Lyme disease history and symptoms: Difference between revisions

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{{Lyme disease}}
{{Lyme disease}}
{{CMG}} {{AE}} {{IMD}}
{{CMG}} {{AE}}{{Anmol}}, {{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. Initial symptoms include "bulls-eye" [[rash]], with accompanying constitutional symptoms. It can progress to [[cardiovascular]] or [[neurological]] complications.


==History==
==History==
Line 9: Line 9:
*The specific areas of focus when obtaining the history, are outlined below:
*The specific areas of focus when obtaining the history, are outlined below:
** [[Tick]] bite
** [[Tick]] bite
** Vacation,living, or working environment in endemic areas
** Vacation, living, or working environment in [[Endemic (epidemiology)|endemic]] areas
**Spending time outdoor (especially in woody or grassy area).
**Spending time outdoor (especially in woody or grassy area).


==Symptoms==
==Symptoms==
[[Lyme disease]] is divided into 3 stages and symptoms are stage specific.
[[Lyme disease]] is divided into 3 stages and symptoms are stage specific.
#Stage 1 - Early localized disease
#Stage 2 - Early disseminated disease
#Stage 3 - Late disseminated disease


===Common Symptoms===
===Stage 1 - Early localized disease===
*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 [[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]].  
Features of early localized disease includes erythema migrans and constitutional symptoms.
*An [[infection]] resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]].
*'''Erythema migrans (EM)''' also known as Erythema chronicum migrans, "bull’s-eye" rash, or Lyme rash develops in around 70% - 80% of patients.<ref name="pmid12802042">{{cite journal| author=Steere AC, Sikand VK| title=The presenting manifestations of Lyme disease and the outcomes of treatment. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 24 | pages= 2472-4 | pmid=12802042 | doi=10.1056/NEJM200306123482423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802042  }} </ref>
**EM begins at the site of a [[tick]] bite after a delay of 3 to 30 days (average is about 7 days).
**EM gradually expands over a period of days reaching up to 12 inches(30 cm)or more across.
**EM may feel warm to touch but is rarely [[Itch|itchy]] or [[Pain|painful]].
**EM clears as it enlarges, resulting in a target or “bull’s-eye” appearance.
**EM may appear on any area of the body but majority of times present in areas including [[axilla]], [[inguinal region]], [[popliteal fossa]], or along belt line.
**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]].
*Constitutional symptoms includes:<ref name="pmid8644761">{{cite journal| author=Nadelman RB, Nowakowski J, Forseter G, Goldberg NS, Bittker S, Cooper D et al.| title=The clinical spectrum of early Lyme borreliosis in patients with culture-confirmed erythema migrans. | journal=Am J Med | year= 1996 | volume= 100 | issue= 5 | pages= 502-8 | pmid=8644761 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8644761  }} </ref>
**[[Fatigue]]
**[[Arthralgia]]
**[[Myalgia]]
**[[Headache]]
**[[Fever]] and/or [[chills]]
**[[Stiff neck]]
**[[Anorexia]]
|
[[Image:Classic Lyme disease rash.jpg|thumb|250px|center|Classic [[Lyme disease]] rash]]
[[Image:Lyme disease Expanding rash with central crust.jpg|thumb|250px|center|[[Lyme disease]], expamding rash with central clearing]]
|}


