Lyme disease history and symptoms: Difference between revisions
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== | ==History and 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 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 [[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 Lyme bacteria, [[Lyme disease microbiology|''Borrelia burgdorferi'' sensu lato]]. | ||
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Other, less common findings in acute Lyme disease include 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> | Other, less common findings in acute Lyme disease include 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> | ||
===Chronic | ===Chronic Symptoms=== | ||
Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]], cardiac inflammation ([[myocarditis]]), and 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 progession, much like tertiary [[neurosyphilis]]. | Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]], cardiac inflammation ([[myocarditis]]), and 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 progession, much like tertiary [[neurosyphilis]]. | ||
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==References== | ==References== | ||
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Revision as of 23:08, 3 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
History and 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,[1] appearing anywhere from one day to a month after a tick bite.[2] The rash does not represent an allergic reaction to the bite, but rather a skin infection with the Lyme bacteria, Borrelia burgdorferi sensu lato.
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.[3] Asymptomatic infection exists, but is uncommon.[4]
Other, less common findings in acute Lyme disease include 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 Symptoms
Untreated or persistent cases may progress to a chronic form most commonly characterized by meningoencephalitis, cardiac inflammation (myocarditis), and 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 progession, much like tertiary neurosyphilis.
In addition to the acute symptoms, chronic Lyme disease can be manifested by a wide-range of neurological disorders, either central or peripheral, including encephalitis or encephalomyelitis, muscle twitching, polyneuropathy or paresthesia, and vestibular symptoms or other otolaryngologic symptoms[7][8], among others. 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 mis-diagnoses 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.(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.)</ref>
References
- ↑ 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.
- ↑ Edlow JA (2007-01-25). "Lyme disease". eMedicine. Retrieved 2007-08-21.
- ↑ Steere AC, Sikand VK, Schoen RT, Nowakowski J (2003). "Asymptomatic infection with Borrelia burgdorferi". Clin. Infect. Dis. 37 (4): 528–32. PMID 12905137.
- ↑ 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.