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{{Lyme disease}}
{{Lyme disease}}
{{CMG}} {{AE}} {{Anmol}}{{IMD}}
{{CMG}} {{AE}}{{Anmol}}, {{IMD}}
==Overview==
==Overview==
[[Lyme disease]] is the most commonly reported vector-borne illness in the United States. In 2015, it was the sixth most common Nationally Notifiable disease. The number of people diagnosed with [[Lyme disease]] each year in the United States is around 30,000. This disease is concentrated heavily in the northeast and upper mid-west.  
[[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.
==Epidemiology and Demographics==


===Incidence===
==History==
*Lyme disease is the most common [[tick-borne disease]] in North America and Europe, and one of the fastest-growing [[infectious diseases]] in the United States.
*The [[incubation period]] from [[infection]] to the onset of symptoms is usually 1&ndash;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>
* The number of people diagnosed with [[Lyme disease]] each year in the United States is around 30,000.<ref name="urlLyme disease data tables | Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/stats/tables.html |title=Lyme disease data tables &#124; Lyme Disease &#124; CDC |format= |work= |accessdate=}}</ref>  
*The specific areas of focus when obtaining the history, are outlined below:
* In the United states, the [[incidence]] of [[Lyme disease]] is 8.9 per 100,000 persons; as per data collected by [[Center for Disease Control]] ([[CDC]]). <ref name="urlLyme disease data tables | Lyme Disease | CDC" />
** [[Tick]] bite
*In the fourteen states where [[Lyme disease]] is most common , the average was 40.4 cases for every 100,000 persons for the year 2015.<ref name="urlLyme disease data tables | Lyme Disease | CDC" /><ref name="urlData and Statistics | Lyme Disease | CDC">{{cite web |url=https://www.cdc.gov/lyme/stats/index.html |title=Data and Statistics &#124; Lyme Disease &#124; CDC |format= |work= |accessdate=}}</ref>
** Vacation,living, or working environment in endemic areas
*Although [[Lyme disease]] has now been reported in majority of states in the U.S, about 95% of all reported cases are confined to just five geographic areas including New England, Mid-Atlantic, East-North Central, South Atlantic, and West North-Central.<ref name="urlData and Statistics | Lyme Disease | CDC" />
**Spending time outdoor (especially in woody or grassy area).
[[Image:Reported cases of lyme disease in usa from 2001-2015.gif|center|750px|frame|Reported cases of Lyme disease in the United Stated from 2001 to 2015]]


=== Seasonal Variation ===
==Symptoms==
*[[Prevalence]] of [[infection]] in adult [[ticks]] are more then nymph stage by [[pathogens]] [[infectious]] to humans.<ref name="SchwartzFish1997">{{cite journal|last1=Schwartz|first1=Ira|last2=Fish|first2=Durland|last3=Daniels|first3=Thomas J.|title=Prevalence of the Rickettsial Agent of Human Granulocytic Ehrlichiosis in Ticks from a Hyperendemic Focus of Lyme Disease|journal=New England Journal of Medicine|volume=337|issue=1|year=1997|pages=49–50|issn=0028-4793|doi=10.1056/NEJM199707033370111}}</ref> But the majority of [[infections]] are caused by [[ticks]] in the nymph stage during late spring and summer.<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>
[[Lyme disease]] is divided into 3 stages and symptoms are stage specific.
*This is the reason for an increase in [[incidence]] of [[Lyme disease]] during the months of May to August.
#Early localized disease
#Early disseminated disease
#Late disseminated disease


[[image:Seasonal variation of lyme disease.jpg|center|500px|thumb|Confirmed [[Lyme disease]] cases by month of disease onset–United States, 2001-2015]]
===Early localized disease===
Features of early localized disease includes erythema migrans and constitutional symptoms.
*'''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>
**EM egins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days).
**EM gradually expands over a period of days reaching up to 12 inches(30 cm)or more across.
**EM may feel warm to touch but is rarely itchy or painful.
**EM clears as it enlarges, resulting in a target or “bull’s-eye” appearance.
**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.
*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>
**[[Fatigue]]
**[[Arthralgia]]
**[[Myalgia]]
**[[Headache]]
**[[Fever]] and/or [[chills]]
**[[Stiff neck]]
**[[Anorexia]]