===Less Common===
===Stage 2 - Early disseminate disease===
*[[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>)
Features of early disseminated disease can be divided system wise and includes:
*[[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>  
*Neurological symptoms: The triad of neurologic manifestation of [[Lyme disease]] includes [[meningitis]], [[cranial]] [[neuritis]], and radiculoneuritis.<ref name="pmid184528002">{{cite journal|author=Halperin JJ|title=Nervous system Lyme disease.|journal=Infect Dis Clin North Am|year=2008|volume=22|issue=2|pages=261-74, vi|pmid=18452800|doi=10.1016/j.idc.2007.12.009|pmc=|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452800}}</ref>
**[[Lymphocyte|Lymphocytic]] [[meningitis]] (most common neurological symptom)
**[[Cranial nerve palsies|Cranial neuropathies]] (particularly facial nerve palsy)
**Painful [[radiculitis]]
**[[Mononeuritis multiplex]]<ref name="pmid9066359">{{cite journal| author=England JD, Bohm RP, Roberts ED, Philipp MT| title=Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. | journal=Ann Neurol | year= 1997 | volume= 41 | issue= 3 | pages= 375-84 | pmid=9066359 | doi=10.1002/ana.410410313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9066359  }} </ref>
**[[Altered mental status]]<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>
**[[Pseudotumor cerebri]]
**[[Myelitis]]
**[[Chorea]]
**[[Cerebellar ataxia]]
*[[Cardiac]] manifestations
**[[Palpitation|Palpitations]]
**[[Atrioventricular block|Atrio-ventricular block]]
**[[Myopericarditis]]
**[[Sudden cardiac death]]
**Chronic [[cardiomyopathy]]
*[[Dermatological]] manifestations<ref name="pmid15358567">{{cite journal| author=Mullegger RR| title=Dermatological manifestations of Lyme borreliosis. | journal=Eur J Dermatol | year= 2004 | volume= 14 | issue= 5 | pages= 296-309 | pmid=15358567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358567  }} </ref>
**Borrelial lymphocytoma: Most common site is [[earlobe]].
*[[Ocular]] manifestations<ref name="pmid14630446">{{cite journal| author=Stanek G, Strle F| title=Lyme borreliosis. | journal=Lancet | year= 2003 | volume= 362 | issue= 9396 | pages= 1639-47 | pmid=14630446 | doi=10.1016/S0140-6736(03)14798-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14630446  }}</ref>
**Primary [[ocular]] symptoms occurs due to [[inflammation]] of [[ocular]] tissue. These symptoms includes [[conjunctivitis]], [[keratitis]], [[iridocyclitis]], [[retinal]] [[vasculitis]], chorioiditis, and [[optic neuropathy]] (extremely rarely [[episcleritis]], panuveitis, panophthalmitis)


==Chronic Disease==
*Secondary [[ocular]] symptoms occurs due to extraocular manifestations. These symptoms includes [[Cranial nerve palsies|pareses of cranial nerves]] and [[Orbit (anatomy)|orbital]] [[myositis]].
*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 [[Physiology|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===
===Stage 3 - Late disseminated disease===
*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:
*Features of late disseminated disease can take months to years to manifest after the onset of [[infection]].
**[[Encephalitis]] or [[Encephalomyelitis]]
*Lyme arthritis is dominant months later but chronic neurologic involvement becomes more obvious years later.
**[[Fasciculation|Muscle twitching]]
* The symptoms of late disseminated lyme disease includes:
**[[Polyneuropathy]] or [[Paresthesia]]
**[[Musculoskeletal]] manifestation:
**[[Balance disorder|Vestibular symptoms]]
***Lyme arthritis
**[[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>
****Lyme arthritis is the hallmark of stage 3 [[Lyme disease]].
*[[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]].  
****Most frequently presented symptom in late disseminated [[Lyme disease]].
*In rare cases, frank [[psychosis]] have been attributed to chronic [[Lyme disease]] effects, including misdiagnoses of [[schizophrenia]] and [[bipolar disorder]].  
****Commonly affects [[Knee|knee joint]].
*[[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>
**[[Neurology|Neurological]] manifestations:
***These [[neurological]] symptoms may take months to years to manifest after the [[infection]]. In addition to acute symptoms, Neuroborrerliosis can be manifested by a wide-range of [[Neurology|neurological]] disorders, either [[Central nervous system|central]] or [[Peripheral nervous system|peripheral]] including:
**** [[Encephalopathy]] (sub-acute): Affects  [[memory]], [[Mood (psychology)|mood]], [[sleep]], and sometimes with subtle [[language]] disturbances.
**** [[Polyneuropathy]] or [[Paresthesia]]
**** Leukoencephalitis<ref name="pmid192279822">{{cite journal|year=1991|title=Central nervous system abnormalities in Lyme neuroborreliosis.|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1922798|journal=Neurology|volume=41|issue=10|pages=1571-82|doi=|pmc=|pmid=1922798|author=Halperin JJ, Volkman DJ, Wu P}}</ref>
**** [[Fasciculation|Muscle twitching]]
**** [[Otolaryngology|Otolaryngologic]] manifestations: [[Neck pain]], [[odynophagia]], head and neck [[dysesthesia]], [[otalgia]], [[tinnitus]], [[hearing loss]], [[vertigo]], [[temporomandibular joint pain]], [[lymphadenopathy]], [[dysgeusia]].<ref>{{cite journal|year=1988|title=Borrelia infection and vertigo|journal=Acta Otolaryngol.|volume=106|issue=1-2|pages=111-6|pmid=3421091|author=Rosenhall U, Hanner P, Kaijser B}}</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]] symptoms often develop much later in the disease progression, much like tertiary [[neurosyphilis]].<ref name="LogigianKaplan1990">{{cite journal|last1=Logigian|first1=Eric L.|last2=Kaplan|first2=Richard F.|last3=Steere|first3=Allen C.|title=Chronic Neurologic Manifestations of Lyme Disease|journal=New England Journal of Medicine|volume=323|issue=21|year=1990|pages=1438–1444|issn=0028-4793|doi=10.1056/NEJM199011223232102}}</ref>
*** 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 somatoform [[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|year=1994|title=Lyme disease: a neuropsychiatric illness|journal=The American journal of psychiatry|volume=151|issue=11|pages=1571-83|pmid=7943444|author=Fallon BA, Nields JA}}{{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>
**Dermatological manifestation<ref name="pmid15358567">{{cite journal| author=Mullegger RR| title=Dermatological manifestations of Lyme borreliosis. | journal=Eur J Dermatol | year= 2004 | volume= 14 | issue= 5 | pages= 296-309 | pmid=15358567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358567  }} </ref>
***Acrodermatitis chronica atrophicans
 
{|
|
{|
! style="width: 80px; background: #4479BA; text-align: center;" colspan="2" |{{fontcolor|#FFF||Symptoms differentiated on the basis of frequency}}
<ref name="Ciesielski_198922">{{cite journal|year=1989|title=Lyme disease surveillance in the United States, 1983-1986|journal=Rev. Infect. Dis.|volume=11 Suppl 6|issue=|pages=S1435-41|pmid=2682955|author=Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV}}</ref>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Common symptoms'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Less common symptoms'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
*Erythema migrans(Erythema chronicum migrans)
*Constitutional symptoms
*Arthritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
*Cardiac manifestations
*Neurological manifestations
|}
 
{|
! style="width: 80px; background: #4479BA; text-align: center;" colspan="3" |{{fontcolor|#FFF||Difference in clinical features in Europe and North America}}<ref name="pmid18452805">{{cite journal| author=Stanek G, Strle F| title=Lyme disease: European perspective. | journal=Infect Dis Clin North Am | year= 2008 | volume= 22 | issue= 2 | pages= 327-39, vii | pmid=18452805 | doi=10.1016/j.idc.2008.01.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452805  }}</ref>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Features'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Europe'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''North America'''
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Erythema migrans
|Single lesion more frequently
|Multiple lesions occurs more freuqently
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Heterogenous dissemination
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less common
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More common
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Borrelial lymphocytoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Present
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Absent
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Acrodermatitis chronica atrophicans
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Present
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Absent
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Meningoradiculoneuritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More common
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less common
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Lyme arthritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Rarely preceded by Erythema migrans
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Commonly preceded by Erythema migrans
|}
|
[[image:Symptoms of lyme disease 2001-2015.jpg|center|700px|thumb|Frequency of Lyme disease symptoms, 2001-2015]]
|}


