Lyme disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
The physical examination of [[Lyme disease]] is necessary for the diagnosis. Erythema migrans and [[fever]] are commonly seen on physical examination in early disease. Disseminated disease is characterized by multiple erythema migrans, neurological, musculoskeletal, and cardiac symptoms. | The physical examination of [[Lyme disease]] is necessary for the diagnosis. Erythema migrans and [[fever]] are commonly seen on physical examination in early disease. [[Disseminated disease]] is characterized by multiple erythema migrans, [[Neurology|neurological]], [[musculoskeletal]], and [[cardiac]] symptoms.<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> | ||
==Physical Examination in Stage 1 - Early localized disease== | ==Physical Examination in Stage 1 - Early localized disease== | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
*Patients are usually well appearing in early stages; may appear fatigue. | *Patients are usually well appearing in early stages; may appear [[fatigue]]. | ||
===Vital signs=== | ===Vital signs=== | ||
*[[Fever]] and/or chills | *[[Fever]] and/or [[chills]] | ||
=== Skin === | === Skin === | ||
*Erythema migrans (target like lesions) - Usually single, present at the site of tick bite. | *Erythema migrans (target like lesions) - Usually single, present at the site of [[tick]] bite. | ||
*Regional [[Lymphadenopathy]] - Around site of tick bite. | *Regional [[Lymphadenopathy]] - Around site of [[tick]] bite. | ||
===HEENT=== | ===HEENT=== | ||
| Line 27: | Line 27: | ||
*[[Arthralgias]] | *[[Arthralgias]] | ||
*[[Myalgia]] | *[[Myalgia]] | ||
==Physical Examination in Stage 2 - Early disseminated disease== | ==Physical Examination in Stage 2 - Early disseminated disease== | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
*As the disease progresses patient may appear ill. Patient has severe [[malaise]] and fatigue. | *As the disease progresses patient may appear ill. Patient has severe [[malaise]] and [[fatigue]]. | ||
===Vital signs=== | ===Vital signs=== | ||
*Slow or irregular pulse | *Slow or [[irregular pulse]] | ||
=== Skin === | === Skin === | ||
*Erythema migrans (target like lesions) - Usually multiple, multiple lesion are secondary to dissemination; not to be confused with multiple tick bite | *Erythema migrans (target like lesions) - Usually multiple, multiple lesion are secondary to [[Disseminated disease|dissemination]]; not to be confused with multiple [[tick]] bite | ||
*Borrelial lymphocytoma - Cutaneous B-cell pseudolymphoma | *Borrelial lymphocytoma - [[Cutaneous]] [[B-cell]] [[pseudolymphoma]] | ||
*Malar rash | *[[Malar rash]] | ||
*Diffuse erythema or | *Diffuse [[erythema]] or [[urticaria]] | ||
*Regional or generalized [[lymphadenopathy]] | *Regional or generalized [[lymphadenopathy]] | ||
===HEENT=== | ===HEENT=== | ||
*Facial deviation | *[[Facial]] deviation | ||
*Dry eyes | *[[Dry eyes]] | ||
*Drooling of saliva | *Drooling of saliva | ||
*Blurred vision | *Blurred vision | ||
| Line 52: | Line 50: | ||
===Neck=== | ===Neck=== | ||
*[[Neck stiffness]] | *[[Neck stiffness]] | ||
*Neck pain | *[[Neck pain]] | ||
*Cannon A waves in patients with complete heart block | *[[Cannon A waves]] in patients with [[complete heart block]] | ||
===Cardiovascular=== | ===Cardiovascular=== | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*Palpitations | *[[Palpitation|Palpitations]] | ||
*Cardiac rub | *[[Cardiac]] rub | ||
*Dyspnea | *[[Dyspnea]] | ||
*S3 and/or S4 may be present | *[[S3]] and/or [[S4]] may also be present | ||
===Abdomen=== | ===Abdomen=== | ||
*Splenomegaly | *[[Splenomegaly]] | ||
===Neurological=== | ===Neurological=== | ||
| Line 72: | Line 70: | ||
===Muscuoskeletal=== | ===Muscuoskeletal=== | ||