===Widespread disease and endemic regions===
===Early disseminate disease==
*The number of reported cases of [[Disease|the disease]] have been increasing, as are [[Endemic (epidemiology)|endemic]] regions in North America.
Features of early disseminated disease can be divided system wise and includes:
*''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato has been maintained in enzootic cycles in California as well as other regions throughout North America, Europe and North Africa. Indeed, the [[DNA]] of ''[[Borrelia]]'' has been detected in lizards, indicating that they can be [[Infection (disambiguation)|infected]].<ref>{{cite journal |author=Swanson KI, Norris DE |title=Detection of Borrelia burgdorferi DNA in lizards from Southern Maryland |journal=Vector Borne Zoonotic Dis. |volume=7 |issue=1 |pages=42-9 |year=2007 |pmid=17417956 |doi=10.1089/vbz.2006.0548}}</ref>  
*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>
**Lymphocytic meningitis (most common)
**Cranial neuropathies(particularly facial nerve palsy)
**Painful radiculitis
**


*In Europe, cases of ''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato [[infected]] [[Tick|ticks]] are found predominantly in Norway, Netherlands, Germany, France, Italy, Slovenia and Poland, but have been isolated in almost every country on the continent. [[Lyme disease]] statistics for Europe can be found at [http://www.eurosurveillance.org/ew/2006/060622.asp Eurosurveillance website].
===Common Symptoms===
*''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato infested [[Tick|ticks]] are being found more frequently in Japan, as well as in northwest China and far eastern Russia.<ref>{{cite journal |author=Li M, Masuzawa T, Takada N, ''et al'' |title=Lyme disease Borrelia species in northeastern China resemble those isolated from far eastern Russia and Japan |journal=Appl. Environ. Microbiol. |volume=64 |issue=7 |pages=2705-9 |year=1998 |pmid=9647853 |url=http://aem.asm.org/cgi/content/full/64/7/2705?view=long&pmid=9647853}}</ref><ref>{{cite journal |author=Masuzawa T |title=Terrestrial distribution of the Lyme borreliosis agent Borrelia burgdorferi sensu lato in East Asia |journal=Jpn. J. Infect. Dis. |volume=57 |issue=6 |pages=229-35 |year=2004 |pmid=15623946 |url = http://www.nih.go.jp/JJID/57/229.html}}</ref> ''[[Borrelia]]'' has been isolated in Mongolia as well.<ref>{{cite journal |author=Walder G, Lkhamsuren E, Shagdar A, ''et al'' |title=Serological evidence for tick-borne encephalitis, borreliosis, and human granulocytic anaplasmosis in Mongolia |journal=Int. J. Med. Microbiol. |volume=296 Suppl 40 |issue= |pages=69-75 |year=2006 |pmid=16524782 |doi=10.1016/j.ijmm.2006.01.031}}</ref>
*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]]).  
*In South America [[tick-borne disease]] recognition and occurrence is rising.  
*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>  
*[[Tick|Ticks]] carrying ''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato, as well as canine and human [[tick-borne disease]], have been reported widely in Brazil, but the subspecies of ''Borrelia'' has not yet been defined.<ref>{{cite journal |author=Mantovani E, Costa IP, Gauditano G, Bonoldi VL, Higuchi ML, Yoshinari NH |title=Description of Lyme disease-like syndrome in Brazil. Is it a new tick borne disease or Lyme disease variation? |journal=Braz. J. Med. Biol. Res. |volume=40 |issue=4 |pages=443-56 |year=2007 |pmid=17401487 }}</ref> The first reported case of [[Lyme disease]] in Brazil was made in 1993 in Sao Paulo.<ref>{{cite journal |author=Yoshinari NH, Oyafuso LK, Monteiro FG, ''et al'' |title=Lyme disease. Report of a case observed in Brazil |language=Portuguese |journal=Revista do Hospital das Clínicas |volume=48 |issue=4 |pages=170-4 |year=1993 |pmid=8284588 }}</ref> 