==Lyme Carditis==
==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 AV block|first-degree block]] to [[complete heart block]]) including [[lightheadedness]], [[palpitations]], [[shortness of breath]], [[chest pain]], and [[syncope]].<ref>{{cite journal|doi=10.7326/0003-4819-157-3-20120807-01002}}</ref>  
*[[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 AV block|first-degree block]] to [[complete heart block]]) including [[lightheadedness]], [[palpitations]], [[shortness of breath]], [[chest pain]], and [[syncope]].<ref name="pmid22868858">{{cite journal| author=Hu LT| title=In the clinic. Lyme disease. | journal=Ann Intern Med | year= 2012 | volume= 157 | issue= 3 | pages= ITC2-2 - ITC2-16 | pmid=22868858 | doi=10.7326/0003-4819-157-3-20120807-01002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22868858  }} </ref>  
*Less commonly, patients may present with an acute picture of [[left ventricular dysfunction]], [[cardiomegaly]], [[perimyocarditis]], or pancarditis without noticeable [[cardiac murmurs]].<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>  
*Less commonly, patients may present with an acute picture of [[left ventricular dysfunction]], [[cardiomegaly]], [[perimyocarditis]], or pancarditis without noticeable [[cardiac murmurs]].<ref name="Steere1989">{{cite journal|last1=Steere|first1=Allen C.|title=Lyme Disease|journal=New England Journal of Medicine|volume=321|issue=9|year=1989|pages=586–596|issn=0028-4793|doi=10.1056/NEJM198908313210906}}</ref>
*Lyme [[carditis]] can occur independently, it is usually accompanied by other [[cutaneous]], [[joint]], or neurologic features of Lyme disease.<ref name="Fish-2008">{{Cite journal | last1 = Fish | first1 = AE. | last2 = Pride | first2 = YB. | last3 = Pinto | first3 = DS. | title = Lyme carditis. | journal = Infect Dis Clin North Am | volume = 22 | issue = 2 | pages = 275-88, vi | month = Jun | year = 2008 | doi = 10.1016/j.idc.2007.12.008 | PMID = 18452801 }}</ref>
*Lyme [[carditis]] can occur independently, it is usually accompanied by other [[cutaneous]], [[joint]], or [[Neurology|neurologic]] features of [[Lyme disease]].<ref name="FishPride2008">{{cite journal|last1=Fish|first1=Airley E.|last2=Pride|first2=Yuri B.|last3=Pinto|first3=Duane S.|title=Lyme Carditis|journal=Infectious Disease Clinics of North America|volume=22|issue=2|year=2008|pages=275–288|issn=08915520|doi=10.1016/j.idc.2007.12.008}}</ref>