*Migratory arthralgia | *Migratory [[arthralgia]] | ||
==Physical Examination in Stage 3 - Late disseminated disease== | ==Physical Examination in Stage 3 - Late disseminated disease== | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
*Patients appear ill and fatigue. | *Patients appear ill and [[fatigue]]. | ||
===Skin=== | ===Skin=== | ||
*Acrodermatitis chronica atrophicans | *[[Acrodermatitis chronica atrophicans]] | ||
*Localized scleroderma-like lesions | *Localized [[scleroderma]]-like lesions | ||
===HEENT=== | ===HEENT=== | ||
*Severe | *Severe [[headache]] | ||
*Sore throat | *[[Sore throat]] | ||
*Vision changes | *[[Vision]] changes | ||
*Odynophagia | *[[Odynophagia]] | ||
*Otalgia | *[[Otalgia]] | ||
*Tinnitus | *[[Tinnitus]] | ||
*Hearing loss | *[[Hearing loss]] | ||
*Vertigo | *[[Vertigo]] | ||
*Temporomandibular joint pain | *[[Temporomandibular joint pain]] | ||
*Dysgeusia | *[[Dysgeusia]] | ||
===Neck=== | ===Neck=== | ||
*Tender neck flexion | *[[Tenderness (medicine)|Tender]] [[neck]] [[flexion]] | ||
*Neck pain | *[[Neck pain]] | ||
===Neurological=== | ===Neurological=== | ||
*Fasciculations | *[[Fasciculations]] | ||
*Spastic | *[[Spastic]] [[paraparesis]] | ||
*[[Ataxia]] | *[[Ataxia]] | ||
*Neuropsychiatric findings includes dementia, anxiety, depression, | *[[Neuropsychiatric]] findings includes [[dementia]], [[anxiety]], [[depression]], [[schizophrenia]]-like [[psychosis]], [[bipolar disorder]] | ||
=== Muscukoskeletal === | === Muscukoskeletal === | ||
*[[Arthralgias]] - Commonly involving knee, may be migratory | *[[Arthralgias]] - Commonly involving [[knee]], may be migratory | ||
*Joint tenderness | *[[Joint]] [[tenderness]] | ||
*Joint swelling | *[[Joint swelling]] | ||
*Joint | *Joint effusion | ||
*Enthesitis | *[[Enthesitis]] | ||
* | *[[Periostitis]] or [[joint]] [[Subluxation|subluxations]] below [[Acrodermatitis chronica atrophicans|acrodermatitis]] | ||
Revision as of 16:08, 1 August 2017
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Lyme disease physical examination On the Web |
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American Roentgen Ray Society Images of Lyme disease physical examination |
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Risk calculators and risk factors for Lyme disease physical examination |
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]
Overview
The physical examination of Lyme disease is necessary for the diagnosis. Erythema migrans and fever are commonly seen on physical examination in early disease. Disseminated disease is characterized by multiple erythema migrans, neurological, musculoskeletal, and cardiac symptoms.[1]
Physical Examination in Stage 1 - Early localized disease
Appearance of the patient
- Patients are usually well appearing in early stages; may appear fatigue.
Vital signs
Skin
- Erythema migrans (target like lesions) - Usually single, present at the site of tick bite.
- Regional Lymphadenopathy - Around site of tick bite.
HEENT
Neck
Muscukoskeletal
Physical Examination in Stage 2 - Early disseminated disease
Appearance of the patient
Vital signs
- Slow or irregular pulse
Skin
- Erythema migrans (target like lesions) - Usually multiple, multiple lesion are secondary to dissemination; not to be confused with multiple tick bite
- Borrelial lymphocytoma - Cutaneous B-cell pseudolymphoma
- Malar rash
- Diffuse erythema or urticaria
- Regional or generalized lymphadenopathy
HEENT
Neck
- Neck stiffness
- Neck pain
- Cannon A waves in patients with complete heart block
Cardiovascular
- Tachycardia
- Palpitations
- Cardiac rub
- Dyspnea
- S3 and/or S4 may also be present
Abdomen
Neurological
Muscuoskeletal
- Migratory arthralgia
Physical Examination in Stage 3 - Late disseminated disease
Appearance of the patient
- Patients appear ill and fatigue.
