Lyme disease differential diagnosis: Difference between revisions

	Lyme disease Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Epidemiology and Demographics
Causes
Differentiating Lyme disease from other Diseases
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
ECG
X-ray
CT scan
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Sudies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Lyme disease differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Lyme disease differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Lyme disease differential diagnosis
CDC on Lyme disease differential diagnosis
Lyme disease differential diagnosis in the news
Blogs on Lyme disease differential diagnosis
Directions to Hospitals Treating Lyme disease
Risk calculators and risk factors for Lyme disease differential diagnosis

← Older edit Newer edit →

VisualWikitext

Revision as of 16:47, 8 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Lyme disease must be differentiated from babesiosis, leptospirosis, mononucleosis, viral meningitis, and chronic diseases such as SLE, fibromyalgia, and chronic fatigue syndrome.

Differentiating Lyme disease from other tick-borne diseases

Lyme disease must be differentiated from other diseases that may cause arthralgia, fever, and skin manifestations and that are associated with a history of tick exposure.

Disease		Organism	Vector	Symptoms
Bacterial Infection
Borreliosis (Lyme Disease) ^[1]		Borrelia burgdorferi sensu lato complex and B. mayonii	I. scapularis, I. pacificus, I. ricinus, and I. persulcatus	Erythema migrans, flu-like illness(fatigue, fever), Lyme arthritis, neuroborreliosis, and carditis.
Relapsing Fever ^[2]	Tick-borne relapsing fever (TBRF):	Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii	Ornithodoros species	Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental status, painful urination, rash, and rigors.
Relapsing Fever ^[2]	Louse-borne relapsing fever (LBRF) :	Borrelia recurrentis	Pediculus humanus
Typhus (Rickettsia)
Rocky Mountain Spotted Fever		Rickettsia rickettsii	Dermacentor variabilis, Dermacentor andersoni	Fever, altered mental status, myalgia, rash, and headaches.
Helvetica Spotted Fever ^[3]		Rickettsia helvetica	Ixodes ricinus	Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis (Anaplasmosis) ^[4]		Ehrlichia chaffeensis, Ehrlichia ewingii	Amblyomma americanum, Ixodes scapularis	Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia ^[5]		Francisella tularensis	Dermacentor andersoni, Dermacentor variabilis	Ulceroglandular, glandular, oculoglandular, oroglandular, pneumonic, typhoidal.
Viral Infection
Tick-borne meningoencephalitis ^[6]		TBEV virus	Ixodes scapularis, I. ricinus, I. persulcatus	Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Colorado Tick Fever ^[7]		CTF virus	Dermacentor andersoni	Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever		CCHF virus	Hyalomma marginatum, Rhipicephalus bursa	Initially infected patients will likely feel a few of the following symptoms: headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis ^[8]		Babesia microti, Babesia divergens, Babesia equi	Ixodes scapularis, I. pacificus	Non-specific flu-like symptoms.

