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Lyme Disease

Lyme Borreliosis

Lyme disease is a form of tick–borne illness first recognized in the year 1975. The disease is more prevalent in North America and Europe [1].


Presentation

In the preliminary stages, Lyme disease manifests as skin rashes and flu like symptoms. When the individual is first bitten by ixodid tick, a small red bump may develop in the affected area. After few days, the red bump expands to a larger area resembling “bull’s eye pattern”. Such a kind of rash is known as erythema migrans [8]. Many individuals develop multiple lesions which is also a major characteristic of Lyme disease. In addition to rash, affected individuals would also experience fever, body ache, fatigue and headache.

In the later stages, as the disease progresses, individuals complain of joint pain and neurological problems set in. Neurological conditions such as Bell’s palsy, meningitis, weakness of one or both limbs and impaired muscular movements are some of the grave problems experienced.

Some of the less common signs and symptoms of Lyme disease include inflammation of the liver and eyes, development of cardiac problems and extreme fatigue.

Fever
  • We present a 49-year-old man with subacute onset of fever, weakness, shortness of breath, unilateral lower extremity oedema and pancytopenia who was found to have positive serology for Lyme disease.[ncbi.nlm.nih.gov]
  • Individuals affected with this disease often present with arthritis, fever, rashes, conjunctivitis and many other debilitating conditions.[symptoma.com]
  • Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen.[ncbi.nlm.nih.gov]
  • All cases presented with typical erythema migraines, fever and fatigue. The serological findings were positive for Borrelia burgdorferi, for 3 cases.[ncbi.nlm.nih.gov]
  • In 2007, at around age 19 years, I had an acute onset of sore throat, tonsillitis, low-grade fever, stiff upper back and neck muscles, migraines and severely stiff, cracking jaw joints.[ncbi.nlm.nih.gov]
Fatigue
  • This common disorder of women, frequently, but not always causing pelvic pain, can present simply as chronic fatigue.[ncbi.nlm.nih.gov]
  • All cases presented with typical erythema migraines, fever and fatigue. The serological findings were positive for Borrelia burgdorferi, for 3 cases.[ncbi.nlm.nih.gov]
  • Prior to antibiotic treatment, patients experience notable symptoms of fatigue and pain statistically higher than controls.[ncbi.nlm.nih.gov]
  • Some patients with a history of Borrelia burgdorferi infection develop a chronic symptomatology characterized by cognitive deficits, fatigue, and pain, despite antibiotic treatment.[ncbi.nlm.nih.gov]
  • She returned to school and church participation with minimal total body tremor when fatigued and daily pain rated 0 to 3/10.[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • To show that chronic fatigue syndrome can be mistakenly attributed to Lyme disease rather than considering sympathetic neural hyperalgesia edema syndrome.[ncbi.nlm.nih.gov]
  • We concluded that women with endometriosis are more likely to have chronic fatigue syndrome, systemic lupus erythematous, Sjögren's syndrome, rheumatoid arthritis, multiple sclerosis, and other autoimmune inflammatory and endocrine diseases.[ncbi.nlm.nih.gov]
  • Fatigue Syndrome, Weakness, peripheral neuropathy or partial paralysis Pressure in the head Numbness in body, tingling, pinpricks Poor balance, dizziness, difficulty walking Increased motion sickness Lightheadedness, wooziness Mood swings, irritability[ticktalkireland.org]
  • Fatigue Syndrome, weakness, peripheral neuropathy or partial paralysis Pressure in the head Numbness in body, tingling, pinpricks Poor balance, dizziness, difficulty walking Increased motion sickness Light-headedness, wooziness Psychological Well-being[canlyme.com]
  • The medical profession’s nickname for Lyme Disease is the Great Imitator, because symptoms mimic hundreds of other conditions including Multiple Sclerosis, Chronic Fatigue Syndrome, Epstein-Barr virus, and rheumatoid arthritis.[lyme-disease-research-database.com]
Difficulty Walking
  • walking Increased motion sickness Lightheadedness, wooziness Mood swings, irritability, bi-polar disorder Unusual depression Disorientation (getting or feeling lost) Feeling as if you are losing your mind Over-emotional reactions, crying easily Too much[ticktalkireland.org]
  • walking Increased motion sickness Light-headedness, wooziness Psychological Well-being Mood swings, irritability, bi-polar disorder Unusual depression Disorientation (getting or feeling lost) Feeling as if you are losing your mind Over-emotional reactions[canlyme.com]
  • walking Increased motion sickness Lightheadedness, wooziness Seizures - often 'atypical' Mood swings, irritability, bi-polar disorder Unusual depression Disorientation (getting or feeling lost) Feeling as if you are losing your mind Over-emotional reactions[lymedisease.org.au]
