Lyme disease history and symptoms: Difference between revisions

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===Stage 2 - Early disseminate disease===
===Stage 2 - Early disseminate disease===
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Features of early disseminated disease can be divided system wise and includes:
Features of early disseminated disease can be divided system wise and includes:
*Multiple Erythema migrans<ref name="pmid158674072">{{cite journal| author=Wormser GP, McKenna D, Carlin J, Nadelman RB, Cavaliere LF, Holmgren D et al.| title=Brief communication: hematogenous dissemination in early Lyme disease. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 9 | pages= 751-5 | pmid=15867407 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15867407  }}</ref>
*Multiple Erythema migrans<ref name="pmid158674072">{{cite journal| author=Wormser GP, McKenna D, Carlin J, Nadelman RB, Cavaliere LF, Holmgren D et al.| title=Brief communication: hematogenous dissemination in early Lyme disease. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 9 | pages= 751-5 | pmid=15867407 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15867407  }}</ref>
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**[[Chorea]]
**[[Chorea]]
**[[Cerebellar ataxia]]
**[[Cerebellar ataxia]]
|
[[Image:LymeMultiple rash, disseminated infection.jpg|thumb|250px|right|Disseminated [[Lyme disease]], Multiple rash]]
|}
*[[Cardiac]] manifestations
*[[Cardiac]] manifestations
**[[Palpitation|Palpitations]]
**[[Palpitation|Palpitations]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Less common symptoms'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Less common symptoms'''
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #DCDCDC; padding: 5px; " |
*Erythema migrans(Erythema chronicum migrans)
*Erythema migrans(Erythema chronicum migrans)
*Constitutional symptoms
*Constitutional symptoms
*Arthritis
*Arthritis
*Neurological manifestation
*Neurological manifestation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #DCDCDC; padding: 5px; " |
*Cardiac manifestations
*Cardiac manifestations
*Ocular manifestations
*Ocular manifestations

Revision as of 14:44, 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:

Disseminated Lyme disease, Multiple rash

Stage 3 - Late disseminated disease

Symptoms differentiated on the basis of frequency

[16]

Common symptoms Less common symptoms
  • Erythema migrans(Erythema chronicum migrans)
  • Constitutional symptoms
  • Arthritis
  • Neurological manifestation
  • Cardiac manifestations
  • Ocular manifestations
  • Hepatitis
Difference in clinical features in Europe and North America[17]
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[19]
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. Wormser GP, McKenna D, Carlin J, Nadelman RB, Cavaliere LF, Holmgren D; et al. (2005). "Brief communication: hematogenous dissemination in early Lyme disease". Ann Intern Med. 142 (9): 751–5. PMID 15867407.
  6. 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.
  7. 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.
  8. 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.
  9. 9.0 9.1 Mullegger RR (2004). "Dermatological manifestations of Lyme borreliosis". Eur J Dermatol. 14 (5): 296–309. PMID 15358567.
  10. Stanek G, Strle F (2003). "Lyme borreliosis". Lancet. 362 (9396): 1639–47. doi:10.1016/S0140-6736(03)14798-8. PMID 14630446.
  11. Halperin JJ, Volkman DJ, Wu P (1991). "Central nervous system abnormalities in Lyme neuroborreliosis". Neurology. 41 (10): 1571–82. PMID 1922798.
  12. Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
  13. 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.
  14. 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.
  15. 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.)
  16. 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.
  17. 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.
  18. 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.
  19. 19.0 19.1 Steere, Allen C. (1989). "Lyme Disease". New England Journal of Medicine. 321 (9): 586–596. doi:10.1056/NEJM198908313210906. ISSN 0028-4793.
  20. 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.


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