*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]].  
*''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu stricto antigens in patients have been identified in Colombia and in Bolivia.
*An [[infection]] resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]].
*In Northern Africa, ''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato has been identified in Morocco, Algeria, Egypt and Tunisia.<ref>{{cite journal |author=Bouattour A, Ghorbel A, Chabchoub A, Postic D |title=Lyme borreliosis situation in North Africa |language=French |journal=Archives de l'Institut Pasteur de Tunis |volume=81 |issue=1-4 |pages=13-20 |year=2004 |pmid=16929760 }}</ref><ref>{{cite journal |author=Dsouli N, Younsi-Kabachii H, Postic D, ''et al'' |title=Reservoir role of lizard Psammodromus algirus in transmission cycle of Borrelia burgdorferi sensu lato (Spirochaetaceae) in Tunisia |journal=J. Med. Entomol. |volume=43 |issue=4 |pages=737-42 |year=2006 |pmid=16892633 }}</ref><ref>{{cite journal |author=Helmy N |title=Seasonal abundance of Ornithodoros (O.) savignyi and prevalence of infection with Borrelia spirochetes in Egypt |journal=Journal of the Egyptian Society of Parasitology |volume=30 |issue=2 |pages=607-19 |year=2000 |pmid=10946521}}</ref>
*In Western and sub-Saharan Africa, tick-borne [[relapsing fever]] was first identified by the British physicians Joseph Dutton and John Todd in 1905. ''[[Borrelia]]'' in the manifestation of [[Lyme disease]] in this region is presently unknown but evidence indicates that Lyme disease may occur in humans in sub-Saharan Africa. The abundance of hosts and [[tick]] [[Vector|vectors]] would favor the establishment of [[Lyme]] [[infection]] in Africa.<ref>{{cite journal |author=Fivaz BH, Petney TN |title=Lyme disease--a new disease in southern Africa? |journal=Journal of the South African Veterinary Association |volume=60 |issue=3 |pages=155-8 |year=1989 |pmid=2699499}}</ref> In East Africa, two cases of [[Lyme disease]] have been reported in Kenya.<ref>{{cite journal |author=Jowi JO, Gathua SN |title=Lyme disease: report of two cases |journal=East African medical journal |volume=82 |issue=5 |pages=267-9 |year=2005 |pmid=16119758}}</ref>
*In Australia there is no definitive evidence for the existence of ''[[Borrelia burgdorferi|B. burgdorferi]]'' or for any other [[Tick-borne disease|tick-borne]] [[Spirochaete|spirochete]] that may be responsible for a local syndrome being reported as [[Lyme disease]].<ref>{{cite journal |author=Piesman J, Stone BF |title=Vector competence of the Australian paralysis tick, Ixodes holocyclus, for the Lyme disease spirochete Borrelia burgdorferi |journal=Int. J. Parasitol. |volume=21 |issue=1 |pages=109-11 |year=1991 |pmid=2040556}}</ref> Cases of neuroborreliosis have been documented in Australia but are often ascribed to travel to other continents. The existence of [[Lyme disease]] in Australia is controversial. 
*Data shows that Northern hemisphere temperate regions are most [[Endemic (epidemiology)|endemic]] for [[Lyme disease|Lyme diseas]]<nowiki/>e.<ref>{{cite journal |author=Grubhoffer L, Golovchenko M, Vancová M, Zacharovová-Slavícková K, Rudenko N, Oliver JH |title=Lyme borreliosis: insights into tick-/host-borrelia relations |journal=Folia Parasitol. |volume=52 |issue=4 |pages=279-94 |year=2005 |pmid=16405291}}</ref><ref>{{cite journal |author=Higgins R |title=Emerging or re-emerging bacterial zoonotic diseases: bartonellosis, leptospirosis, Lyme borreliosis, plague |journal=Rev. - Off. Int. Epizoot. |volume=23 |issue=2 |pages=569-81 |year=2004 |pmid=15702720}}</ref>


