Lyme Disease Update Review
Information on lyme disease symptoms,sign,diagnosis,treatment and complication.This is an infectious disease caused by ticks infected with Borrelia burgdorferi.
Pathogenesis of Lyme Disease
Pathogenesis of lyme disease. After inoculation in the skin, B burgdorferi replicates within the dermis producing EM and spreads hematogenously to other organs. The organism has tropism for the skin, joints, heart and CNS. A rise in immunoglobulin M (IgM) is detected within 2-3 weeks after the onset of infection; an increase in IgG and IgA is established after 2-3 months of infection. Host genetic factors may determine the likelihood of tissue damage; for example, patients with human leukocyte antigens DR4 and DR2 may be more susceptible to chronic arthritis.
How to diagnose Lyme disease
How to diagnose Lyme disease ?
- Most common in the northeastern, upper midwestern, and western parts of the United States.
- Borrelia burgdorferi is the longest and narrowest ) spirochete member of the Borrelia genus and has the fewest flagella .
- Erythema migrans (EM) is a red expanding lesion with central clearing that is commonly seen during the early stage of Lyme disease.
- The most common systems affected are the skin (EM), the joints (arthritis), the CNS (facial palsy), and the heart (conduction defects).
- Serology is not standardized; it is insensitive in early infection and does not distinguish active from inactive infection.
- Grows in Barbour-Stoenner-Kelly medium from skin biopsy and other specimens.
Differential Diagnosis of Lyme Disease
Lyme disease mimics many different diseases. The EM lesion may be confused with streptococcal cellulitis, erythema multiforme (the latter lesions tend to be smaller, urticarial, or vesicular and may occur on mucosal surfaces), and erythema marginatum (these lesions are smaller and migrate rapidly in minutes to hours). Lyme arthritis can be distinguished from other rheumatoid diseases, such as acute rheumatic fever, based on the EM lesion and the brief episode of synovitis. The chronic form of Lyme arthritis may resemble pauciarticular juvenile rheumatoid arthritis, psoriatic arthritis, Reiter’s syndrome, and reactive arthritis caused by members of the Salmonella, Shigella, Campylobacter, and Yersinia genera. This form of arthritis may also be associated with rubella, hepatitis B, or echoviruses. The aseptic meningitis in Lyme disease may resemble enteroviral, leptospiral, or early tuberculous meningitis. It is important to consider sarcoidosis, Behรงet’s disease, and multiple sclerosis when the disease becomes chronic.
Risk factor of Lyme Disease
The main risk factor for Lyme disease is exposure to ticks that are infected with Lyme disease bacteria. In areas where Lyme disease is widespread, several factors may increase your risk, including:
