Lyme disease history and symptoms: Difference between revisions
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{{CMG}} {{AE}} {{IMD}} | {{CMG}} {{AE}} {{IMD}} | ||
==Overview== | ==Overview== | ||
Lyme disease is divided into 3 stages and symptoms are stage specific. Symptoms include "bulls-eye" [[rash]], with accompanying [[fever]], [[malaise]], and musculoskeletal pain ([[arthralgia]] or [[myalgia]]. It can progress to cardiovascular or neurological complications. | [[Lyme disease]] is divided into 3 stages and symptoms are stage specific. Symptoms include "bulls-eye" [[rash]], with accompanying [[fever]], [[malaise]], and [[musculoskeletal pain]] ([[arthralgia]] or [[myalgia]]). It can progress to [[cardiovascular]] or [[neurological]] complications. | ||
==History and Symptoms== | ==History and Symptoms== | ||
The [[incubation period]] from infection to the onset of symptoms is usually 1–2 weeks, but can be much shorter (days), or much longer (months to years). Symptoms most often occur from May through September because the nymphal stage of the tick is responsible for most cases.<ref>{{cite | The [[incubation period]] from [[infection]] to the onset of symptoms is usually 1–2 weeks, but can be much shorter (days), or much longer (months to years). Symptoms most often occur from May through September because the nymphal stage of the [[tick]] is responsible for most cases. <ref name="pmid10206627">{{cite journal| author=Falco RC, McKenna DF, Daniels TJ, Nadelman RB, Nowakowski J, Fish D et al.| title=Temporal relation between Ixodes scapularis abundance and risk for Lyme disease associated with erythema migrans. | journal=Am J Epidemiol | year= 1999 | volume= 149 | issue= 8 | pages= 771-6 | pmid=10206627 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10206627 }}</ref>[[Asymptomatic]] [[infection]] exists, but is uncommon.<ref name="pmid12905137">{{cite journal |author=Steere AC, Sikand VK, Schoen RT, Nowakowski J |title=Asymptomatic infection with Borrelia burgdorferi |journal=Clin. Infect. Dis. |volume=37 |issue=4 |pages=528-32 |year=2003 |pmid=12905137}}</ref> | ||
===Common Symptoms=== | ===Common Symptoms=== | ||
*The [[Acute (medicine)|acute]] phase of Lyme disease infection is a characteristic reddish "bulls-eye" [[rash]], with accompanying [[fever]], [[malaise]], and [[musculoskeletal]] [[pain]] ([[arthralgia]] or [[myalgia]]). | *The [[Acute (medicine)|acute]] phase of [[Lyme disease]] infection is a characteristic reddish "bulls-eye" [[rash]], with accompanying [[fever]], [[malaise]], and [[musculoskeletal]] [[pain]] ([[arthralgia]] or [[myalgia]]). | ||
*The characteristic reddish "bull's-eye" rash (known as ''[[erythema chronicum migrans]]'') may be seen in up to 80% of early stage Lyme disease patients,<ref>{{cite web | author=CDC | title=Lyme Disease Erythema Migrans | date=2005-07-06 | accessdate = 2007-08-21 | url=http://www.cdc.gov/ncidod/dvbid/lyme/ld_LymeDiseaseRashPhotos.htm}}</ref> appearing anywhere from one day to a month after a tick bite.<ref name="pmid11982305">{{cite journal | author=Donta ST | title=Late and chronic Lyme disease | journal=Med Clin North Am | year=2002 | pages=341-9, vii | volume=86 | issue=2 | pmid= 11982305 | url=http://www.immunesupport.com/library/print.cfm?ID=3579&t=CFIDS_FM}}</ref> | *The characteristic reddish "bull's-eye" [[rash]] (known as ''[[erythema chronicum migrans]]'') may be seen in up to 80% of early stage [[Lyme disease]] patients,<ref>{{cite web | author=CDC | title=Lyme Disease Erythema Migrans | date=2005-07-06 | accessdate = 2007-08-21 | url=http://www.cdc.gov/ncidod/dvbid/lyme/ld_LymeDiseaseRashPhotos.htm}}</ref> appearing anywhere from one day to a month after a [[tick]] bite.<ref name="pmid11982305">{{cite journal | author=Donta ST | title=Late and chronic Lyme disease | journal=Med Clin North Am | year=2002 | pages=341-9, vii | volume=86 | issue=2 | pmid= 11982305 | url=http://www.immunesupport.com/library/print.cfm?ID=3579&t=CFIDS_FM}}</ref> | ||