[[Image:Geographical distribution of reported Lyme Disease cases.png|centre|650px|Geographical distribution of Lyme disease.]]
===Less Common===
*[[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>)
*[[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>


<br clear="left" />
==Chronic Disease==
*Untreated or persistent cases may progress to a chronic form most commonly characterized by [[meningoencephalitis]]
*[[Cardiac]] [[inflammation]] ([[myocarditis]])
*Frank [[arthritis]]
*It should be noted, however, that chronic [[Lyme disease]] can have a multitude of symptoms affecting numerous [[Physiology|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 progression, much like tertiary [[neurosyphilis]].


===Age===
===Chronic neurological disorders===
*There's a higher [[incidence]] of [[infection]] among children and infants of less than a year to 15 years.
*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:
*Another peak occurs in individuals between the ages of 40 to 55 years.
**[[Encephalitis]] or [[Encephalomyelitis]]
**[[Fasciculation|Muscle twitching]]
**[[Polyneuropathy]] or [[Paresthesia]]
**[[Balance disorder|Vestibular symptoms]]
**[[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>
*[[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]].
*In rare cases, frank [[psychosis]] have been attributed to chronic [[Lyme disease]] effects, including misdiagnoses 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.<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>


===Gender===
==Lyme Carditis==
*On average, there is a higher incidence among males than females.
*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>
*However among ages 70 and higher, females tend to have a higher incidence of infection.
*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>
[[Image:Agesex lyme.gif|center|500px|thumb|Peaks occur in males between the ages of less than one year to 15 and 40 to 55 years. Female patients are at a slightly higher risk than male patients above the age of 70.]]
*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>


===Race===
==Manifestations of Lyme Disease by Stage==
*[[Lyme disease]] is more prevalent in the white people.<ref name="urlRacial Disparities in Nationally Notifiable Diseases --- United States, 2002">{{cite web |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a4.htm |title=Racial Disparities in Nationally Notifiable Diseases --- United States, 2002 |format= |work= |accessdate=}}</ref>
{| 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>'''
|-
| 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)'''
|-
| ''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
|-
| ''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
|-
| ''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]]
|-
| ''Lymphatic'' || valign="top" | ▸ Regional [[lymphadenopathy]] || valign="top" | ▸ Regional or generalized [[lymphadenopathy]] <BR> ▸ [[Splenomegaly]] || —
|-
| ''Heart'' || — || valign="top" | ▸ [[Atrioventricular block]] <BR> ▸ [[Myopericarditis]] <BR> ▸ Pancarditis || —
|-
| ''Eyes'' || — || valign="top" | ▸ [[Conjunctivitis]] <BR> ▸ [[Iritis]] <BR> ▸ [[Choroiditis]] <BR> ▸ Retinal hemorrhage or [[retinal detachment]] <BR> ▸ Panophthalmitis|| valign="top" | ▸ [[Keratitis]]
|-
| ''Liver'' || — || ▸ Mild or recurrent [[hepatitis]] || —
|-
| ''Respiratory'' || — || valign="top" | ▸ Nonexudative [[sore throat]] <BR> ▸ Nonproductive [[cough]] <BR> ▸ [[Adult respiratory distress syndrome]] || —
|-
| ''Kidney'' || — || valign="top" | ▸ Microscopic [[hematuria]] or [[proteinuria]] || —
|-
| ''Genitourinary'' || — || ▸ [[Orchitis]] || —
|-
| ''Constitutional systems'' || ▸ Minor || ▸ Severe [[malaise]] and [[fatigue]] || ▸ [[Fatigue]]
|}
<SMALL><span style="align=center">''Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.''</span></SMALL>


==References==
==References==
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[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Dermatology]]
[[Category:Dermatology]]
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[[Category:Intensive care medicine]]


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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. Symptoms include "bulls-eye" rash, with accompanying fever, malaise, and musculoskeletal pain (arthralgia or myalgia). 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. Early localized disease
  2. Early disseminated disease
  3. Late disseminated disease

Early localized disease

Features of early localized disease includes erythema migrans and constitutional symptoms.