Malaise
  • Here, we report a 63-year-old American man living in Japan who presented with malaise, headache, myalgia, and arthralgia. We suspected Lyme disease because of his travel history to Minnesota and presence of erythema migrans.[ncbi.nlm.nih.gov]
  • From 90 days before the diagnosis, malaise and fatigue (OR, 1.7; 95% CI, 1.1-2.6; p   0.05), other nervous system disorders (OR, 2.0; 95% CI, 1.3-3.1; p   0.01), and nontraumatic joint disorder (OR, 1.4; 95% CI, 1.0-2.0; p   0.05) were more likely found[ncbi.nlm.nih.gov]
Skin Lesion
  • The aim of the study is to present a patient with skin lesions and histopathological features of palisaded neutrophilic and granulomatous dermatitis during the course of infection Borrelia burgdorferi.[ncbi.nlm.nih.gov]
  • Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions.[ncbi.nlm.nih.gov]
  • Early skin lesions have an expanding ring form, often with a central clear zone. Fever, chills, myalgia and headache are common. Meningeal involvement may follow.[who.int]
  • Symptoms include severe headaches, meningitis, swollen joints, skin lesions, heart palpitations, dizziness, persistent fatigue, sleep disturbance, as well as loss of muscle tone in the face (Bell's palsy).[iamat.org]
  • The acute Lyme disease clinic at Green Spring Station offers urgent appointments for patients with active skin lesions of acute Lyme disease. Appointments for the Rash Consult Service can be made by calling 410-616-7596.[hopkinsrheumatology.org]
Arthritis
  • A 71-year-old woman presented to a rheumatologist with what she believed to be a 2-year history of Lyme disease, progressing from erythema migrans to Lyme arthritis.[ncbi.nlm.nih.gov]
  • Palisaded neutrophilic and granulomatous dermatitis (PNGD) are terms which include such diseases as rheumatoid nodules, Churg-Strauss granuloma, and interstitial granulomatous dermatitis with arthritis.[ncbi.nlm.nih.gov]
  • The manifestations of Lyme disease include erythema migrans (EM), arthritis, neuroborrelliosis (NB), and others.[ncbi.nlm.nih.gov]
  • We concluded that women with endometriosis are more likely to have chronic fatigue syndrome, systemic lupus erythematous, Sjögren's syndrome, rheumatoid arthritis, multiple sclerosis, and other autoimmune inflammatory and endocrine diseases.[ncbi.nlm.nih.gov]
  • What is the prognosis for Late Lyme Arthritis? Following antibiotic therapy, approximately 90% of late Lyme arthritis patients recover from extensive joint swelling, arthritis, and pain.[hopkinsarthritis.org]
Myalgia
  • Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen.[ncbi.nlm.nih.gov]
  • Here, we report a 63-year-old American man living in Japan who presented with malaise, headache, myalgia, and arthralgia. We suspected Lyme disease because of his travel history to Minnesota and presence of erythema migrans.[ncbi.nlm.nih.gov]
  • A young, previously healthy patient had been hiking in the woods of upstate New York and 4 weeks later developed fever, night sweats, and myalgias.[ncbi.nlm.nih.gov]
  • Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive[ncbi.nlm.nih.gov]
  • Fever, chills, myalgia and headache are common. Meningeal involvement may follow. Central nervous system and other complications may occur weeks or months after the onset of illness. Arthritis may develop up to 2 years after onset.[who.int]
Arthralgia
  • In a second case, a 40-year-old male, with a previously known microscopic hematuria, presented with rash, arthralgias, new proteinuria and gross hematuria following a tick bite. Biopsy revealed focal proliferative IgA nephropathy.[ncbi.nlm.nih.gov]
  • Here, we report a 63-year-old American man living in Japan who presented with malaise, headache, myalgia, and arthralgia. We suspected Lyme disease because of his travel history to Minnesota and presence of erythema migrans.[ncbi.nlm.nih.gov]
  • Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive[ncbi.nlm.nih.gov]
  • […] condition, the term ‘Lyme-like illness’ is applied to a variety of illnesses which range from an acute illness with headache, fever and fatigue which lasts weeks or months to a non-specific chronic illness with symptoms such as headache, myalgia, and arthralgia[health.nsw.gov.au]
  • This manifests as an increase in fever and/or myalgia and arthralgia 24–48 hours after antimicrobial treatment is begun. The reaction is self-limited and usually resolves in 24–48 hours.[clinicaladvisor.com]
Knee Pain
  • Knee pain may be a symptom of advanced Lyme disease. Image Source: Image reprinted with permission from eMedicine.com, 2008. (left), CDC / James Gathany (right) Text Reference: "Lyme Disease." Centers for Disease Control and Prevention.[emedicinehealth.com]
Headache