*The rash does not represent an [[allergic reaction]] to the bite, but rather a [[skin infection]] with the Lyme bacteria, [[Lyme disease microbiology|''Borrelia burgdorferi'' sensu lato]]. | *The [[rash]] does not represent an [[allergic reaction]] to the bite, but rather a [[skin infection]] with the [[Borrelia burgdorferi|Lyme bacteria]], [[Lyme disease microbiology|''Borrelia burgdorferi'' sensu lato]]. | ||
*An infection resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]]. | *An [[infection]] resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]]. | ||
===Less Common=== | ===Less Common=== | ||
*Cardiac manifestations (up to 10% of patients may have cardiac manifestations including [[heart block]] and [[palpitations]]<ref name="Ciesielski_1989">{{cite journal |author=Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV |title=Lyme disease surveillance in the United States, 1983-1986 |journal=Rev. Infect. Dis. |volume=11 Suppl 6 |issue= |pages=S1435-41 |year=1989 |pmid=2682955}}</ref>) | *[[Cardiac]] manifestations (up to 10% of patients may have [[cardiac]] manifestations including [[heart block]] and [[palpitations]]<ref name="Ciesielski_1989">{{cite journal |author=Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV |title=Lyme disease surveillance in the United States, 1983-1986 |journal=Rev. Infect. Dis. |volume=11 Suppl 6 |issue= |pages=S1435-41 |year=1989 |pmid=2682955}}</ref>) | ||
*Neurologic symptoms (neuroborreliosis may occur in up to 18%), as well as simple [[altered mental status]] as the sole presenting symptom has been reported in early neuroborreliosis.<ref>{{cite journal |author=Chabria SB, Lawrason J |title=Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report |journal= |volume=1 |issue=1 |pages=62 |year=2007 |pmid=17688693 |doi=10.1186/1752-1947-1-62}}</ref> | *[[Neurology|Neurologic]] symptoms (neuroborreliosis may occur in up to 18%), as well as simple [[altered mental status]] as the sole presenting symptom has been reported in early neuroborreliosis.<ref>{{cite journal |author=Chabria SB, Lawrason J |title=Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report |journal= |volume=1 |issue=1 |pages=62 |year=2007 |pmid=17688693 |doi=10.1186/1752-1947-1-62}}</ref> | ||
==Chronic Disease== | ==Chronic Disease== | ||
*Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]] | *Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]] | ||
*Cardiac inflammation ([[myocarditis]]) | *[[Cardiac]] [[inflammation]] ([[myocarditis]]) | ||
*Frank [[arthritis]] | *Frank [[arthritis]] | ||
*It should be noted, however, that chronic Lyme disease can have a multitude of symptoms affecting numerous physiological systems. | *It should be noted, however, that chronic [[Lyme disease]] can have a multitude of symptoms affecting numerous [[Physiology|physiological]] [[systems]]. | ||
*The symptoms appear [[heterogeneous]] in the affected population, which may be due to [[innate immunity]] or variations in ''Borrelia'' bacteria. | *The symptoms appear [[heterogeneous]] in the affected [[population]], which may be due to [[innate immunity]] or variations in ''[[Borrelia]]'' [[bacteria]]. | ||
*Late symptoms of Lyme disease can appear months or years after initial [[infection]] and often progress in cumulative fashion over time. | *Late symptoms of [[Lyme disease]] can appear months or years after initial [[infection]] and often progress in cumulative fashion over time. | ||
*Neuropsychiatric symptoms often develop much later in the disease progression, much like tertiary [[neurosyphilis]]. | *[[Neuropsychiatric]] symptoms often develop much later in the disease progression, much like tertiary [[neurosyphilis]]. | ||
===Chronic neurological disorders=== | ===Chronic neurological disorders=== | ||
*In addition to the acute symptoms, chronic Lyme disease can be manifested by a wide-range of neurological disorders, either [[central nervous system|central]] or [[peripheral nervous system|peripheral]] including: | *In addition to the acute symptoms, chronic [[Lyme disease]] can be manifested by a wide-range of neurological disorders, either [[central nervous system|central]] or [[peripheral nervous system|peripheral]] including: | ||
**[[Encephalitis]] or [[Encephalomyelitis]] | **[[Encephalitis]] or [[Encephalomyelitis]] | ||
**[[Fasciculation|Muscle twitching]] | **[[Fasciculation|Muscle twitching]] | ||
| Line 34: | Line 34: | ||