==Manifestations of Lyme Disease by Stage==
==Manifestations of Lyme Disease by Stage==
{| align="center" style="font-size:85%;" border="1" cellspacing="0" cellpadding="4"
{| 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="pmid 2668764">{{cite journal| author=Steere AC| title=Lyme disease. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 9 | pages= 586-96 | pmid= 2668764 | doi=10.1056/NEJM198908313210906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2668764 }}</ref>
|-
|-
| style="background:LightSlateGray; width:15%;" | '''System''' || style="background: #efefef; width:25%;" | '''Stage 1 (Localized Infection)''' || style="background: #efefef; width:25%;" | '''Stage 2 (Disseminated Infection)''' || style="background: #ffdead; width:35%" | '''Stage 3 (Persistent Infection)'''
| style="background:LightSlateGray; width:15%;" | '''System''' || style="background: #efefef; width:25%;" | '''Stage 1 (Localized Infection)''' || style="background: #efefef; width:25%;" | '''Stage 2 (Early Disseminated Infection)''' || style="background: #ffdead; width:35%" | '''Stage 3 (Late Persistent Infection)'''
|-
|-
| ''Skin'' || valign="top" | ▸ [[Erythema migrans]] || valign="top" | ▸ Secondary annular lesions <BR> ▸ [[Malar rash]] <BR> ▸ Diffuse [[erythema]] or [[urticaria]] <BR> ▸ Evanescent lesions <BR> ▸ Lymphocytoma || valign="top" | ▸ [[Acrodermatitis chronica atrophicans]] <BR> ▸ Localized [[scleroderma]]-like lesions
| ''Skin'' || valign="top" |
* [[Erythema migrans]]
| valign="top" |
* Secondary annular lesions  
* [[Malar rash]]
* Diffuse [[erythema]] or [[urticaria]]  
* Evanescent lesions  
* Lymphocytoma
| valign="top" |
* [[Acrodermatitis chronica atrophicans]]  
* Localized [[scleroderma]]-like lesions
|-
|-
| ''Musculoskeletal'' || — || valign="top" | ▸ Migratory [[arthralgia]] <BR> ▸ Brief [[arthritis]] attacks <BR> ▸ [[Myositis]] <BR> ▸ [[Osteomyelitis]] <BR> ▸ [[Panniculitis]]|| valign="top" | ▸ Prolonged [[arthritis]] attacks <BR> ▸ Chronic [[arthritis]] <BR> ▸ Peripheral [[enthesopathy]] <BR> ▸ [[Periostitis]] or joint subluxations below acrodermatitis
|
* ''Musculoskeletal''
|
* —
| valign="top" |
* Migratory [[arthralgia]]
* Brief [[arthritis]] attacks
* [[Myositis]]
* [[Osteomyelitis]]  
* [[Panniculitis]]
| valign="top" |
* Prolonged [[arthritis]] attacks
* Chronic [[arthritis]]
* Peripheral [[enthesopathy]]  
* [[Periostitis]] or joint subluxations below acrodermatitis
|-
|-
| ''Neurologic'' || — || valign="top" | ▸ [[Meningitis]] <BR> ▸ Cranial [[neuritis]] or [[Bell's palsy]] <BR> ▸ Motor or sensory radiculoneuritis <BR> ▸ [[Encephalitis]] <BR>▸ [[Mononeuritis multiplex]] <BR> ▸ [[Pseudotumor cerebri]] <BR> ▸ [[Myelitis]] <BR> ▸ [[Chorea]] <BR> ▸ [[Cerebellar ataxia]] || valign="top" | ▸ Chronic [[encephalomyelitis]] <BR> ▸ Spastic parapareses <BR> ▸ [[Ataxic gait]] <BR> ▸ Mental disorders <BR> ▸ Chronic axonal polyradiculopathy <BR> ▸ [[Dementia]]
| ''Neurologic'' || — || valign="top" |
* [[Meningitis]]
* Cranial [[neuritis]] or [[Bell's palsy]]  
* Motor or sensory radiculoneuritis
* [[Encephalitis]]
* [[Mononeuritis multiplex]]
* [[Pseudotumor cerebri]]
* [[Myelitis]]
* [[Chorea]]
* [[Cerebellar ataxia]]
| valign="top" |
* Chronic [[encephalomyelitis]]  
* Spastic parapareses
* [[Ataxic gait]]
* Mental disorders
* Chronic axonal polyradiculopathy
* [[Dementia]]
|-
|-
| ''Lymphatic'' || valign="top" | ▸ Regional [[lymphadenopathy]] || valign="top" | ▸ Regional or generalized [[lymphadenopathy]] <BR> ▸ [[Splenomegaly]] || —  
| ''Lymphatic'' || valign="top" |
* Regional [[lymphadenopathy]]
| valign="top" |
* Regional or generalized [[lymphadenopathy]]
* [[Splenomegaly]]
| —  
|-
|-
| ''Heart'' || — || valign="top" | ▸ [[Atrioventricular block]] <BR> ▸ [[Myopericarditis]] <BR> ▸ Pancarditis || —  
| ''Heart'' || — || valign="top" |
* [[Atrioventricular block]]  
* [[Myopericarditis]]
* Pancarditis
| —  
|-
|-
| ''Eyes'' || — || valign="top" | ▸ [[Conjunctivitis]] <BR> ▸ [[Iritis]] <BR> ▸ [[Choroiditis]] <BR> ▸ Retinal hemorrhage or [[retinal detachment]] <BR> ▸ Panophthalmitis|| valign="top" | ▸ [[Keratitis]]
| ''Eyes'' || — || valign="top" |
* [[Conjunctivitis]]
 