Differentiating Lyme Arthritis from other causes of Infectious Arthritis

Microorganism or other infectious disease	Associated risk factors	Key clinical clues
Lyme disease	Living in endemic area or history of recent visit to endemic area Exposure to ticks	History of erythema migrans
Staphylococcus aureus	Rheumatoid arthritis^[9] Diabetes mellitus^[10] HIV patients^[11]	Healthy adult with skin lesions and previously history of damaged joint (e.g, rheumatoid arthritis) or prosthetic joint
Streptococcus pyogenes Streptococcal pneumonia	Autoimmune diseases^[12] Chronic skin infections^[10] Trauma	Healthy adults with spleenic dysfunction
Groups B Streptococcal infection	Immunocompromised patients^[13] Diabetes mellitus Malignancy Severe genitourinary or gastrointestinal infections	Healthy adults with spleenic dysfunction
Neisseria gonorrhoeae	Complement deficiency Systemic lupus erythematosus Male homosexuality low socioeconomic status	Healthy young and sexually active adult with Tenosynovitis Skin lesions such as vesicular pustules Complement deficiency (C5-9 deficiency) Culture negativity on synovial fluid analysis
Gram-negative bacilli Pseudomonas Escherichia coli	History of intravenous drug abuse^[14] Extremes of age Immunocompromised patients	Immunocompromised patients Recent history gastrointestinal infections such as infectious diarrhea caused by Shigella, Salmonella, Campylobacter, or Yersinia
Haemophilus influenzae	Unimmunized children^[15]
Anaerobes	Diabetes mellitus Patients with prosthetic joints	Immunocompromised hosts Recent history of gastrointestinal infection
Mycobacterium spp.	Recent history of travel to endemic areas	Immunocompromised patients Recent history of travel to endemic areas (e.g. India, South Africa, Mexico etc.) Incidious onset of monoarthritis
Fungal infection such as Blastomycosis Cryptococcus Coccidioidomycosis Sporotrichosis	Immunocompromised patients	Immunocompromised patients Incidious onset of monoarthritis
Mycoplasma hominis	Recent history of urinary tract procedure	Immunocompromised patients Recent history of urinary tract procedure^[16]
Viral arthritis	Immunocompromised patient	Polyarthritis Fever Rash
HIV infection	History of multiple sexual partners History of IVDA	Sterile, acute synovitis or reactive arthritis
Reactive arthritis	Recent gastrointestinal/ genitourinary infection	Recent gastrointestinal/ genitourinary infection Enthesopathy Skin lesions Uveitis Conjunctivitis
Endocarditis	History of endocarditis Damaged heart valves Congenital heart diseases	Fever New onset of heart murmur Septic and sterile synovitis Septic joint more common in IVDA

Differentiating Lyme arthritis from other causes of Acute Arthritis

Lyme disease can be differentiated from other causes of acute arthritis on the basis of synovial fluid analysis.

Type of Arthritis	Color	Transparency	Viscosity	Volume (in ml)	WBC count (per mm3)	PMN cellcount (%)	Gram stain	Gram Culture	polymerase chain reaction (PCR) test	Crystals
Normal	Clear	Transparent	High/thick	< 3.5	< 200	< 25	Negative	Negative	Negative	Negative
Lyme arthritis	Yellow	Cloudy	Low	Often >3.5	3,000 to 100,000 (mean: 25,000)	> 50	Negative	Negative	Positive (85 percent)	Negative
Gonococcal arthritis	Yellow	Cloudy-opaque	Low	Often >3.5	34,000 to 68,000	> 75	Variable (< 50 percent)	Positive (25 to 70 percent)	Positive (> 75 percent)	Negative
Non-gonococcal arthritis	Yellowish-green	Opaque	Very low	Often >3.5	> 50,000 (> 100,000 is more specific)	> 75	Positive (60 to 80 percent)	Positive (> 90 percent)	--	Negative
Inflammatory: crystalline arthritis (e.g.Gout, Pseudogout)	Yellow	Cloudy	Low/thin	Often >3.5	2,000 to 100,000	> 50	Negative	Negative	Negative	Positive
Inflammatory: non-crystalline arthritis (e.g. Rheumatoid arthritis, reactive arthritis)	Yellow	Cloudy	Low/thin	Often >3.5	2,000 to 100,000	> 50	Negative	Negative	Negative	Negative
Noninflammatory arthritis (e.g. Osteoarthritis)	Straw	Translucent	High/thick	Often >3.5	200 to 2,000	< 25	Negative	Negative	Negative	Negative
Hemorrhagic	Red	Bloody	Variable	Usually >3.5	Variable	50-75	Negative	Negative	Negative	Negative

Differentiating Lyme disease from other diseases

References

↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
↑ Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
↑ ^10.0 ^10.1 Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63 (2):103-10. PMID: 8689280
↑ Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76 (4):284-94. PMID: 9279334
↑ Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665
↑ Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77 (2):122-39. PMID: 9556703
↑ Deesomchok U, Tumrasvin T (1990) Clinical study of culture-proven cases of non-gonococcal arthritis. J Med Assoc Thai 73 (11):615-23. PMID: 2283490
↑ De Jonghe M, Glaesener G (1995) [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg.] Bull Soc Sci Med Grand Duche Luxemb 132 (2):17-20. PMID: 7497542
↑ Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) Mycoplasma hominis septic arthritis: two case reports and review. Clin Infect Dis 19 (6):1067-70. PMID: 7888535
↑ "Lyme Disease Diseases With Similar Symptoms - Lyme Disease Health Information - NY Times Health". Retrieved 2013-03-14.