**[[Balance disorder|Vestibular symptoms]] | **[[Balance disorder|Vestibular symptoms]] | ||
**[[Otolaryngology|Otolaryngologic]]<ref>{{cite journal |author=Rosenhall U, Hanner P, Kaijser B |title=Borrelia infection and vertigo |journal=Acta Otolaryngol. |volume=106 |issue=1-2 |pages=111-6 |year=1988 |pmid=3421091}}</ref><ref>{{cite journal |author=Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F |title=Otolaryngologic aspects of Lyme disease |journal=Laryngoscope |volume=101 |issue=6 Pt 1 |pages=592-5 |year=1991 |pmid=2041438}}</ref> | **[[Otolaryngology|Otolaryngologic]]<ref>{{cite journal |author=Rosenhall U, Hanner P, Kaijser B |title=Borrelia infection and vertigo |journal=Acta Otolaryngol. |volume=106 |issue=1-2 |pages=111-6 |year=1988 |pmid=3421091}}</ref><ref>{{cite journal |author=Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F |title=Otolaryngologic aspects of Lyme disease |journal=Laryngoscope |volume=101 |issue=6 Pt 1 |pages=592-5 |year=1991 |pmid=2041438}}</ref> | ||
*Neuropsychiatric disturbances can occur (possibly from a low-level [[encephalitis]]), which may lead to symptoms of [[memory loss]], [[sleep disturbance]]s, or changes in [[Mood (psychology)|mood]] or [[Affect (psychology)|affect]]. | *[[Neuropsychiatric]] disturbances can occur (possibly from a low-level [[encephalitis]]), which may lead to symptoms of [[memory loss]], [[sleep disturbance]]s, or changes in [[Mood (psychology)|mood]] or [[Affect (psychology)|affect]]. | ||
*In rare cases, frank [[psychosis]] have been attributed to chronic Lyme disease effects, including misdiagnoses of [[schizophrenia]] and [[bipolar disorder]]. | *In rare cases, frank [[psychosis]] have been attributed to chronic [[Lyme disease]] effects, including misdiagnoses of [[schizophrenia]] and [[bipolar disorder]]. | ||
*[[Panic attack]] and [[anxiety]] can occur, also [[delusional]] [[behavior]], including somataform [[delusions]], sometimes accompanied by a [[depersonalization]] or [[derealization]] syndrome similar to what was seen in the past in the prodromal or early stages of general paresis.<ref>{{cite journal |author=Fallon BA, Nields JA |title=Lyme disease: a neuropsychiatric illness |journal=The American journal of psychiatry |volume=151 |issue=11 |pages=1571-83 |year=1994 |pmid=7943444}}{{cite journal |author=Hess A, Buchmann J, Zettl UK, ''et al'' |title=Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder |journal=Biol. Psychiatry |volume=45 |issue=6 |pages=795 |year=1999 |pmid=10188012}})</ref> | *[[Panic attack]] and [[anxiety]] can occur, also [[delusional]] [[behavior]], including somataform [[delusions]], sometimes accompanied by a [[depersonalization]] or [[derealization]] syndrome similar to what was seen in the past in the prodromal or early stages of general paresis.<ref>{{cite journal |author=Fallon BA, Nields JA |title=Lyme disease: a neuropsychiatric illness |journal=The American journal of psychiatry |volume=151 |issue=11 |pages=1571-83 |year=1994 |pmid=7943444}}{{cite journal |author=Hess A, Buchmann J, Zettl UK, ''et al'' |title=Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder |journal=Biol. Psychiatry |volume=45 |issue=6 |pages=795 |year=1999 |pmid=10188012}})</ref> | ||
| Line 44: | Line 44: | ||
==Manifestations of Lyme Disease by Stage== | ==Manifestations of Lyme Disease by Stage== | ||
{| | {| align="center" style="font-size:85%;" border="1" cellspacing="0" cellpadding="4" | ||
|+ '''Manifestations of Lyme Disease by Stage<ref name="Steere-1989">{{Cite journal | last1 = Steere | first1 = AC. | title = Lyme disease. | journal = N Engl J Med | volume = 321| issue = 9 | pages = 586-96 | month = Aug | year = 1989 | doi = 10.1056/NEJM198908313210906 |PMID = 2668764 }}</ref>''' | |+ '''Manifestations of Lyme Disease by Stage<ref name="Steere-1989">{{Cite journal | last1 = Steere | first1 = AC. | title = Lyme disease. | journal = N Engl J Med | volume = 321| issue = 9 | pages = 586-96 | month = Aug | year = 1989 | doi = 10.1056/NEJM198908313210906 |PMID = 2668764 }}</ref>''' | ||
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Revision as of 15:11, 31 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.
