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| style="background: #DCDCDC; padding: 5px;" |Non-specific flu-like symptoms.
| style="background: #DCDCDC; padding: 5px;" |Non-specific flu-like symptoms.
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==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%"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Microorganism or other infectious disease'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Associated risk factors'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Key clinical clues}}
|-
![[Lyme disease]]
|
*Living in endemic area or history of recent visit to endemic area
*Exposure to ticks
|
* History of [[Erythema chronicum migrans|erythema migrans]]
|-
! '''[[Staphylococcus aureus]]'''
|
* [[Rheumatoid arthritis]]<ref name="pmid769545">Goldenberg DL, Cohen AS (1976) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=769545 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: [https://pubmed.gov/769545 769545]</ref>
* [[Diabetes mellitus]]<ref name="pmid8689280">Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8689280 Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases.] ''Rev Rhum Engl Ed'' 63 (2):103-10. PMID: [https://pubmed.gov/8689280 8689280]</ref>
* [[Human Immunodeficiency Virus (HIV)|HIV]] patients<ref name="pmid9279334">Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9279334 Musculoskeletal infections in patients with human immunodeficiency virus infection.] ''Medicine (Baltimore)'' 76 (4):284-94. PMID: [https://pubmed.gov/9279334 9279334]</ref>
|
* Healthy adult with skin lesions and previously history of damaged joint (e.g, [[rheumatoid arthritis]]) or [[Prosthetic|prosthetic joint]]
|-
! '''[[Streptococcus pyogenes]]'''
'''[[Streptococcal Infection|Streptococcal pneumonia]]'''
|
* [[Autoimmune diseases]]<ref name="pmid8972665">Morgan DS, Fisher D, Merianos A, Currie BJ (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8972665 An 18 year clinical review of septic arthritis from tropical Australia.] ''Epidemiol Infect'' 117 (3):423-8. PMID: [https://pubmed.gov/8972665 8972665]</ref>
* Chronic skin infections<ref name="pmid8689280">Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8689280 Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases.] ''Rev Rhum Engl Ed'' 63 (2):103-10. PMID: [https://pubmed.gov/8689280 8689280]</ref>
* Trauma
|
* Healthy adults with spleenic dysfunction
|-
! '''[[Group B streptococcal infection|Groups B Streptococcal infection]]'''
|
* [[Immunocompromised]] patients<ref name="pmid9556703">Schattner A, Vosti KL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9556703 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: [https://pubmed.gov/9556703 9556703]</ref>
* [[Diabetes mellitus]]
* [[Malignancy]]
* Severe [[Genitourinary pathology|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 [[Pustules|vesicular pustules]]
** [[Complement deficiency]] (C5-9 deficiency)
** Culture negativity on synovial fluid analysis
|-
| '''[[Gram-negative bacilli]]'''
* [[Pseudomonas]]
* [[Escherichia coli]]
|
* History of intravenous drug abuse<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref>
* Extremes of age
* [[Immunocompromised host|Immunocompromised patients]]
|
* [[Immunocompromised host|Immunocompromised patients]]
* Recent history gastrointestinal infections such as [[infectious diarrhea]] caused by [[Shigella]], [[Salmonella]], [[Campylobacter]], or [[Yersinia]]
|-
!'''[[Haemophilus influenzae]]'''
|
* Unimmunized children<ref name="pmid7497542">De Jonghe M, Glaesener G (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7497542 [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg].] ''Bull Soc Sci Med Grand Duche Luxemb'' 132 (2):17-20. PMID: [https://pubmed.gov/7497542 7497542]</ref>
|
|-
!'''[[Anaerobes]]'''
|
* [[Diabetes mellitus]] 
* Patients with [[Prosthetic|prosthetic joints]]
|
* [[Immunocompromised host|Immunocompromised hosts]]
* Recent history of gastrointestinal infection
|-
!'''[[Mycobacterium|Mycobacterium spp.]]'''
|
* Recent history of travel to endemic areas
|
* [[Immunocompromised host|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 host|Immunocompromised patients]]
|
* [[Immunocompromised host|Immunocompromised patients]]
* Incidious onset of monoarthritis
|-
!'''[[Mycoplasma hominis]]'''
|
* Recent history of urinary tract procedure
|
* [[Immunocompromised host|Immunocompromised patients]]
* Recent history of urinary tract procedure<ref name="pmid7888535">Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7888535 Mycoplasma hominis septic arthritis: two case reports and review.] ''Clin Infect Dis'' 19 (6):1067-70. PMID: [https://pubmed.gov/7888535 7888535]</ref>
|-
!Viral arthritis
|
* [[Immunocompromised host|Immunocompromised patient]]
|
* Polyarthritis
* [[Fever]]
* [[Rash]]
|-
![[Human Immunodeficiency Virus (HIV)|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 [[Heart murmur|murmur]]
* Septic and sterile [[synovitis]]
** Septic joint more common in IVDA
|}
==Differentiating Lyme arthritis from other causes of Acute Arthritis


==Differentiating Lyme disease from other diseases==
==Differentiating Lyme disease from other diseases==

Revision as of 15:21, 8 August 2017

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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.
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
Staphylococcus aureus
Streptococcus pyogenes

Streptococcal pneumonia

  • Healthy adults with spleenic dysfunction
Groups B Streptococcal infection
  • Healthy adults with spleenic dysfunction
Neisseria gonorrhoeae
Gram-negative bacilli
Haemophilus influenzae
  • Unimmunized children[15]
Anaerobes
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
Mycoplasma hominis
  • Recent history of urinary tract procedure
Viral arthritis
HIV infection
  • History of multiple sexual partners
  • History of IVDA
Reactive arthritis
  • Recent gastrointestinal/ genitourinary infection
Endocarditis

==Differentiating Lyme arthritis from other causes of Acute Arthritis

Differentiating Lyme disease from other diseases

References

  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
  2. ↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
  3. ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
  4. ↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
  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
  6. ↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
  7. ↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
  8. ↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.
  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
  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
  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
  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
  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
  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
  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
  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
  17. ↑ "Lyme Disease Diseases With Similar Symptoms - Lyme Disease Health Information - NY Times Health". Retrieved 2013-03-14.


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