Template:WikiDoc Sources

[Lyme_CDC”-1] Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015

[TBRF_CDC”-2] Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015

[RMSF_CDC”-3] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015

[Ehrlichiosis_CDC”-4] Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015

[Tulameria_CDC”-5] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015

[TBE_CDC”-6] General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015

[GenTickDis_CDC”-7] General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015

[Babesiosis_CDC”-8] Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.

[pmid769545-9] Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545

[pmid8689280-10] 10.0 ^10.1 Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63 (2):103-10. PMID: 8689280

[pmid9279334-11] Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76 (4):284-94. PMID: 9279334

[pmid8972665-12] Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665

[pmid9556703-13] Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77 (2):122-39. PMID: 9556703

[pmid2283490-14] Deesomchok U, Tumrasvin T (1990) Clinical study of culture-proven cases of non-gonococcal arthritis. J Med Assoc Thai 73 (11):615-23. PMID: 2283490

[pmid7497542-15] De Jonghe M, Glaesener G (1995) [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg.] Bull Soc Sci Med Grand Duche Luxemb 132 (2):17-20. PMID: 7497542

[pmid7888535-16] Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) Mycoplasma hominis septic arthritis: two case reports and review. Clin Infect Dis 19 (6):1067-70. PMID: 7888535

[urlLyme_Disease_Diseases_With_Similar_Symptoms_-_Lyme_Disease_Health_Information_-_NY_Times_Health-17] "Lyme Disease Diseases With Similar Symptoms - Lyme Disease Health Information - NY Times Health". Retrieved 2013-03-14.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

@@ Line 7: / Line 7: @@
 ==Differentiating Lyme disease from other tick-borne diseases==
 Lyme disease must be differentiated from other diseases that may cause [[arthralgia]], [[fever]], and skin manifestations and that are associated with a history of tick exposure.
-{| style="font-size: 85%;
+{| style="font-size: 85%;"
 ! style="width: 80px; background: #4479BA; text-align: center;" colspan="2" |{{fontcolor|#FFF|Disease}}
 ! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Organism}}
@@ Line 87: / Line 87: @@
 ==Differentiating Lyme Arthritis from other causes of Infectious Arthritis==
-{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
+{| width="75%" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" border="2" cellspacing="0" cellpadding="4"
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Microorganism or other infectious disease'''}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF| '''Microorganism or other infectious disease'''}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Associated risk factors'''}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF| '''Associated risk factors'''}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Key clinical clues}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Key clinical clues}}
 |-
 ![[Lyme disease]]
@@ Line 227: / Line 227: @@
 ==Differentiating Lyme arthritis from other causes of Acute Arthritis==
-Lyme disease can be differentiated from other causes of acute arthritis on the basis of synovial fluid analysis
+Lyme disease can be differentiated from other causes of acute arthritis on the basis of synovial fluid analysis.
 {| border="1"
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Type of
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Type of
 Arthritis}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Color}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Color}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Transparency}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Transparency}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Viscosity}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Viscosity}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Volume
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Volume
 (in ml)}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|WBC count
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|WBC count
 (per mm3)}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|PMN
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|PMN
 cellcount (%)}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Gram stain}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Gram stain}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Gram Culture}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Gram Culture}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|polymerase chain reaction
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|polymerase chain reaction
 (PCR) test}}
-!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Crystals}}
+! style="background: #4479BA; text-align: center;" colspan="1" | {{fontcolor|#FFF|Crystals}}
 |-
 ! Normal !! Clear !! Transparent !! High/thick