  • Erythema migrans (EM) also known as Erythema chronicum migrans, "bull’s-eye" rash, or Lyme rash develops in around 70% - 80% of patients.[3]
    • EM egins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days).
    • EM gradually expands over a period of days reaching up to 12 inches(30 cm)or more across.
    • EM may feel warm to touch but is rarely itchy or painful.
    • EM clears as it enlarges, resulting in a target or “bull’s-eye” appearance.
    • 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.
  • Constitutional symptoms includes:[4]

=Early disseminate disease

Features of early disseminated disease can be divided system wise and includes:

  • Neurological symptoms:[5]
    • Lymphocytic meningitis (most common)
    • Cranial neuropathies(particularly facial nerve palsy)
    • Painful radiculitis

Common Symptoms

Less Common

Chronic Disease

Chronic neurological disorders

Lyme Carditis

Manifestations of Lyme Disease by Stage

Manifestations of Lyme Disease by Stage[14]
System Stage 1 (Localized Infection) Stage 2 (Disseminated Infection) Stage 3 (Persistent Infection)
Skin ▸ Erythema migrans ▸ Secondary annular lesions
▸ Malar rash
▸ Diffuse erythema or urticaria
▸ Evanescent lesions
▸ Lymphocytoma		 ▸ Acrodermatitis chronica atrophicans
▸ Localized scleroderma-like lesions
Musculoskeletal — ▸ Migratory arthralgia
▸ Brief arthritis attacks
▸ Myositis
▸ Osteomyelitis
▸ Panniculitis		 ▸ Prolonged arthritis attacks
▸ Chronic arthritis
▸ Peripheral enthesopathy
▸ Periostitis or joint subluxations below acrodermatitis
Neurologic — ▸ Meningitis
▸ Cranial neuritis or Bell's palsy
▸ Motor or sensory radiculoneuritis
▸ Encephalitis
▸ Mononeuritis multiplex
▸ Pseudotumor cerebri
▸ Myelitis
▸ Chorea
▸ Cerebellar ataxia		 ▸ Chronic encephalomyelitis
▸ Spastic parapareses
▸ Ataxic gait
▸ Mental disorders
▸ Chronic axonal polyradiculopathy
▸ Dementia
Lymphatic ▸ Regional lymphadenopathy ▸ Regional or generalized lymphadenopathy
▸ Splenomegaly		 —
Heart — ▸ Atrioventricular block
▸ Myopericarditis
▸ Pancarditis		 —
Eyes — ▸ Conjunctivitis
▸ Iritis
▸ Choroiditis
▸ Retinal hemorrhage or retinal detachment
▸ Panophthalmitis		 ▸ Keratitis
Liver — ▸ Mild or recurrent hepatitis —
Respiratory — ▸ Nonexudative sore throat
▸ Nonproductive cough
▸ Adult respiratory distress syndrome		 —
Kidney — ▸ Microscopic hematuria or proteinuria —
Genitourinary — ▸ Orchitis —
Constitutional systems ▸ Minor ▸ Severe malaise and fatigue ▸ Fatigue

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. ↑ 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.
  6. ↑ CDC (2005-07-06). "Lyme Disease Erythema Migrans". Retrieved 2007-08-21.
  7. ↑ Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am. 86 (2): 341–9, vii. PMID 11982305.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
  11. ↑ 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.
  12. ↑ 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.)
  13. ↑ . doi:10.7326/0003-4819-157-3-20120807-01002. Missing or empty |title= (help)
  14. ↑ 14.0 14.1 Steere, AC. (1989). "Lyme disease". N Engl J Med. 321 (9): 586–96. doi:10.1056/NEJM198908313210906. PMID 2668764. Unknown parameter |month= ignored (help)
  15. ↑ Fish, AE.; Pride, YB.; Pinto, DS. (2008). "Lyme carditis". Infect Dis Clin North Am. 22 (2): 275–88, vi. doi:10.1016/j.idc.2007.12.008. PMID 18452801. Unknown parameter |month= ignored (help)


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