Lyme disease
Lyme disease is a vector-borne infectious disease caused by Borrelia burgdorferi, transmitted by ticks. Its most common manifestation is a rash, but it can cause debilitating, chronic neurologic and fatigue syndrome. Once the disease is established, long-term antibiotic treatment may be needed.
Symptoms
Dermatologic
The true incidence of the rash, erythema migrans, is disputed, with estimates ranging from less than 50%[1][2] to over 80% of those infected.[3] A systematic review by the Rational Clinical Examination of studies estimates that 80% of patients may have an expanding rash, erythema migrans (EM), at the site of the tick bite.[4] Most patients with EM do not recall a deer tick bite.
The Rational Clinical Examination review found that the characteristic "bull's-eye" rash with central clearing is present in about 20% of endemic cases in the United States; whereas in Europe and the non-endemic United States 80% of rashes have central clearing.[4]In endemic areas of the United States homogeneously red rashes are more frequent.[5][6] The rash is classically 5 to 6.8 cm in diameter appearing as an annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%).[7]
Sometimes, erythema migrans may be less than 5 cm in diameter.[8] Multiple painless EM rashes may occur, indicating disseminated infection.
Neurological
Neurologic symptoms (neuroborreliosis) may occur in 18%.[9] Bannwarth's syndrome is the triad of lymphocytic meningitis, cranial nerve palsy, and radiculoneuritis. The most common cranial palsy is the 7th cranial nerve (facial paralysis) in the form of Bell's Palsy.
Chronic Lyme disease controversy
There is extensive discussion over whether Lyme disease can be a chronic disease.[10]
References
- ↑ Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am 86 (2): 341-9, vii. PMID 11982305.
- ↑ Cameron D, Gaito A, Narris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Scherrer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R; ILADS Working Group (2004). "Evidence-based guidelines for the management of Lyme disease" (PDF). Expert Rev Anti Infect Ther 2 ((1 Suppl)): S1-13. PMID 15581390.
- ↑ [http://www.cdc.gov/ncidod/dvbid/lyme/ld_LymeDiseaseRashPhotos.htm CDC Lyme Disease Erythema Migrans Disease Retrieved May 13 2007
- ↑ 4.0 4.1 Tibbles CD, Edlow JA (2007). "Does this patient have erythema migrans?". JAMA 297 (23): 2617-27. DOI:10.1001/jama.297.23.2617. PMID 17579230. Research Blogging.
- ↑ Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC (2002). "Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans" (PDF). Ann Intern Med 136 (6): 421-8. PMID 11900494.
- ↑ Edlow JA (2002). "Erythema migrans". Med Clin North Am 86 (2): 239-60. PMID 11982300.
- ↑ Feder HM Jr, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM. Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis. Clin Dermatol. 2006 Nov-Dec;24(6):509-20. Because of the "bull's-eye" description to describe the Lyme disease rash, the condition commonly called ringworm is sometimes confused with Lyme disease. PMID 17113969
- ↑ [1] Weber K, Wilske B. "Mini erythema migrans--a sign of early Lyme borreliosis". Dermatology. 2006;212(2):113-6 PMID 16484816
- ↑ Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV (1989). "Lyme disease surveillance in the United States, 1983-1986". Rev. Infect. Dis. 11 Suppl 6: S1435–41. PMID 2682955. [e]
- ↑ Feder HM, Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP (2007). "A critical appraisal of "chronic Lyme disease"". N. Engl. J. Med. 357 (14): 1422–30. DOI:10.1056/NEJMra072023. PMID 17914043. Research Blogging.