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**Painful radiculitis
**Painful radiculitis
**Mononeuritis multiplex<ref name="pmid9066359">{{cite journal| author=England JD, Bohm RP, Roberts ED, Philipp MT| title=Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. | journal=Ann Neurol | year= 1997 | volume= 41 | issue= 3 | pages= 375-84 | pmid=9066359 | doi=10.1002/ana.410410313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9066359  }} </ref>
**Mononeuritis multiplex<ref name="pmid9066359">{{cite journal| author=England JD, Bohm RP, Roberts ED, Philipp MT| title=Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. | journal=Ann Neurol | year= 1997 | volume= 41 | issue= 3 | pages= 375-84 | pmid=9066359 | doi=10.1002/ana.410410313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9066359  }} </ref>
**Altered mental status<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>
**Pseudotumor cerebri
**Pseudotumor cerebri
**Myelitis
**Myelitis
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**The triad of neurologic manifestation of Lyme disease includes meningitis, cranial neuritis, and radiculoneuritis.
**The triad of neurologic manifestation of Lyme disease includes meningitis, cranial neuritis, and radiculoneuritis.
*Cardiac manifestations
*Cardiac manifestations
**Palpitations
**Atrio-ventricular block
**Atrio-ventricular block
**Myopericarditis
**Myopericarditis
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|
|
{| class="wikitable"
{| class="wikitable"
! colspan="2" |Symptoms differentiated on the basis of frequency
! colspan="2" |Symptoms differentiated on the basis of frequency<ref name="Ciesielski_198922">{{cite journal|year=1989|title=Lyme disease surveillance in the United States, 1983-1986|journal=Rev. Infect. Dis.|volume=11 Suppl 6|issue=|pages=S1435-41|pmid=2682955|author=Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV}}</ref>
|-
|-
|'''Common symptoms'''
|'''Common symptoms'''
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[[image:Symptoms of lyme disease 2001-2015.jpg|center|500px|frame|Frequency of Lyme disease symptoms, 2001-2015]]
[[image:Symptoms of lyme disease 2001-2015.jpg|center|500px|frame|Frequency of Lyme disease symptoms, 2001-2015]]
|}
|}
===Less Common===
*[[Cardiac]] manifestations (up to 10% of patients may have [[cardiac]] manifestations including  [[heart block]] and [[palpitations]])<ref name="Ciesielski_19892">{{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>


==Chronic Disease==
==Chronic Disease==

Revision as of 19:36, 31 July 2017

Lyme disease Microchapters

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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.
    • The rash does not represent an allergic reaction to the bite, but rather a skin infection with the Lyme bacteria, Borrelia burgdorferi sensu lato.
    • An infection resulting from a B. mayonii infection may cause a diffuse rash, erupting in "red spots," spanning the entire body.
  • 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 neurological symptom)
    • Cranial neuropathies(particularly facial nerve palsy)
    • Painful radiculitis
    • Mononeuritis multiplex[6]
    • Altered mental status[7]
    • Pseudotumor cerebri
    • Myelitis
    • Chorea
    • Cerebellar ataxia
    • The triad of neurologic manifestation of Lyme disease includes meningitis, cranial neuritis, and radiculoneuritis.
  • Cardiac manifestations
    • Palpitations
    • Atrio-ventricular block
    • Myopericarditis
    • Sudden cardiac death
    • Chronic cardiomyopathy
  • Dermatological manifestations[8]
    • Borrelial lymphocytoma
  • Ocular manifestations

Late disseminated disease

  • Features of late disseminated disease can take months to years to manifest after the onset of infection.
  • Lyme arthritis is dominant months later but chronic neurologic involvement becomes more obvious years later.
  • The symptoms of late disseminated lyme disease includes:
    • Arthritis
      • Commonly affects knee joint
    • Neurological: These neurological symptoms may take months to years to manifest after the infection. Neuropsychiatric symptoms often develop much later in the disease progression, much like tertiary neurosyphilis.[9]
      • Sub-acute encephalopathy: Affects memory, mood, sleep, and sometimes with subtle language disturbances.
      • Polyneuropathy
      • Leukoencephalitis[10]
    • Dermatological manifestation[8]
  • Acrodermatitis chronica atrophicans
Symptoms differentiated on the basis of frequency[11]
Common symptoms Less common symptoms
Erythema migrans(Erythema chronicum migrans)

Constitutional symptoms

Arthritis

Cardiac manifestations

Neurological manifestations

Difference in clinical features in Europe and North America[12]
Features Europe North America
Erythema migrans Single lesion more frequently Multiple lesions occurs more freuqently
Heterogenous dissemination Less common More common
Borrelial lymphocytoma Present Absent
ACA Present Absent
Meningoradiculoneuritis More common Less common
Lyme arthritis Rarely preceded by Erythema migrans Commonly preceded by Erythema migrans
Frequency of Lyme disease symptoms, 2001-2015

Chronic Disease

Chronic neurological disorders

Lyme Carditis

Manifestations of Lyme Disease by Stage

Manifestations of Lyme Disease by Stage[17]
System Stage 1 (Localized Infection) Stage 2 (Early Disseminated Infection) Stage 3 (Late 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. England JD, Bohm RP, Roberts ED, Philipp MT (1997). "Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease". Ann Neurol. 41 (3): 375–84. doi:10.1002/ana.410410313. PMID 9066359.
  7. 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.
  8. 8.0 8.1 Mullegger RR (2004). "Dermatological manifestations of Lyme borreliosis". Eur J Dermatol. 14 (5): 296–309. PMID 15358567.
  9. Logigian, Eric L.; Kaplan, Richard F.; Steere, Allen C. (1990). "Chronic Neurologic Manifestations of Lyme Disease". New England Journal of Medicine. 323 (21): 1438–1444. doi:10.1056/NEJM199011223232102. ISSN 0028-4793.
  10. Halperin JJ, Volkman DJ, Wu P (1991). "Central nervous system abnormalities in Lyme neuroborreliosis". Neurology. 41 (10): 1571–82. PMID 1922798.
  11. 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.
  12. Stanek G, Strle F (2008). "Lyme disease: European perspective". Infect Dis Clin North Am. 22 (2): 327–39, vii. doi:10.1016/j.idc.2008.01.001. PMID 18452805.
  13. Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
  14. 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.
  15. 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.)
  16. . doi:10.7326/0003-4819-157-3-20120807-01002. Missing or empty |title= (help)
  17. 17.0 17.1 Steere, AC. (1989). "Lyme disease". N Engl J Med. 321 (9): 586–96. doi:10.1056/NEJM198908313210906. PMID 2668764. Unknown parameter |month= ignored (help)
  18. 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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