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__NOTOC__
__NOTOC__
{{Lyme disease}}
{{Lyme disease}}
{{CMG}} {{AE}}{{Anmol}}, {{IMD}}
{{CMG}}
 
==Overview==
==Overview==
[[Lyme disease]] is divided into 3 stages and symptoms are stage specific. Initial symptoms include "bulls-eye" [[rash]], with accompanying constitutional symptoms. It can progress to [[cardiovascular]] or [[neurological]] complications.
The physical examination of lyme disease is necessary for the diagnosis. [[Fever]] and target shaped rash are commonly seen on physical examination. Cardiac examination is significant for [[carditis]].
 
==Physical Examination==
===Appearance of the patient===
Patients are usually well appearing in early stages, but as the disease progresses they may appear ill.
 
===Vital signs===
*[[Fever]] (in 15% of patients)
*[[Tachycardia]]
 
===HEENT===
*Facial deviation
*Dry eyes
*Drooling of saliva
 
===Cardiovascular===
*[[Tachycardia]]
*[[S1]] and [[S2]] normal
 
===Neurological===
*[[Headache]]
*[[Dizziness]]
*[[Neck stiffness]]
 
===Musculoskeletal===
*[[Arthritis]]
 
===Dermatological===
*Target like rash
 
'''Images'''
<gallery>
Image:BullseyeLymeDiseaseRash.jpg|Common bullseye rash pattern associated with Lyme Disease.
Image:lymebite.png|Characteristic "bulls-eye"-like rash caused by Lyme disease.
Image:erythema chronicum migrans (Lyme Disease).jpg|Erythema Chronicum Migrans
</gallery>


==History==
*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 specific areas of focus when obtaining the history, are outlined below:
** [[Tick]] bite
** Vacation, living, or working environment in [[Endemic (epidemiology)|endemic]] areas
**Spending time outdoor (especially in woody or grassy area).


==Symptoms==
<gallery>
[[Lyme disease]] is divided into 3 stages and symptoms are stage specific.
#Stage 1 - Early localized disease
#Stage 2 - Early disseminated disease
#Stage 3 - Late disseminated disease


===Stage 1 - Early localized disease===
Image: 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. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
{|
|
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 begins 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 [[Itch|itchy]] or [[Pain|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 [[Borrelia burgdorferi|Lyme bacteria]], [[Lyme disease microbiology|''Borrelia burgdorferi'' sensu lato]].
**An [[infection]] resulting from a [[Borrelia mayonii|B. mayonii]] [[infection]] may cause a diffuse [[rash]], erupting in "red spots," spanning the entire [[body]].
*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]]
|
[[Image:Classic Lyme disease rash.jpg|thumb|250px|center|Classic [[Lyme disease]] rash]]
[[Image:Lyme disease Expanding rash with central crust.jpg|thumb|250px|center|[[Lyme disease]], expamding rash with central clearing]]
|}


===Stage 2 - Early disseminate disease===
Image: 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. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Features of early disseminated disease can be divided system wise and includes:
*Neurological symptoms: The triad of neurologic manifestation of [[Lyme disease]] includes [[meningitis]], [[cranial]] [[neuritis]], and radiculoneuritis.<ref name="pmid184528002">{{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>
**[[Lymphocyte|Lymphocytic]] [[meningitis]] (most common neurological symptom)
**[[Cranial nerve palsies|Cranial neuropathies]] (particularly facial nerve palsy)
**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>
**[[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]]
**[[Myelitis]]
**[[Chorea]]
**[[Cerebellar ataxia]]
*[[Cardiac]] manifestations
**[[Palpitation|Palpitations]]
**[[Atrioventricular block|Atrio-ventricular block]]
**[[Myopericarditis]]
**[[Sudden cardiac death]]
**Chronic [[cardiomyopathy]]
*[[Dermatological]] manifestations<ref name="pmid15358567">{{cite journal| author=Mullegger RR| title=Dermatological manifestations of Lyme borreliosis. | journal=Eur J Dermatol | year= 2004 | volume= 14 | issue= 5 | pages= 296-309 | pmid=15358567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358567  }} </ref>
**Borrelial lymphocytoma: Most common site is [[earlobe]].
*[[Ocular]] manifestations<ref name="pmid14630446">{{cite journal| author=Stanek G, Strle F| title=Lyme borreliosis. | journal=Lancet | year= 2003 | volume= 362 | issue= 9396 | pages= 1639-47 | pmid=14630446 | doi=10.1016/S0140-6736(03)14798-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14630446  }}</ref>
**Primary [[ocular]] symptoms occurs due to [[inflammation]] of [[ocular]] tissue. These symptoms includes [[conjunctivitis]], [[keratitis]], [[iridocyclitis]], [[retinal]] [[vasculitis]], chorioiditis, and [[optic neuropathy]] (extremely rarely [[episcleritis]], panuveitis, panophthalmitis)


