Lyme Disease

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Lyme Disease
Lyme disease is a tick-transmitted inflammatory disorder characterized by an
early focal skin lesion, and subsequently a growing red area on the skin (erythema
chronicum migrans or ECM). The disorder may be followed weeks later by
neurological, heart or joint abnormalities. Symptomatology The first symptom of

Lyme disease is a skin lesion. Known as erythema chronicum migrans, or ECM, this
usually begins as a red discoloration (macule) or as an elevated round spot
(papule). The skin lesion usually appears on an extremity or on the trunk,
especially the thigh, buttock or the under arm. This spot expands, often with
central clearing, to a diameter as large as 50 cm (c. 12 in.). Approximately 25%
of patients with Lyme disease report having been bitten at that site by a tiny
tick 3 to 32 days before onset of ECM. The lesion may be warm to touch. Soon
after onset nearly half the patients develop multiple smaller lesions without
hardened centers. ECM generally lasts for a few weeks. Other types of lesions
may subsequently appear during resolution. Former skin lesions may reappear
faintly, sometimes before recurrent attacks of arthritis. Lesions of the mucous
membranes do not occur in Lyme disease. The most common symptoms accompanying

ECM, or preceding it by a few days, may include malaise, fatigue, chills, fever,
headache and stiff neck. Less commonly, backache, muscle aches (myalgias),
nausea, vomiting, sore throat, swollen lymph glands, and an enlarged spleen may
also be present. Most symptoms are characteristically intermittent and changing,
but malaise and fatigue may linger for weeks. Arthritis is present in about half
of the patients with ECM, occurring within weeks to months following onset and
lasting as long as 2 years. Early in the illness, migratory inflammation of many
joints (polyarthritis) without joint swelling may occur. Later, longer attacks
of swelling and pain in several large joints, especially the knees, typically
recur for several years. The knees commonly are much more swollen than painful;
they are often hot, but rarely red. Baker's cysts (a cyst in the knee) may form
and rupture. Those symptoms accompanying ECM, especially malaise, fatigue and
low-grade fever, may also precede or accompany recurrent attacks of arthritis.

About 10% of patients develop chronic knee involvement (i.e. unremittent for 6
months or longer). Neurological abnormalities may develop in about 15% of
patients with Lyme disease within weeks to months following onset of ECM, often
before arthritis occurs. These abnormalities commonly last for months, and
usually resolve completely. They include: 1. lymphocytic meningitis or
meningoencephalitis 2. jerky involuntary movements (chorea) 3. failure of muscle
coordination due to dysfunction of the cerebellum (cerebellar ataxia) 4. cranial
neuritis including Bell's palsy (a form of facial paralysis) 5. motor and
sensory radiculo-neuritis (symmetric weakness, pain, strange sensations in the
extremities, usually occurring first in the legs) 6. injury to single nerves
causing diminished nerve response (mononeuritis multiplex) 7. inflammation of
the spinal cord (myelitis). Abnormalities in the heart muscle (myocardium) occur
in approximately 8% of patients with Lyme disease within weeks of ECM. They may
include fluctuating degrees of atrioventricular block and, less commonly,
inflammation of the heart sack and heart muscle (myopericarditis) with reduced
blood volume ejected from the left ventricle and an enlarged heart (cardiomegaly).

When Lyme Disease is contracted during pregnancy, the fetus may or may not be
adversely affected, or may contract congenital Lyme Disease. In a study of
nineteen pregnant women with Lyme Disease, fourteen had normal pregnancies and
normal babies. If Lyme Disease is contracted during pregnancy, possible fetal
abnormalities and premature birth can occur. Etiology Lyme disease is caused by
a spirochete bacterium (Borrelia Burgdorferi) transmitted by a small tick called

Ixodes dammini. The spirochete is probably injected into the victim's skin or
bloodstream at the time of the insect bite. After an incubation period of 3 to

32 days, the organism migrates outward in the skin, is spread through the
lymphatic system or is disseminated by the blood to different body organs or
other skin sites. Lyme Disease was first described in 1909 in European medical
journals. The first outbreak in the United States occurred in the early 1970's
in Old lyme, Connecticut. An unusually high incidence of juvenile arthritis in
the area led scientists to investigate and identify the disorder. In 1981, Dr.

Willy Burgdorfer identified the bacterial spirochete organism (Borrelia

Burgdorferi) which causes this disorder. Affected Population Lyme Disease occurs
in wooded areas with populations of mice and deer which carry ticks, and can be
contracted during any season of the year. Related Disorders Rheumatoid Arthritis
is a disorder similar in appearance to

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