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Causes and symptoms
Early localized lyme disease
Late disseminated disease and chronic lyme disease
- 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.
Update on vaccination
Minimizing risk of exposure
- 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.
Minimizing risk of disease
- 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.
Lyme dis·easeAvoid the incorrect phrase Lyme's disease.
About 18,000 cases of Lyme disease are confirmed annually in the U.S. The largest proportion of cases occur in people aged 5-9 years and 50-59 years. States with the highest incidence are Connecticut, Rhode Island, and New Jersey. Lyme disease is generally benign and self-limited even without treatment. Antibody studies in endemic areas suggest that as many as 50% of people who contract the infection never show symptoms. The case fatality rate is virtually zero. The diagnosis is essentially clinical. Serologic tests for antibody to Borellia burgdorferi are notoriously poor in both sensitivity and specificity. In nonendemic areas, false positive test results statistically outnumber true positives. Because IgM antibody appears and peaks relatively late, one half of patients are seronegative during the first month following appearance of the rash. Antibiotic treatment administered early can alter or prevent the expected acute immune response. IgG antibody persists for months or years after infection and hence affords no help in diagnosing acute disease. Given the nonspecific and variable clinical picture and the unreliability of laboratory diagnostic measures, it is inevitable that many cases of Lyme disease are missed, and that, conversely, the diagnosis is often wrongly made. The drug of choice is doxycycline administered orally for several weeks. Amoxicillin is the standard alternative for children and pregnant patients. Recovery does not confer immunity to future attacks. In fact, in highly endemic areas, the reinfection rate may be as high as 20%. Infectious disease authorities do not recommend antibiotic prophylaxis after a tick bite, even in endemic areas, nor do they countenance treatment of asymptomatic people who have serologic evidence of past infection. A vaccine consisting of lipidated outer surface protein A (OspA) of B. burgdorferi synthesized by a nonvirulent strain of recombinant Escherichia coli induces formation of antibody that enters a feeding tick and binds any spirochetes present, preventing their mobilization. However, because of low demand the vaccine was withdrawn from the market by the manufacturer in 2002.
Lyme diseaseAn infection by Borrelia burgdorferi, acquired from tick bites. Lyme disease symptoms may resemble an anxiety disorder and include fatigue, concentration difficulties and/or joint pain; the clinical findings may be mediated by IL-1.
25–30,000 cases occurred in the US in 2010, making it the most common zoonosis in the US, especially along the Eastern seaboard; B burgdorferi has also been found in Northern Europe and Australia.
Deer tick (Ixodes dammini), Eastern USA—up to 60% carry the spirochete; white-footed mouse tick (I pacificus), Western US—±1% carry the spirochete; wood tick (I ricinus), Europe; Lone Star tick (Amblyomma americanum); and rarely in deerflies and horseflies.
Deer mice, field mice.
Nonspecific findings include increased ESR, IgM cryoglobulins, decreased C3 and C4, increased IgG and IgM antibody titers to B burgdorferi; definitive diagnosis requires identification of IgG antibodies to B recurrentis by the “Western” tick (immunoblot).
60% of untreated subjects develop recurring arthritis—chronic Lyme arthritis—lasting up to years after infection.
May be positive in patients 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.
1 month of doxycycline or amoxicillin or 2 weeks of IV ceftriaxone or penicillin.
Osp A vaccine.
Lyme disease stages
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, persistis for months to years; potentially pruritic with IgM and C3 deposition in vessels; first described in 1910 by Afzelius.
Cardiovascular–myocarditis, pericarditis, transient atrioventricular block, ventricular dysfunction; neurologic—Bell’s palsy, meningoencephalitis, optic atrophy, polyneuritis symptoms.
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 or cardiac abnormalities.
Lyme diseaseLyme 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 dis·ease(līm di-zēz')
Lyme disease(līm) [ Lyme, CT, where a cluster of cases was reported in 1975],
The infected tick injects its spirochete-laden saliva into the bloodstream, where they incubate for 3 to 32 days and then migrate to the skin, causing the characteristic erythema migrans (EM) rash.
The disease is best diagnosed by the presence of EM, which begins as a red macule or papule at the site of the tick bite and expands in a red ring, leaving a clear center like a target or bull’s eye. The lesion usually feels hot and itchy and may grow to over 20 in (50.8 cm) as more lesions erupt. The lesion is later replaced by red blotches or diffuse urticaria. Conjunctivitis, malaise, fatigue, and flulike symptoms and lymphadenopathy may occur. Antibody tests for Borrelia burgdorferi with an enzyme-linked immunosorbent assay (ELISA) test are also used for diagnosis in patients with a history of exposure and signs and symptoms of Lyme disease but with no evidence of rash. The antibodies are developed against flagellar and outer surface proteins on the spirochete. See: illustration
The course of Lyme disease is divided into three stages. 1 localized infection: begins with the tick bite and proceeds as above.2 disseminated infection: begins weeks to months later. The spirochetes spread to the rest of the body through the blood, in some cases causing arthritis (esp. of the knee joints), muscle pain, cardiac dysrhythmias, pericarditis, lymphadenopathy, or meningoencephalitis. Nonprotective antibodies develop during this stage.3 chronic infection: begins weeks to years after the initial bite. Patients develop mild to severe arthritis, encephalitis, or both, which rarely are fatal.