* [[Iritis]]
* [[Choroiditis]]
* Retinal hemorrhage or [[retinal detachment]]
* Panophthalmitis
| valign="top" |
* [[Keratitis]]
|-
|-
| ''Liver'' || — || ▸ Mild or recurrent [[hepatitis]] || —  
|
* ''Liver''
|
* —
|
* Mild or recurrent [[hepatitis]]
| —  
|-
|-
| ''Respiratory'' || — || valign="top" | ▸ Nonexudative [[sore throat]] <BR> ▸ Nonproductive [[cough]] <BR> ▸ [[Adult respiratory distress syndrome]] || —  
| ''Respiratory'' || — || valign="top" |
* Nonexudative [[sore throat]]
* Nonproductive [[cough]]
* [[Adult respiratory distress syndrome]]
| —  
|-
|-
| ''Kidney'' || — || valign="top" | ▸ Microscopic [[hematuria]] or [[proteinuria]] || —  
| ''Kidney'' || — || valign="top" |
* Microscopic [[hematuria]] or [[proteinuria]]
| —  
|-
|-
| ''Genitourinary'' || — || ▸ [[Orchitis]] || —  
| ''Genitourinary'' || — ||
* [[Orchitis]]
| —  
|-
|-
| ''Constitutional systems'' || ▸ Minor || ▸ Severe [[malaise]] and [[fatigue]] || ▸ [[Fatigue]]  
| ''Constitutional systems'' ||
* [[Fatigue]]
 
* [[Arthralgia]]
 
* [[Myalgia]]
* [[Headache]]
* [[Fever]] and/or [[chills]]
* [[Stiff neck]]
* [[Anorexia]]
|
* Severe [[malaise]] and [[fatigue]]
|
* [[Fatigue]]
|}
|}
<SMALL><span style="align=center">''Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.''</span></SMALL>
<SMALL><span style="align=center">''Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.''</span></SMALL>

Revision as of 13:28, 1 August 2017

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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], Ilan Dock, B.S.

Overview

Lyme disease is divided into 3 stages and symptoms are stage specific. Initial symptoms include "bulls-eye" rash, with accompanying constitutional symptoms. It can progress to cardiovascular or neurological complications.

History

  • 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]
  • The specific areas of focus when obtaining the history, are outlined below:
    • Tick bite
    • Vacation, living, or working environment in endemic areas
    • Spending time outdoor (especially in woody or grassy area).

Symptoms

Lyme disease is divided into 3 stages and symptoms are stage specific.

  1. Stage 1 - Early localized disease
  2. Stage 2 - Early disseminated disease
  3. Stage 3 - Late disseminated disease

Stage 1 - Early localized disease

Features of early localized disease includes erythema migrans and constitutional symptoms.

Classic Lyme disease rash
Lyme disease, expamding rash with central clearing

Stage 2 - Early disseminate disease

Features of early disseminated disease can be divided system wise and includes:

Stage 3 - Late disseminated disease

Symptoms differentiated on the basis of frequency

[15]

Common symptoms Less common symptoms
  • Erythema migrans(Erythema chronicum migrans)
  • Constitutional symptoms
  • Arthritis
  • Cardiac manifestations
  • Neurological manifestations
Difference in clinical features in Europe and North America[16]
Features Europe North America
Erythema migrans Single lesion more frequently Multiple lesions occurs more freuqently
Heterogenous dissemination Less common More common
Borrelial lymphocytoma Present Absent
Acrodermatitis chronica atrophicans Present Absent
Meningoradiculoneuritis More common Less common
Lyme arthritis Rarely preceded by Erythema migrans Commonly preceded by Erythema migrans
Frequency of Lyme disease symptoms, 2001-2015

Lyme Carditis

Manifestations of Lyme Disease by Stage

Manifestations of Lyme Disease by Stage[20]
System Stage 1 (Localized Infection) Stage 2 (Early Disseminated Infection) Stage 3 (Late Persistent Infection)
Skin
  • Musculoskeletal
  • —
Neurologic —
Lymphatic —
Heart — —
Eyes —
  • Liver
  • —
 —
Respiratory — —
Kidney — —
Genitourinary — —
Constitutional systems

Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.