Overview
Lyme disease is divided into 3 stages and symptoms are stage specific. Symptoms include "bulls-eye" rash, with accompanying fever, malaise, and musculoskeletal pain (arthralgia or myalgia). It can progress to cardiovascular or neurological complications.
History and Symptoms
The incubation period from infection to the onset of symptoms is usually 1–2 weeks, but can be much shorter (days), or much longer (months to years). Symptoms most often occur from May through September because the nymphal stage of the tick is responsible for most cases. [1]Asymptomatic infection exists, but is uncommon.[2]
Common Symptoms
- The acute phase of Lyme disease infection is a characteristic reddish "bulls-eye" rash, with accompanying fever, malaise, and musculoskeletal pain (arthralgia or myalgia).
- The characteristic reddish "bull's-eye" rash (known as erythema chronicum migrans) may be seen in up to 80% of early stage Lyme disease patients,[3] appearing anywhere from one day to a month after a tick bite.[4]
- The rash does not represent an allergic reaction to the bite, but rather a skin infection with the Lyme bacteria, Borrelia burgdorferi sensu lato.
- An infection resulting from a B. mayonii infection may cause a diffuse rash, erupting in "red spots," spanning the entire body.
Less Common
- Cardiac manifestations (up to 10% of patients may have cardiac manifestations including heart block and palpitations[5])
- Neurologic symptoms (neuroborreliosis may occur in up to 18%), as well as simple altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.[6]
Chronic Disease
- Untreated or persistent cases may progress to a chronic form most commonly characterized by meningoencephalitis
- Cardiac inflammation (myocarditis)
- Frank arthritis
- It should be noted, however, that chronic Lyme disease can have a multitude of symptoms affecting numerous physiological systems.
- The symptoms appear heterogeneous in the affected population, which may be due to innate immunity or variations in Borrelia bacteria.
- Late symptoms of Lyme disease can appear months or years after initial infection and often progress in cumulative fashion over time.
- Neuropsychiatric symptoms often develop much later in the disease progression, much like tertiary neurosyphilis.
Chronic neurological disorders
- In addition to the acute symptoms, chronic Lyme disease can be manifested by a wide-range of neurological disorders, either central or peripheral including:
- Neuropsychiatric disturbances can occur (possibly from a low-level encephalitis), which may lead to symptoms of memory loss, sleep disturbances, or changes in mood or affect.
- In rare cases, frank psychosis have been attributed to chronic Lyme disease effects, including misdiagnoses of schizophrenia and bipolar disorder.