*Secondary [[ocular]] symptoms occurs due to extraocular manifestations. These symptoms includes [[Cranial nerve palsies|pareses of cranial nerves]] and [[Orbit (anatomy)|orbital]] [[myositis]].
Image: 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. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


===Stage 3 - Late disseminated disease===
Image: Borrelia11.jpeg| Posterior knee with the erythema migrans (EM) rash characteristic of what was diagnosed as Lyme disease, caused by the bacterium, Borrelia burgdorferi. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
*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:
**[[Musculoskeletal]] manifestation:
***Lyme arthritis
****Lyme arthritis is the hallmark of stage 3 [[Lyme disease]].
****Most frequently presented symptom in late disseminated [[Lyme disease]].
****Commonly affects [[Knee|knee joint]].
**[[Neurology|Neurological]] manifestations:
***These [[neurological]] symptoms may take months to years to manifest after the [[infection]]. In addition to acute symptoms, Neuroborrerliosis can be manifested by a wide-range of [[Neurology|neurological]] disorders, either [[Central nervous system|central]] or [[Peripheral nervous system|peripheral]] including:
**** [[Encephalopathy]] (sub-acute): Affects  [[memory]], [[Mood (psychology)|mood]], [[sleep]], and sometimes with subtle [[language]] disturbances.
**** [[Polyneuropathy]] or  [[Paresthesia]]
**** Leukoencephalitis<ref name="pmid192279822">{{cite journal|year=1991|title=Central nervous system abnormalities in Lyme neuroborreliosis.|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1922798|journal=Neurology|volume=41|issue=10|pages=1571-82|doi=|pmc=|pmid=1922798|author=Halperin JJ, Volkman DJ, Wu P}}</ref>
**** [[Fasciculation|Muscle twitching]]
**** [[Otolaryngology|Otolaryngologic]] manifestations: [[Neck pain]], [[odynophagia]], head and neck [[dysesthesia]], [[otalgia]], [[tinnitus]], [[hearing loss]], [[vertigo]], [[temporomandibular joint pain]], [[lymphadenopathy]], [[dysgeusia]].<ref>{{cite journal|year=1988|title=Borrelia infection and vertigo|journal=Acta Otolaryngol.|volume=106|issue=1-2|pages=111-6|pmid=3421091|author=Rosenhall U, Hanner P, Kaijser B}}</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]] symptoms often develop much later in the disease progression, much like tertiary [[neurosyphilis]].<ref name="LogigianKaplan1990">{{cite journal|last1=Logigian|first1=Eric L.|last2=Kaplan|first2=Richard F.|last3=Steere|first3=Allen C.|title=Chronic Neurologic Manifestations of Lyme Disease|journal=New England Journal of Medicine|volume=323|issue=21|year=1990|pages=1438–1444|issn=0028-4793|doi=10.1056/NEJM199011223232102}}</ref>
*** 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 somatoform [[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|year=1994|title=Lyme disease: a neuropsychiatric illness|journal=The American journal of psychiatry|volume=151|issue=11|pages=1571-83|pmid=7943444|author=Fallon BA, Nields JA}}{{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>
**Dermatological manifestation<ref name="pmid15358567">{{cite journal| author=Mullegger RR| title=Dermatological manifestations of Lyme borreliosis. | journal=Eur J Dermatol | year= 2004 | volume= 14 | issue= 5 | pages= 296-309 | pmid=15358567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358567  }} </ref>
***Acrodermatitis chronica atrophicans