  • Special attention should be paid to patients with headaches who have traveled to endemic areas.[ncbi.nlm.nih.gov]
  • A 46-year-old man presented with recurrent left hemiparesis and headache.[ncbi.nlm.nih.gov]
  • He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity.[ncbi.nlm.nih.gov]
  • Here, we report a 63-year-old American man living in Japan who presented with malaise, headache, myalgia, and arthralgia. We suspected Lyme disease because of his travel history to Minnesota and presence of erythema migrans.[ncbi.nlm.nih.gov]
  • Other symptoms include joint pain, neurological problems, fever, fatigue, headache and muscle aches. Diagnosis Diagnosis of Lyme disease gets difficult as the symptoms often mimic other disease conditions.[symptoma.com]
Confusion
  • BLDLI diagnosis requires additional attention by physicians, since the disease has a tendency to progress to the late, recurrent stage or the chronic form, and the associated headache can be confused with chronic primary headache or with analgesic-overuse[ncbi.nlm.nih.gov]
  • This, however, can be confused with other illnesses including southern tick-associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is coprevalent with Lyme disease in portions of the eastern[ncbi.nlm.nih.gov]
  • (getting or feeling lost) Feeling as if you are losing your mind Over-emotional reactions, crying easily Too much sleep, or insomnia Difficulty falling or staying asleep Narcolepsy, sleep apnea Panic attacks, anxiety Memory loss (short or long term) Confusion[ticktalkireland.org]
  • […] feeling lost) Feeling as if you are losing your mind Over-emotional reactions, crying easily Too much sleep, or insomnia Difficulty falling or staying asleep Narcolepsy, sleep apnea Panic attacks, anxiety Mental Capability Memory loss (short or long term) Confusion[canlyme.com]
  • Because of the somewhat confusing permissive recommendation, the Lyme disease vaccine did not reach as many individuals as it otherwise might have.[historyofvaccines.org]
Peripheral Neuropathy
  • neuropathy or partial paralysis Pressure in the head Numbness in body, tingling, pinpricks Poor balance, dizziness, difficulty walking Increased motion sickness Lightheadedness, wooziness Mood swings, irritability, bi-polar disorder Unusual depression[ticktalkireland.org]
  • neuropathy or partial paralysis Pressure in the head Numbness in body, tingling, pinpricks Poor balance, dizziness, difficulty walking Increased motion sickness Light-headedness, wooziness Psychological Well-being Mood swings, irritability, bi-polar[canlyme.com]
  • neuropathy or partial paralysis Pressure in the head Numbness in body, tingling, pinpricks Poor balance, dizziness, difficulty walking Increased motion sickness Lightheadedness, wooziness Seizures - often 'atypical' Mood swings, irritability, bi-polar[lymedisease.org.au]
  • The nervous system signs can include facial muscle paralysis ( Bell's palsy ), abnormal sensation due to disease of peripheral nerves ( peripheral neuropathy ), meningitis , and confusion .[medicinenet.com]
Tremor
  • She returned to school and church participation with minimal total body tremor when fatigued and daily pain rated 0 to 3/10.[ncbi.nlm.nih.gov]
  • […] back, neck, tennis elbow Muscle pain or cramps, (Fibromyalgia) Shortness of breath, can't get full/satisfying breath, cough Chest pain or rib soreness Night sweats or unexplained chills Heart palpitations or extra beats Endocarditis, Heart blockage Tremors[ticktalkireland.org]
  • Fibromyalgia) Respiratory and Circulatory Systems Shortness of breath, can’t get full/satisfying breath, cough Chest pain or rib soreness Night sweats or unexplained chills Heart palpitations or extra beats Endocarditis, heart blockage Neurologic System Tremors[canlyme.com]
  • , back, neck, tennis elbow Muscle pain or cramps (fibromyalgia) Shortness of breath, can't get full/satisfying breath, cough Chest pain or rib soreness Night sweats or unexplained chills Heart palpitations or extra beats Endocarditis, heart blockage Tremors[lymedisease.org.au]
Difficulty Concentrating
  • These can include pain and swelling in the joints - inflammatory arthritis, problems affecting the nervous system such as numbness and pain in limbs, paralysis of facial muscles, memory problems and difficulty concentrating.[express.co.uk]
  • If left untreated, Lyme disease sufferers can develop much more serious symptoms including: Serious joint pain Nervous system pain which can lead to paralysis of facial muscles, memory problems and difficulties concentrating Heart problems, such as inflammation[thesun.co.uk]
  • This stage is characterized by: severe headaches arthritis of one or more large joints disturbances in heart rhythm brain disorders ( encephalopathy ) involving memory, mood, and sleep short-term memory loss difficulty concentrating mental fogginess problems[healthline.com]

