Revision 4 for 'Lyme disease'

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Lyme disease

Lyme disease, also known as borreliosis, is a controversial condition that is caused by the bacteria Borrelia burgdorferi, with infection being via a tick-borne vector. 

Terminology

Controversy around Lyme disease centers on chronic infection with some 3 doubting its existence. There are some terms that help differentiate these patients with non-specific symptoms of fatigue, myalgia and arthralgia, from those with acute infection 3:

  • post-Lyme disease symptoms: symptoms for <6 months
  • post-Lyme disease syndrome: disabling symptoms lasting for >6 months

Epidemiology

Lyme disease is endemic in some areas of North America and Europe. 

Clinical presentation

Three disease stages have been proposed manifesting after the tick bite 2:

  • stage 1: flu-like illness and enlarging skin lesion (erythema migrains) (2-30 days)
  • stage 2: cardiac and neurological symptoms (1-4 months)
  • stage 3: arthritis and neurological symptoms (many years)

Lyme disease has nonspecific symptoms with multisystemic involvement 1,2:​

Pathology

Lyme disease caused by the bacteria Borrelia burgdorferi and is transmitted by the bite of the ticks Ixodes scapularis and Ixodes pacificus.

Disease manifestations can be multisystem and non-specific includes 1,2,4:

  • cutaneous: erythema migrans
  • CNS: peripheral neuropathy, radiculoneuropathy, myelopathy, encephalitis, meningitis
  • cardiac: myopericarditis, cardiac arrhythmia
  • musculoskeletal: Lyme arthritis

Treatment and prognosis

Treatment is based with antibiotics depending on the stage of the disease and its severity 1. There is no evidence that long-term antibiotic therapy is appropriate for patients with post-Lyme disease symptoms or syndrome 4.

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