Lyme Disease Treatment

Early Symptomps of Lyme Disease
Early symptoms of Lyme disease appear 3 to 32 days after the bite of an infected tick which was attached for at least 24 hours.

Most people with Lyme disease will get a rash called “erythema migrans” where they were bitten. The rash starts as a small red round area, which usually gets bigger and can reach two or more inches across. The center of the rash may clear giving a “bull’s eye” appearance.

Other symptoms during the early stage of Lyme disease include:

• Chills
• Fever
• Headache
• Tiredness
• Stiff neck
• Joint pain
• Swollen lymph nodes
• Rash that spreads to other parts of the body

Early Lyme disease is usually curable using antibiotics that your health care provider can prescribe. Without treatment, the disease may progress to arthritis, meningitis, facial nerve paralysis, or hearing abnormalities. The later symptoms may occur in people who did not recognize early symptoms. Swelling and joint pain may recur over many years.

If you have had a tick attached for more than 24 hours, any of these symptoms, or think you have Lyme disease, promptly check with your medical care provider.

Lyme Disease Signs and Symptoms
B burgdorferi infection caused lyme disease can involve the skin, musculoskeletal system, CNS, and cardiac tissues .

• Skin. EM appears at the site of the tick bite 3-30 days after the bite and begins as a red macule or papule with areas of redness that expand with partial central clearing. The lesion often feels warm to hot; it may burn, prickle, or itch, and it is more common in the thigh, groin, and axilla. The lesion usually fades within 3-4 weeks (range, 1 day-14 months). The migratory nature of skin lesions most likely represents spirochetemia with secondary seeding of the skin rather than multiple tick bites. EM may be accompanied by fatigue, fever, chills, achiness, headache, and lymphadenopathy. It can also present with CNS and liver involvement. Multiple annular secondary lesions tend to be smaller and less migratory and to lack indurated centers. Acrodermatitis chronica atrophicans lesions follow years after EM. There is usually bluish-red discoloration, and then the lesion becomes sclerotic or atrophic. This condition has been associated with elevated antibodies to B burgdorferi and usually responds to antibiotic therapy; it is seen primarily in elderly women in Europe.
• Musculoskeletal system. Joint symptoms are the second most common clinical manifestation after EM. These symptoms may begin 5-6 weeks (range, 1 week to 2 years) after the bite, and they include, at one end of the spectrum, subjective joint pain, and at the other, arthritis or chronic erosive synovitis. The arthritis is usually of sudden onset, monoarticular or oligoarticular, and migratory. The knee is the most frequently involved joint, followed by the shoulder, elbow, temporomandibular joint, ankle, wrist, and hip. Initially, recurrent attacks of arthritis are common, but their frequency decreases by 10-20% each year. During recurrences, usually more joints are involved than in the initial episode. These attacks last ~ 1 week, with intervals of 1 week to 2 years between attacks. Joint fluid leukocyte counts range from 500 to 110,000 cells/mm3. Of all patients with Lyme disease, ~ 10% develop a severe chronic erosive arthritis often associated with IgG antibody response to OSPs A and B of the organism and with human leukocyte antigen DR4.
• CNS. Neurologic abnormalities begin within 4 weeks (range, 2-11 weeks) after the tick bite. The most common symptoms are headache, stiff neck, photophobia, facial palsy, and peripheral nerve paresthesias. CSF findings are similar to those seen in viral meningitis with lymphocytic pleocytosis of ~ 100 cells/mm3 and elevated protein levels. Cranial nerve VII is the most frequently involved; unilateral or bilateral facial palsies occur in 11% of patients, and these findings can be seen in 50% of patients with meningitis. Other cranial nerves, particularly III, IV, V, and VIII, are less often involved. Months to years after the initial infection, patients may have chronic encephalopathy (manifested by memory impairment, mood changes, sleep disturbances, and difficulty with concentration), polyneuropathy, or, less commonly, leukoencephalitis. These patients may present with neuropsychiatric symptoms, focal CNS disease, or severe fatigue. However, it is often difficult to establish B burgdorferi as the etiologic agent in patients who present with fatigue or psychiatric manifestations.
• Cardiac tissue. Cardiac involvement begins within 5 weeks (range, 3-21 weeks) after the bite, in ~ 5-10% of patients. Such abnormalities usually consist of atrioventricular block (first degree, Wenckebach, or complete heart block) and can last for 3 days-6 weeks. Some patients can present with myopericarditis, pericardial effusion, and chronic cardiomyopathy.
• Other clinical findings. Other unusual manifestations include ophthalmologic involvement (conjunctivitis, keratitis, uveitis, choroiditis, retinal detachments, and optic neuritis), hepatitis, myositis, dermatomyositis, eosinophilic lymphadenitis, and adult respiratory distress syndrome.
• Congenital infection. Maternal-fetal transmission of B burgdorferi has been reported with adverse fetal and neonatal outcome in a few cases (congenital heart disease, encephalitis, cortical blindness, intrauterine fetal death, and premature birth). Of note, a prospective study found no association between congenital malformation and infection by B burgdorferi. Despite the fact that there is no definitive proof that B burgdorferi causes fetal damage or an adverse outcome in the offspring, prompt diagnosis in the mother and treatment should be emphasized.