Skin
- Acrodermatitis chronica atrophicans
- Localized scleroderma-like lesions
HEENT
- Severe headache
- Sore throat
- Vision changes
- Odynophagia
- Otalgia
- Tinnitus
- Hearing loss
- Vertigo
- Temporomandibular joint pain
- Dysgeusia
Neck
Neurological
- Fasciculations
- Spastic paraparesis
- Ataxia
- Neuropsychiatric findings includes dementia, anxiety, depression, schizophrenia-like psychosis, bipolar disorder
Muscukoskeletal
- Arthralgias - Commonly involving knee, may be migratory
- Joint tenderness
- Joint swelling
- Joint effusion
- Enthesitis
- Periostitis or joint subluxations below acrodermatitis
Images
-
Common bullseye rash pattern associated with Lyme Disease. -
Characteristic "bulls-eye"-like rash caused by Lyme disease. -
Erythema Chronicum Migrans
.jpg)
-
![Right posterior shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/images/c/c8/Borrelia07.jpeg)
Right posterior shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2] -
![Left lateral buttock of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/images/b/b4/Borrelia08.jpeg)
Left lateral buttock of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2] -
![Right hip and waist region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/images/2/2a/Borrelia10.jpeg)
Right hip and waist region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2] -
![Posterior knee with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by the bacterium, Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/images/1/1c/Borrelia11.jpeg)
Posterior knee with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by the bacterium, Borrelia burgdorferi. From Public Health Image Library (PHIL). [2] -
![Medial aspect of the right calf of a patient who’d presented with what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/images/f/fa/Borrelia14.jpeg)
Medial aspect of the right calf of a patient who’d presented with what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2] -
![Posterior right shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/images/6/61/Borrelia15.jpeg)
Posterior right shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2] -
![This Lyme disease patient presented with the signs and symptoms indicative of arthritic changes to his right knee due to a Borrelia burgdorferi bacterial infection. From Public Health Image Library (PHIL). [2]](/images/c/c8/Borrelia17.jpeg)
This Lyme disease patient presented with the signs and symptoms indicative of arthritic changes to his right knee due to a Borrelia burgdorferi bacterial infection. From Public Health Image Library (PHIL). [2] -
![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2]](/images/4/40/Borrelia31.jpeg)
Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2] -
![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2]](/images/6/69/Borrelia32.jpeg)
Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2] -
![Facial palsy caused by an infection by the bacterial spirochete Borrelia burgdorferi. Patient was subsequently diagnosed with Lyme disease. From Public Health Image Library (PHIL). [2]](/images/6/6c/Borrelia36.png)
Facial palsy caused by an infection by the bacterial spirochete Borrelia burgdorferi. Patient was subsequently diagnosed with Lyme disease. From Public Health Image Library (PHIL). [2]
![Right posterior shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia07.jpeg)
![Left lateral buttock of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia08.jpeg)
![Right hip and waist region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia10.jpeg)
![Posterior knee with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by the bacterium, Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia11.jpeg)
![Medial aspect of the right calf of a patient who’d presented with what was diagnosed as Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia14.jpeg)
![Posterior right shoulder region of a patient who’d presented with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by Borrelia burgdorferi. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia15.jpeg)
![This Lyme disease patient presented with the signs and symptoms indicative of arthritic changes to his right knee due to a Borrelia burgdorferi bacterial infection. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia17.jpeg)
![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia31.jpeg)
![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia32.jpeg)
![Facial palsy caused by an infection by the bacterial spirochete Borrelia burgdorferi. Patient was subsequently diagnosed with Lyme disease. From Public Health Image Library (PHIL). [2]](/index.php/File:Borrelia36.png)