Lyme disease physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

The physical examination of Lyme disease is necessary for diagnosis. Erythema migrans and fever are commonly seen on physical examination in early disease.[1] Disseminated disease is characterized by multiple erythema migrans, neurological, musculoskeletal, and cardiac symptoms.[2]

Physical Examination in Stage 1 - Early localized disease

Appearance of the patient

  • Patients are usually well appearing in early stages but may appear fatigued

Vital signs

Skin

HEENT

Neck

Classic Lyme disease rash - Source: CDC.gov
Lyme disease, expamding rash with central clearing - Source: CDC.gov

Cardiovascular

Abdomen

Neurological

Muscukoskeletal

Physical Examination in Stage 2 - Early disseminated disease

Appearance of the patient

  • As the disease progresses, the patient may appear ill. The patient has severe malaise and fatigue.

Vital signs

Skin

HEENT

Disseminated Lyme disease, multiple rash - Source: CDC.gov

Neck

Cardiovascular

Abdomen

Neurological

Muscuoskeletal

Physical Examination in Stage 3 - Late disseminated disease

Appearance of the patient

Skin

HEENT

Neck

Neurological

Muscukoskeletal


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References

  1. Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Rahn DW; et al. (1983). "The early clinical manifestations of Lyme disease". Ann Intern Med. 99 (1): 76–82. PMID 6859726.
  2. Steere, Allen C. (1989). "Lyme Disease". New England Journal of Medicine. 321 (9): 586–596. doi:10.1056/NEJM198908313210906. ISSN 0028-4793.

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