the Ixodes tick and instruction to seek immediate treatment for any Ixodes tick bite or bull's-eye-like rash.

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Lyme disease,

n.pr an acute, recurrent inflammatory infection transmitted by a tick-borne spirochete,
B. burgdorferi. Knees, other large joints, and temporomandibular joints are most commonly involved, with local inflammation and swelling. Chills, fever, headache, malaise, and erythema chronicum migrans (ECM), which is an expanding annular, erythematous skin eruption, often precede the joint manifestations.

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Lyme disease

an acute, often recurrent, polyarthritis of dogs and humans caused by the spirochete Borrelia burgdorferi, and transmitted by the tick Ixodes dammini. The disease is endemic in the northeast and certain other areas of the United States.

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Lyme disease

Lyme borreliosis, Primary lyme disease Infectious disease An infection by Borrelia burgdorferi, possibly mediated by IL-1 Epidemiology 8000 cases were reported in 1993–US, making it the most common zoonosis in the US; B burgdorferi has been identified in Northern Europe, Australia Vectors Deer tick–Ixodes dammini, Eastern USA, up to 60% of which carry the spirochete, white-footed mouse tick–I pacificus, Western US, ±1% carry the organism, wood tick–I ricinus, Europe, Lone Star tick–Amblyomma americanum, and rarely deerflies and horseflies Host Deer mice, field mice Lab Nonspecific findings include ↑ ESR, IgM cryoglobulins, ↓ C3 and C4, ↑ IgG and IgM antibody titers to B burgdorferi; definitive diagnosis requires identification of IgG antibodies to B recurrentis by the 'Western'–immunoblot Prognosis 60% of untreated subjects develop recurring arthritis–chronic Lyme arthritis lasting up to yrs after infection Serology may be positive in Pts who are also infected with Ehrlichia spp, which may be due to a co-infection with the same tick bite; PCR for human granulocytic ehrlichiosis is required to confirm the latter infection Treatment 1 month of doxycycline or amoxicillin or 2 wks of IV ceftriaxone or penicillin Vaccine OspA vaccine. See Chronic Lyme disease.

Lyme disease stages

Stage I Erythema chronicum migrans Rash stage, associated with wood tick bites and confined to Northern Europe until 1970 when the first US cases were described, presenting as a solitary reddish papule and plaque with centrifugal expansion–up to 20 cm, peripheral induration and central clearing, persisting for months to years; potentially pruritic with IgM and C3 deposition in vessels

Stage II Cardiovascular–myocarditis, pericarditis, transient atrioventricular block, ventricular dysfunction; neurologic–Bell's palsy, meningoencephalitis, optic atrophy, polyneuritis symptoms

Stage III Migratory polyarthritis Lyme disease may be accompanied by headache, stiff neck, fever, and malaise that is subsequently manifest as migratory polyarthritis, intermittent oligoarthritis, chronic arthritis of the knees, chronic meningoencephalitis, cranial or peripheral neuropathy, migratory musculoskeletal pains, cardiac abnormalities

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Patient discussion about Lyme disease.

Q. I need a Lyme LIterate Doctor in MA Moving to MA - son has chronic Lyme

A. Hi! Where are you moving to? I'm here in Boston with early Lyme that I hope is not going chronic (the treatment I've taken so far is only suppressing it, and it comes back if I stop antibiotics).

Apparently there is a Dr. Sam Donta who works in Falmouth and Boston: 508-539-6666. But he is pretty busy.

Q. What to do for early Lyme that's not responding to treatment? I came down with Lyme disease three months ago with a bulls-eye rash. Even though it was supposedly a recent case, I already was having Bell's palsy, memory loss, trouble thinking of words, joint arthritis, severe bone pain, and fatigue. I took 100mg doxycycline 2x a day, as my doctor prescribed, for 3 weeks, but still felt bad, so I took it for 3 more weeks. When I stopped after 6 weeks, all my symptoms came back and I kept getting worse. I finally convinced my doctors to give me a refill, and I've been taking the same prescription since then. Any time when I'm late on a dose or eat something with magnesium, I get very sick again. I'm not getting better, I'm merely suppressing the Lyme disease, and it comes back whenever I stop the antibiotics. What can I do to actually get rid of it? Higher dose doxycycline? Another antibiotic? Two antibiotics at once? IV antibiotics? Supplements? (I'm biased against this, but) Rife machines?

A. I did test positive for Lyme disease on the ELISA test.

I think it is just disseminated (I've been having Bell's palsy), so maybe I need 400mg doxy/day (200mg 2x a day) in order to reach the proper concentrations to inhibit B. burgdorferi in the CSF.

Q. lyme disease, how long do the effects last? How often do they come back? What helps?

A. Lyme disease affects different areas of the body in varying degrees as it progresses. The site where the tick bites the body is where the bacteria enter through the skin. Initially, the disease affects the skin, causing an expanding reddish rash often associated with "flu-like" symptoms. Later, it can produce abnormalities in the joints, heart, and nervous system. Lyme disease is medically described in three phases as: (1) early localized disease with skin inflammation; (2) early disseminated disease with heart and nervous system involvement, including palsies and meningitis; and (3) late disease featuring motor and sensory nerve damage and brain inflammation and arthritis. It takes weeks to months after the initial redness of the skin for its effects to spread throughout the body. Lyme disease can be treated with antibiotics. Lyme disease can be prevented by using tick avoidance techniques.
http://www.medicinenet.com/lyme_disease/index.htm
Hope this helps.