- Panic attack and anxiety can occur, also delusional behavior, including somataform delusions, sometimes accompanied by a depersonalization or derealization syndrome similar to what was seen in the past in the prodromal or early stages of general paresis.[9]
Lyme Carditis
- Cardiac involvement occurs in about 5—10% of untreated Lyme disease and patients usually have symptoms related to fluctuating degrees of atrioventricular block (first-degree block to complete heart block) including lightheadedness, palpitations, shortness of breath, chest pain, and syncope.[10]
- Less commonly, patients may present with an acute picture of left ventricular dysfunction, cardiomegaly, perimyocarditis, or pancarditis without noticeable cardiac murmurs.[11]
- Lyme carditis can occur independently, it is usually accompanied by other cutaneous, joint, or neurologic features of Lyme disease.[12]
Manifestations of Lyme Disease by Stage
| System | Stage 1 (Localized Infection) | Stage 2 (Disseminated Infection) | Stage 3 (Persistent Infection) |
| Skin | ▸ Erythema migrans | ▸ Secondary annular lesions ▸ Malar rash ▸ Diffuse erythema or urticaria ▸ Evanescent lesions ▸ Lymphocytoma |
▸ Acrodermatitis chronica atrophicans ▸ Localized scleroderma-like lesions |
| Musculoskeletal | — | ▸ Migratory arthralgia ▸ Brief arthritis attacks ▸ Myositis ▸ Osteomyelitis ▸ Panniculitis |
▸ Prolonged arthritis attacks ▸ Chronic arthritis ▸ Peripheral enthesopathy ▸ Periostitis or joint subluxations below acrodermatitis |
| Neurologic | — | ▸ Meningitis ▸ Cranial neuritis or Bell's palsy ▸ Motor or sensory radiculoneuritis ▸ Encephalitis ▸ Mononeuritis multiplex ▸ Pseudotumor cerebri ▸ Myelitis ▸ Chorea ▸ Cerebellar ataxia |
▸ Chronic encephalomyelitis ▸ Spastic parapareses ▸ Ataxic gait ▸ Mental disorders ▸ Chronic axonal polyradiculopathy ▸ Dementia |
| Lymphatic | ▸ Regional lymphadenopathy | ▸ Regional or generalized lymphadenopathy ▸ Splenomegaly |
— |
| Heart | — | ▸ Atrioventricular block ▸ Myopericarditis ▸ Pancarditis |
— |
| Eyes | — | ▸ Conjunctivitis ▸ Iritis ▸ Choroiditis ▸ Retinal hemorrhage or retinal detachment ▸ Panophthalmitis |
▸ Keratitis |
| Liver | — | ▸ Mild or recurrent hepatitis | — |
| Respiratory | — | ▸ Nonexudative sore throat ▸ Nonproductive cough ▸ Adult respiratory distress syndrome |
— |
| Kidney | — | ▸ Microscopic hematuria or proteinuria | — |
| Genitourinary | — | ▸ Orchitis | — |
| Constitutional systems | ▸ Minor | ▸ Severe malaise and fatigue | ▸ Fatigue |
Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.
References
- ↑ Falco RC, McKenna DF, Daniels TJ, Nadelman RB, Nowakowski J, Fish D; et al. (1999). "Temporal relation between Ixodes scapularis abundance and risk for Lyme disease associated with erythema migrans". Am J Epidemiol. 149 (8): 771–6. PMID 10206627.
- ↑ Steere AC, Sikand VK, Schoen RT, Nowakowski J (2003). "Asymptomatic infection with Borrelia burgdorferi". Clin. Infect. Dis. 37 (4): 528–32. PMID 12905137.
- ↑ CDC (2005-07-06). "Lyme Disease Erythema Migrans". Retrieved 2007-08-21.
- ↑ Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am. 86 (2): 341–9, vii. PMID 11982305.
- ↑ 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.
- ↑ Chabria SB, Lawrason J (2007). "Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report". 1 (1): 62. doi:10.1186/1752-1947-1-62. PMID 17688693.
- ↑ Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
- ↑ Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F (1991). "Otolaryngologic aspects of Lyme disease". Laryngoscope. 101 (6 Pt 1): 592–5. PMID 2041438.
- ↑ Fallon BA, Nields JA (1994). "Lyme disease: a neuropsychiatric illness". The American journal of psychiatry. 151 (11): 1571–83. PMID 7943444.Hess A, Buchmann J, Zettl UK; et al. (1999). "Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder". Biol. Psychiatry. 45 (6): 795. PMID 10188012.)
- ↑ . doi:10.7326/0003-4819-157-3-20120807-01002. Missing or empty
|title=(help) - ↑ 11.0 11.1 Steere, AC. (1989). "Lyme disease". N Engl J Med. 321 (9): 586–96. doi:10.1056/NEJM198908313210906. PMID 2668764. Unknown parameter
|month=ignored (help) - ↑ Fish, AE.; Pride, YB.; Pinto, DS. (2008). "Lyme carditis". Infect Dis Clin North Am. 22 (2): 275–88, vi. doi:10.1016/j.idc.2007.12.008. PMID 18452801. Unknown parameter
|month=ignored (help)