{|
Image: Borrelia14.jpeg| Medial aspect of the right calf of a patient who’d presented with what was diagnosed as Lyme disease. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
|
{|
! style="width: 80px; background: #4479BA; text-align: center;" colspan="2" |{{fontcolor|#FFF||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>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Common symptoms'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Less common symptoms'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
*Erythema migrans(Erythema chronicum migrans)
*Constitutional symptoms
*Arthritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
*Cardiac manifestations
*Neurological manifestations
|}


{|
Image: 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. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
! style="width: 80px; background: #4479BA; text-align: center;" colspan="3" |{{fontcolor|#FFF||Difference in clinical features in Europe and North America}}<ref name="pmid18452805">{{cite journal| author=Stanek G, Strle F| title=Lyme disease: European perspective. | journal=Infect Dis Clin North Am | year= 2008 | volume= 22 | issue= 2 | pages= 327-39, vii | pmid=18452805 | doi=10.1016/j.idc.2008.01.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452805  }}</ref>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Features'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Europe'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''North America'''
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Erythema migrans
|Single lesion more frequently
|Multiple lesions occurs more freuqently
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Heterogenous dissemination
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less common
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More common
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Borrelial lymphocytoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Present
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Absent
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Acrodermatitis chronica atrophicans
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Present
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Absent
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Meningoradiculoneuritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More common
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less common
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Lyme arthritis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Rarely preceded by Erythema migrans
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Commonly preceded by Erythema migrans
|}
|
[[image:Symptoms of lyme disease 2001-2015.jpg|center|700px|thumb|Frequency of Lyme disease symptoms, 2001-2015]]
|}


==Lyme Carditis==
Image: 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. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
*[[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 name="pmid22868858">{{cite journal| author=Hu LT| title=In the clinic. Lyme disease. | journal=Ann Intern Med | year= 2012 | volume= 157 | issue= 3 | pages= ITC2-2 - ITC2-16 | pmid=22868858 | doi=10.7326/0003-4819-157-3-20120807-01002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22868858  }} </ref>
*Less commonly, patients may present with an acute picture of [[left ventricular dysfunction]], [[cardiomegaly]], [[perimyocarditis]], or pancarditis without noticeable [[cardiac murmurs]].<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>
*Lyme [[carditis]] can occur independently, it is usually accompanied by other [[cutaneous]], [[joint]], or [[Neurology|neurologic]] features of [[Lyme disease]].<ref name="FishPride2008">{{cite journal|last1=Fish|first1=Airley E.|last2=Pride|first2=Yuri B.|last3=Pinto|first3=Duane S.|title=Lyme Carditis|journal=Infectious Disease Clinics of North America|volume=22|issue=2|year=2008|pages=275–288|issn=08915520|doi=10.1016/j.idc.2007.12.008}}</ref>


