Lyme Disease General Considerations

Lymedisease is a tick-borne illness caused by the spirochete B burgdorferi. Lymedisease can be divided into early disease (stage 1, EM), disseminated infection (stage 2), and late disease (stage 3, persistent infection). The first stage involves the skin, followed by stages 2 and 3, which often affect the skin, joints, CNS, and heart. However, any of the stages may fail to appear or may overlap with one another

Clinical stages of Lymedisease in children and adults

Stage Timing
Localized erythema chronicum migrans Early infection
Disseminated infection Within days or years
Persistent infection Months to years

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Posted in Complication, Diagnosis, Investigation, LymeDisease, LymeDisease Symptoms, Prognosis, Treatment

Lyme Disease Epidemiology and Incidence

Lyme disease is the most common vector-borne infection in the United States. In 1997, there were 12,801 cases reported in the United States. It is transmitted by ticks from the genus Ixodes. The Ixodes tick goes through a 2-year life cycle that is composed of three stages: larva, nymph, and adult. Tick larvae acquire the spirochete via a blood meal from an infected host. Both the nymph and female adult infect humans.

A tick must be attached for at least 24 h to transmit the spirochete. Tick engorgement and attachment for 72 h are predictors of subsequent human infection. Ixodes ticks in the northeastern and midwestern United States belong to the Ixodes dammini (scapularis) species, in the western United States to Ixodes pacificus, in Europe to Ixodes ricinus, and in Asia to Ixodes persulcatus. Rodents and small mammals are the natural hosts of the larval and nymphal stages.

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Posted in LymeDisease

Lyme Disease Treatment

Once diagnosed, Lyme disease can be treated. Physicians can determine if an individual has been infected by the Lymedisease organism using a simple blood test; however, some people test negative but have the disease. The CDC warns against unproven tests and it is advised to check for proper testing procedures.

Infection can be treated by taking certain antibiotics. However, no immunity is conferred from infection so a person could get Lymedisease again from another infected tick.

Pets and other animals can contract Lymedisease as well, exhibiting symptoms similar to those in humans. Veterinarians can test for Lyme disease in pets and domestic animals exhibiting suspicious signs of arthritis (in younger animals), heart problems, or neurological signs.

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Posted in Treatment

Lyme Disease Treatment

Early lyme disease responds readily to several oral agents (such as doxycycline, amoxicillin, or cefuroxime), which are usually prescribed for 2-3 weeks. There are few published, controlled trials that compare different regimens for late Lymedisease. Intravenous therapy, usually ceftriaxone or penicillin, is used for 2-3 weeks for late Lymedisease.

  • Erythema migrans. In EM, oral antibiotic therapy with doxycycline shortens the duration of the rash and prevents the development of late sequelae. Amoxicillin is also effective and preferred for children under 9 years of age and in pregnant or lactating women.
  • Musculoskeletal disease. Treatment for one month with oral doxycycline or amoxicillin is usually effective. For refractory cases, intravenous therapy with ceftriaxone or penicillin G, and arthroscopic synovectomy may lead to clinical improvement. Analgesics such as acetaminophen or nonsteroidal anti-inflammatory agents should be used in patients with symptomatic arthritis.
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