References

  1. ↑ 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.
  2. ↑ Steere AC, Sikand VK, Schoen RT, Nowakowski J (2003). "Asymptomatic infection with Borrelia burgdorferi". Clin. Infect. Dis. 37 (4): 528–32. PMID 12905137.
  3. ↑ Steere AC, Sikand VK (2003). "The presenting manifestations of Lyme disease and the outcomes of treatment". N Engl J Med. 348 (24): 2472–4. doi:10.1056/NEJM200306123482423. PMID 12802042.
  4. ↑ Nadelman RB, Nowakowski J, Forseter G, Goldberg NS, Bittker S, Cooper D; et al. (1996). "The clinical spectrum of early Lyme borreliosis in patients with culture-confirmed erythema migrans". Am J Med. 100 (5): 502–8. PMID 8644761.
  5. ↑ Halperin JJ (2008). "Nervous system Lyme disease". Infect Dis Clin North Am. 22 (2): 261–74, vi. doi:10.1016/j.idc.2007.12.009. PMID 18452800.
  6. ↑ England JD, Bohm RP, Roberts ED, Philipp MT (1997). "Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease". Ann Neurol. 41 (3): 375–84. doi:10.1002/ana.410410313. PMID 9066359.
  7. ↑ 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.
  8. ↑ 8.0 8.1 Mullegger RR (2004). "Dermatological manifestations of Lyme borreliosis". Eur J Dermatol. 14 (5): 296–309. PMID 15358567.
  9. ↑ Stanek G, Strle F (2003). "Lyme borreliosis". Lancet. 362 (9396): 1639–47. doi:10.1016/S0140-6736(03)14798-8. PMID 14630446.
  10. ↑ Halperin JJ, Volkman DJ, Wu P (1991). "Central nervous system abnormalities in Lyme neuroborreliosis". Neurology. 41 (10): 1571–82. PMID 1922798.
  11. ↑ Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
  12. ↑ 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.
  13. ↑ Logigian, Eric L.; Kaplan, Richard F.; Steere, Allen C. (1990). "Chronic Neurologic Manifestations of Lyme Disease". New England Journal of Medicine. 323 (21): 1438–1444. doi:10.1056/NEJM199011223232102. ISSN 0028-4793.
  14. ↑ 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.)
  15. ↑ 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.
  16. ↑ Stanek G, Strle F (2008). "Lyme disease: European perspective". Infect Dis Clin North Am. 22 (2): 327–39, vii. doi:10.1016/j.idc.2008.01.001. PMID 18452805.
  17. ↑ Hu LT (2012). "In the clinic. Lyme disease". Ann Intern Med. 157 (3): ITC2-2–ITC2-16. doi:10.7326/0003-4819-157-3-20120807-01002. PMID 22868858.
  18. ↑ Steere, Allen C. (1989). "Lyme Disease". New England Journal of Medicine. 321 (9): 586–596. doi:10.1056/NEJM198908313210906. ISSN 0028-4793.
  19. ↑ Fish, Airley E.; Pride, Yuri B.; Pinto, Duane S. (2008). "Lyme Carditis". Infectious Disease Clinics of North America. 22 (2): 275–288. doi:10.1016/j.idc.2007.12.008. ISSN 0891-5520.
  20. ↑ Steere AC (1989). "Lyme disease". N Engl J Med. 321 (9): 586–96. doi:10.1056/NEJM198908313210906. PMID 2668764  2668764 Check |pmid= value (help).


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