Workup

Signs and symptoms of Lyme disease often mimic other disease conditions and therefore the disease is sometimes also referred to as “The great imitator”. The following are the diagnostic procedures employed to detect Lyme disease:

  • ELISA test is carried out to detect the antibodies to the bacterium. However, this test can sometimes provide false positive results and is also not useful in the initial stages of the disease [9].
  • Western blot test is done for confirming the presence of Lyme disease.
  • The polymerase chain reaction (PCR) test involves testing of the bacterial DNA from the fluid that is obtained from the joint of the affected individual.
Borrelia Burgdorferi
  • Some patients with a history of Borrelia burgdorferi infection develop a chronic symptomatology characterized by cognitive deficits, fatigue, and pain, despite antibiotic treatment.[ncbi.nlm.nih.gov]
  • The primary etiological agent in North America is Borrelia burgdorferi sensu stricto.[ncbi.nlm.nih.gov]
  • Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases.[ncbi.nlm.nih.gov]
  • Lyme disease is caused by the bacterium Borrelia burgdorferi. It is transmitted to humans when they are bitten by ixodid ticks.[symptoma.com]
  • Lyme disease is a vector-borne multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi sensu lato. This disease is frequently seen in North America and to a lesser degree in Europe.[ncbi.nlm.nih.gov]
HLA-DR2
  • Association of chronic Lyme arthritis with HLA-DR4 and HLA-DR2 alleles. N. Engl. J. Med . 1990;323, 219-223. To read PDFs, download and install Adobe Reader . Last update 5 May 2018[historyofvaccines.org]

Treatment

Lyme disease can be successfully treated when the disease has been diagnosed in the initial stages. Antibiotics are the only way by which the disease can be treated. These are administered either orally or through the intravenous route depending on the condition of the patient. For oral antibiotics, the course duration is as long as 14 – 21 days depending on the severity of the condition [10] [11]. When administered through the intravenous route, the course duration is about 14 – 28 days. However, some studies have postulated that antibiotics given for 10 – 14 days are equally effective.

Prognosis

The prognosis of Lyme disease is usually favorable as the condition can be successfully treated with prompt initiation of strong antibiotic regime. Failure to initiate early treatment can pave way for several unpleasant complications to set in [7].

Etiology

Lyme disease occurs due to tick bites that are infected by the bacteria known as Borrelia burgdorferi. The disease manifests itself in 2 stages namely the initial stage and the late or the chronic stage [3]. For an infection to occur, the bacterium must gain entry into the human body which is achieved through infected ixodid ticks. The ticks appear so small that it is almost impossible to spot them with naked eye. Once the bacterium gains entry, it spreads through the blood affecting various body organs and systems.