Oral doxycycline or ampicillin (14–21 or –28 day course) effectively eradicates early uncomplicated Lyme disease. Erythromycin or cefuroxime axetil may be administered to patients allergic to penicillin. Patients with cardiac and neurological involvement may need to be treated with intravenous cephalosporins.
When the disease is treated early, results are good. If treated late, convalescence is prolonged, but complete recovery is the usual outcome in most patients.
The Centers for Disease Control recommends that people should discuss with their health care providers the possibility of getting a Lyme disease vaccination if they are between 15 and 70 years old; live, work, or vacation in endemic areas; or frequently go into wooded or grassy areas. The vaccine is not recommended for children, pregnant women, and those who do not live in or visit endemic areas.
When planning to spend time in places where ticks may be located, people should wear clothing impregnated with insect repellents, hats, long sleeves, pants tucked into socks, heavy shoes, and a tick repellent containing DEET (N, N-diethyltoluamide). Tick repellent should not be directly applied to an infant or toddler’s skin because of the danger of neurotoxicity. If possible, people should stay on paths and away from high grass or brush. They should check clothing carefully for ticks when leaving those areas although tick nymphs, which are smaller than 1 mm in length, may not be easily seen. Once home, people should remove and wash clothing and check their entire body, esp. the hairline and ankles, for ticks or nymphs. If a tick or nymph is found, it should be carefully removed with tweezers, esp. the head and mouth parts, but the body of the tick or nymph must not be squeezed. The site may then be cleansed with an antiseptic, but should be observed for signs of infection (redness, swelling, pain, rash), and the primary health care provider contacted if infection is suspected. Some people make the mistake of trying to remove ticks or nymphs with alcohol, a lighted match, or petroleum jelly. These measures are ineffective and may increase the risk of transmission of tick-borne diseases. Prophylactic antibiotics generally should not be requested (or given). Although pet dogs may receive Lyme vaccine, they should still be checked to prevent them from bringing ticks into the house.
The patient is checked for any drug allergies. Prescribed pharmacologic therapy is explained to the patient, including dosing schedule, the importance of completing the course of therapy even if he feels better, and adverse effects. Patients being treated for Lyme disease often require antibiotics for a prolonged period, esp. in advanced stages, which increases their risk for developing adverse effects (e.g., diarrhea). Methods for dealing with these problems are explained. Patients with chronic Lyme disease often require assistance to deal with changes in lifestyle, family interactions, and ability to perform daily activities. Available local and national support groups can assist with such problems. Patients should be made aware that one occurrence of Lyme disease does not prevent recurrences. The U.S. Department of Health and Human Services has made Lyme disease prevention a priority under its program “Healthy People 2010.” Patients can be referred to the Lyme Disease Foundation (860-870-0070; http://www.lyme.org) or the American Lyme Disease Foundation (http://www.aldf.com) for information and support.
Lyme diseaseA disease caused by the spiral organism (spirochaete) Borrelia burgdorferi , and transmitted by the bite of the tick Ixodes dammini . A slightly itchy red spot appears, within a month at the site of the mite bite. This expands to form a ring. Up to 100 other similar spots may soon appear and there is fever, fatigue, headaches, stiff neck, muscle and joint pain and enlarged lymph nodes. The Borrelia organism can affect almost every organ of the body. Several weeks or months after onset, up to 15 per cent of affected people develop nervous system complications such as MENINGITIS, ENCEPHALITIS, nerve paralysis, muscle weakness or shingles-like pain in the skin. Some develop mental illness and others have a profound fatigue and weakness that may last for months or years. The joints are affected in at least half the cases, usually intermittently and mildly, but sometimes severely with joint damage similar to mild RHEUMATOID ARTHRITIS. Heart involvement occurs in about 8%, usually HEART BLOCK but also heart enlargement and inflammation of the heart capsule (PERICARDITIS). Lyme disease can be passed from a mother to her unborn baby, and Borrelia have been found in children with severe congenital defects. If the early skin pattern is recognized and treatment with antibiotics given, all these complications are avoided. Lyme disease was first reported among the inhabitants of Old Lyme, Connecticut, in l975, but is now occurring in Britain and in many other parts of the world.
Lyme,city in Connecticut where disease was first recognized.
Lyme dis·ease(līm di-zēz')
Patient discussion about Lyme disease
Q. what is lyme disease my dog can't seem to get rid of it - anything other than antibiotics for treatment?
Q. lyme disease, how long do the effects last? How often do they come back? What helps?
Hope this helps.
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?
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.