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| __NOTOC__ | | __NOTOC__ |
| {{Lyme disease}}
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| {{CMG}} {{AE}}{{Anmol}}, {{IMD}}
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| ==Overview==
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| [[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.
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| ==History==
| | {{CMG}}; {{AE}} {{Anmol}} |
| *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>
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| *The specific areas of focus when obtaining the history, are outlined below:
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| ** [[Tick]] bite
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| ** Vacation,living, or working environment in endemic areas
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| **Spending time outdoor (especially in woody or grassy area).
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| ==Symptoms== | | ==Tables== |
| [[Lyme disease]] is divided into 3 stages and symptoms are stage specific.
| | {| class="wikitable" |
| #Early localized disease
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| #Early disseminated disease
| | !Diagnosis |
| #Late disseminated disease
| | !Lab findings |
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| ===Early localized disease===
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| Features of early localized disease includes erythema migrans and constitutional symptoms.
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| *'''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>
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| **EM egins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days).
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| **EM gradually expands over a period of days reaching up to 12 inches(30 cm)or more across.
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| **EM may feel warm to touch but is rarely itchy or painful.
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| **EM clears as it enlarges, resulting in a target or “bull’s-eye” appearance.
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| **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.
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| *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>
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| **[[Fatigue]]
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| **[[Arthralgia]]
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| **[[Myalgia]]
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| **[[Headache]]
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| **[[Fever]] and/or [[chills]]
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| **[[Stiff neck]]
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| **[[Anorexia]]
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| ===Early disseminate disease==
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| Features of early disseminated disease can be divided system wise and includes:
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| *Neurological symptoms:<ref name="pmid18452800">{{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>
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| **Lymphocytic meningitis (most common)
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| **Cranial neuropathies(particularly facial nerve palsy)
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| **Painful radiculitis
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| **
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| ===Common Symptoms===
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| *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]]).
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| *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>
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| *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]].
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| *An [[infection]] resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]].
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| ===Less Common===
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| *[[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>)
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| *[[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>
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| ==Chronic Disease==
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| *Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]]
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| *[[Cardiac]] [[inflammation]] ([[myocarditis]])
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| *Frank [[arthritis]]
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| *It should be noted, however, that chronic [[Lyme disease]] can have a multitude of symptoms affecting numerous [[Physiology|physiological]] [[systems]].
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| *The symptoms appear [[heterogeneous]] in the affected [[population]], which may be due to [[innate immunity]] or variations in ''[[Borrelia]]'' [[bacteria]].
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| *Late symptoms of [[Lyme disease]] can appear months or years after initial [[infection]] and often progress in cumulative fashion over time.
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| *[[Neuropsychiatric]] symptoms often develop much later in the disease progression, much like tertiary [[neurosyphilis]].
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| ===Chronic neurological disorders===
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| *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:
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| **[[Encephalitis]] or [[Encephalomyelitis]]
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| **[[Fasciculation|Muscle twitching]]
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| **[[Polyneuropathy]] or [[Paresthesia]]
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| **[[Balance disorder|Vestibular symptoms]]
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| **[[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>
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| *[[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]].
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| *In rare cases, frank [[psychosis]] have been attributed to chronic [[Lyme disease]] effects, including misdiagnoses of [[schizophrenia]] and [[bipolar disorder]].
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| *[[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>
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| ==Lyme Carditis==
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| *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>
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| *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>
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| *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>
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| ==Manifestations of Lyme Disease by Stage==
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| {| 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>''' | |
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| | 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)'''
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| | ''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
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| |- | | |- |
| | ''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
| | ! |
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| | ! |
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| | ''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]] | | | |
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| | ''Lymphatic'' || valign="top" | ▸ Regional [[lymphadenopathy]] || valign="top" | ▸ Regional or generalized [[lymphadenopathy]] <BR> ▸ [[Splenomegaly]] || — | | | |
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| | ''Heart'' || — || valign="top" | ▸ [[Atrioventricular block]] <BR> ▸ [[Myopericarditis]] <BR> ▸ Pancarditis || — | | | |
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| | ''Eyes'' || — || valign="top" | ▸ [[Conjunctivitis]] <BR> ▸ [[Iritis]] <BR> ▸ [[Choroiditis]] <BR> ▸ Retinal hemorrhage or [[retinal detachment]] <BR> ▸ Panophthalmitis|| valign="top" | ▸ [[Keratitis]] | | | |
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| | ''Liver'' || — || ▸ Mild or recurrent [[hepatitis]] || — | |
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| | ''Respiratory'' || — || valign="top" | ▸ Nonexudative [[sore throat]] <BR> ▸ Nonproductive [[cough]] <BR> ▸ [[Adult respiratory distress syndrome]] || —
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| | ''Kidney'' || — || valign="top" | ▸ Microscopic [[hematuria]] or [[proteinuria]] || —
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| | ''Genitourinary'' || — || ▸ [[Orchitis]] || —
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| | ''Constitutional systems'' || ▸ Minor || ▸ Severe [[malaise]] and [[fatigue]] || ▸ [[Fatigue]]
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| |} | | |} |
| <SMALL><span style="align=center">''Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.''</span></SMALL>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{reflist|2}} |
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| [[Category:Bacterial diseases]]
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| [[Category:Insect-borne diseases]]
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| [[Category:Lyme disease]]
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| [[Category:Zoonoses]]
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| [[Category:Spirochaetes]]
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| [[Category:Disease]]
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| [[Category:Infectious disease]]
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| [[Category:Dermatology]]
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