Lyme disease physical examination
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Lyme disease physical examination On the Web |
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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]
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
Vital signsSkin
HEENTNeckAbdomenFew patients may have:[2]
Muscukoskeletal
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Physical Examination in Stage 2 - Early disseminated disease
Appearance of the patient
Vital signs
- Slow or irregular pulse
Skin
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
Image gallary
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Common bullseye rash pattern associated with Lyme Disease.
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Characteristic "bulls-eye"-like rash caused by Lyme disease.
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Erythema Chronicum Migrans
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]
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![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [3]](/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). [3]
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![Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. From Public Health Image Library (PHIL). [3]](/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). [3]
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![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). [3]](/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). [3]
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![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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/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). [3]](/index.php/File:Borrelia36.png)
References
- ↑ Steere, Allen C. (1989). "Lyme Disease". New England Journal of Medicine. 321 (9): 586–596. doi:10.1056/NEJM198908313210906. ISSN 0028-4793.
- ↑ Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Rahn DW; et al. (1983). "The early clinical manifestations of Lyme disease". Ann Intern Med. 99 (1): 76–82. PMID 6859726.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 "Public Health Image Library (PHIL)".