==Manifestations of Lyme Disease by Stage==
Image: Borrelia31.jpeg | Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
{| align="center" style="font-size:85%;" border="1" cellspacing="0" cellpadding="4"
|+ '''Manifestations of Lyme Disease by Stage'''<ref name="pmid 2668764">{{cite journal| author=Steere AC| title=Lyme disease. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 9 | pages= 586-96 | pmid= 2668764 | doi=10.1056/NEJM198908313210906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2668764  }}</ref>
|-
| style="background:LightSlateGray; width:15%;" | '''System''' || style="background: #efefef; width:25%;" | '''Stage 1 (Localized Infection)''' || style="background: #efefef; width:25%;" | '''Stage 2 (Early Disseminated Infection)''' || style="background: #ffdead; width:35%" | '''Stage 3 (Late Persistent Infection)'''
|-
| ''Skin'' || valign="top" |
* [[Erythema migrans]]
| valign="top" |
* Secondary annular lesions
* [[Malar rash]]
* Diffuse [[erythema]] or [[urticaria]]
* Evanescent lesions
* Lymphocytoma
| valign="top" |
* [[Acrodermatitis chronica atrophicans]]
* Localized [[scleroderma]]-like lesions
|-
|
* ''Musculoskeletal''
|
* —
| valign="top" |
* Migratory [[arthralgia]]
* Brief [[arthritis]] attacks
* [[Myositis]]
* [[Osteomyelitis]]
* [[Panniculitis]]
| valign="top" |
* Prolonged [[arthritis]] attacks
* Chronic [[arthritis]]
* Peripheral [[enthesopathy]]
* [[Periostitis]] or joint subluxations below acrodermatitis
|-
| ''Neurologic'' || — || valign="top" |
* [[Meningitis]]
* Cranial [[neuritis]] or [[Bell's palsy]]
* Motor or sensory radiculoneuritis
* [[Encephalitis]]
* [[Mononeuritis multiplex]]
* [[Pseudotumor cerebri]]
* [[Myelitis]]
* [[Chorea]]
* [[Cerebellar ataxia]]
| valign="top" |
* Chronic [[encephalomyelitis]]
* Spastic parapareses
* [[Ataxic gait]]
* Mental disorders
* Chronic axonal polyradiculopathy
* [[Dementia]]
|-
| ''Lymphatic'' || valign="top" |
* Regional [[lymphadenopathy]]
| valign="top" |
* Regional or generalized [[lymphadenopathy]]
* [[Splenomegaly]]
| —
|-
| ''Heart'' || — || valign="top" |
* [[Atrioventricular block]]
* [[Myopericarditis]]
* Pancarditis
| —
|-
| ''Eyes'' || — || valign="top" |
* [[Conjunctivitis]]


* [[Iritis]]
Image: Borrelia32.jpeg | Pathognomonic erythematous rash in the pattern of a “bull’s-eye”. Patient subsequently contracted Lyme disease. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
* [[Choroiditis]]
* Retinal hemorrhage or [[retinal detachment]]
* Panophthalmitis
| valign="top" |
* [[Keratitis]]
|-
|
* ''Liver''
|
* —
|
* Mild or recurrent [[hepatitis]]
| —
|-
| ''Respiratory'' || — || valign="top" |
* Nonexudative [[sore throat]]
* Nonproductive [[cough]]
* [[Adult respiratory distress syndrome]]
| —
|-
| ''Kidney'' || — || valign="top" |
* Microscopic [[hematuria]] or [[proteinuria]]
| —
|-
| ''Genitourinary'' || — ||
* [[Orchitis]]
| —
|-
| ''Constitutional systems'' ||
* [[Fatigue]]


* [[Arthralgia]]
Image: Borrelia36.png|Facial palsy caused by an infection by the bacterial spirochete Borrelia burgdorferi. Patient was subsequently diagnosed with Lyme disease. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


* [[Myalgia]]
</gallery>
* [[Headache]]
* [[Fever]] and/or [[chills]]
* [[Stiff neck]]
* [[Anorexia]]
|
* 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==
{{Reflist|2}}
{{reflist|2}}


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Revision as of 13:38, 1 August 2017

Lyme disease Microchapters

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

Overview

The physical examination of lyme disease is necessary for the diagnosis. Fever and target shaped rash are commonly seen on physical examination. Cardiac examination is significant for carditis.

Physical Examination

Appearance of the patient

Patients are usually well appearing in early stages, but as the disease progresses they may appear ill.

Vital signs

HEENT

  • Facial deviation
  • Dry eyes
  • Drooling of saliva

Cardiovascular

Neurological

Musculoskeletal

Dermatological

  • Target like rash

Images

  • Common bullseye rash pattern associated with Lyme Disease.

    Common bullseye rash pattern associated with Lyme Disease.

  • Characteristic "bulls-eye"-like rash caused by Lyme disease.

    Characteristic "bulls-eye"-like rash caused by Lyme disease.

  • Erythema Chronicum Migrans

    Erythema Chronicum Migrans


References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Public Health Image Library (PHIL)".


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