Epidemiology

Lyme disease commonly affects individuals of North America and Europe. In the year 2013, it was ranked as the 5th most common nationally identifiable disease. It has been estimated that each year in the United States, as high as 30,000 cases of the disease are reported. In the year 2011 alone, the disease struck about 33,097 individuals of the United States [4].

Sex distribution
Age distribution

Pathophysiology

For an individual to develop Lyme disease, he or she should have been bitten by ixodid ticks infected by bacterium Borrelia burgdorferi. Once the bacterium gains entry into the body it spreads through the blood stream giving rise to unpleasant symptoms. For an infection to occur, the tick must be attached to the skin for about 25 – 36 hours [5]. It is therefore necessary to remove the tick as soon as possible in order to prevent transmission of the disease [6].

Prevention

Following certain simple steps can help you prevent from Lyme disease. In countries where Lyme disease is a common occurrence, individuals should avoid wandering in areas where ixodid (deer) ticks are common. These include bushy areas with long grass and wooded areas. Individual are advised to wear long pants when exploring such areas. It is also necessary to use insect repellents. When bitten by deer tick, it is necessary to remove the tick as soon as possible to prevent the infection. Individuals are also advised to check their pets for ticks. Whenever they notice tick bites, it should immediately be removed with the help of tweezers.

Summary

Lyme disease is caused by the bacterium Borrelia burgdorferi. It is transmitted to humans when they are bitten by ixodid ticks. Lyme disease greatly affects the body organs such as the joints, muscles, hearts, neurological system and gastrointestinal system [2]. Individuals affected with this disease often present with arthritis, fever, rashes, conjunctivitis and many other debilitating conditions. Lyme disease is treated with a strong antibiotic course that works towards elimination of the bacterium from the body. The disease can be successfully treated if treatment is initiated in the early stages.

Patient Information

Definition

Lyme disease is a kind of bacterial infection caused by infected ticks. The bacterium that causes the disease is called as Borrelia burgdorferi. It is the most common form of vector illness in the United States. It has been estimated that about 30,000 cases of Lyme disease are detected each year in the US.

Cause

Infected deer tick is the sole cause of Lyme disease. In this, the bacterium gains entry into the human system through the tick bite and spreads through the blood affecting other body organs and system.

Symptoms

Symptoms of Lyme disease include development of rash which is small and red colored in the initial stages. As the disease progresses, the rash extends in bull’s eye pattern. Other symptoms include joint pain, neurological problems, fever, fatigue, headache and muscle aches.

Diagnosis

Diagnosis of Lyme disease gets difficult as the symptoms often mimic other disease conditions. Many a time physical examination of the rash is enough to confirm the diagnosis. However additional tests such as ELISA test, Western blot test and polymerase chain reaction test may also be necessary to confirm the disease condition.

Treatment

A strong antibiotic course for 14 – 21 days would be enough to successfully treat the condition.

References

Article

  1. Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am. Jun 2008;22(2):315-26, vii. 
  2. Steere AC. Lyme disease. N Engl J Med 2001; 345:115.
  3. Oschmann P, Dorndorf W, Hornig C, et al. Stages and syndromes of neuroborreliosis. J Neurol 1998; 245:262.
  4. Centers for Disease Control (CDC). Lyme disease--United States, 1987 and 1988. MMWR Morb Mortal Wkly Rep 1989; 38:668.
  5. Sood SK, Salzman MB, Johnson BJ, Happ CM, Feig K, Carmody L, et al. Duration of tick attachment as a predictor of the risk of Lyme disease in an area in which Lyme disease is endemic. J Infect Dis. Apr 1997;175(4):996-9. 
  6. Kalish RA, Kaplan RF, Taylor E, et al. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis 2001; 183:453.
  7. Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED. Long-term outcomes of persons with Lyme disease. JAMA. Feb 2 2000;283(5):609-16
  8. Steere AC, Bartenhagen NH, Craft JE, et al. The early clinical manifestations of Lyme disease. Ann Intern Med 1983; 99:76.
  9. Ang CW, Notermans DW, Hommes M, Simoons-Smit AM, Herremans T. Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots. Eur J Clin Microbiol Infect Dis. Aug 2011;30(8):1027-32. 
  10. Steere AC, Angelis SM. Therapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum. Oct 2006;54(10):3079-86Steere AC, Sikand VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. Jun 12 2003;348(24):2472-4.

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Last updated: 2017-08-09 17:33