Lyme disease – is the most common transmissible disease in USA, caused by infection with the spirochete Borrelia burgdorferi and is a multi – system disease. Lyme disease is transmitted to persons through tick bites, which are infected of the genus Ixodes.
The reason of Lyme disease is bacteria called B. burgdorferi (Borrelia burgdorferi). These bacteria is carried by blacklegged ticks and other kinds of ticks. The ticks get the bacteria when they bite animals, infected with Borrelia burgdorferi. Human get this disease by an infected tick’s bite.
Lyme disease was founded in 1977 in the town of Old Lyme, Connecticut, USA.
The most concord areas of Lyme disease in USA are:
- Northwest part of West Coast.
- Minnesota, Wisconsin and other North-central states.
- Northeastern states.
Risk factors for Lyme disease include:
- Doing outside activities that increase tick exposure (for example, gardening, hunting, or hiking) in an area where Lyme disease is known to occur
- Having a pet that may carry ticks home
- Walking in high grasses
Lyme disease has 3 stages:
- Early localized Lyme disease is Stage 1. The infection isn’t spread throughout the body yet.
- Early disseminated Lyme disease is Stage 2. The bacteria started to spread throughout the human body.
- Late disseminated Lyme disease is Stage 3. The bacteria already spread throughout the body.
Important facts about Lyme disease:
In USA to affect on your health tick have to stay on your body about 24 – 36 hours. This time will let its to spread the B. Burgdorfery to your blood. In Europe transmission the bacteria is more quickly, and take not more 24 hours. Tticks may be very small, so it will be almost impossible to find them. Most people with this disease have never seen a tick. Not all people, bitten by tick, get Lyme disease.
Symptoms and Signs
Symptoms and Signs of Lyme disease depend on stage. Early signs are follows:
- Erythema migrans – Rash
- Tender local adenopathy
Physical signs in early disseminated stage are as follows:
- generalized or regional tender adenopathy
- Erythema migrans
- Bell palsy and Cranioneuropathy
People, who has late stage of disease, usually have arthritis also, which is located mostly in large articulations, usually in knee. To differ simple arthralgia from distinguish arthritis, remember to notice, such signs as: limited range of motion, swelling from effusion, and warmth.
In endemic areas, patients with probable erythema migrans and a recent source of tick exposure should be started on treatment without blood tests.
For serologic testing, the CDC recommends a two-tier testing procedure, as follows :
- Step 1: EIA or ELISA – Total Lyme titer or IgG and IgM titers
- Step 2: Western blot testing
Western blot testing is performed only if step 1 test results are positive or equivocal. If signs and symptoms have been present for 30 days or less, both IgM and IgG Western blot testing are performed; if signs and symptoms have been present for more than 30 days, only IgG Western blot testing is performed.
Since there is no reason to perform a titer without a confirmatory test if positive, Lyme titers should always be ordered with a reflex confirmatory test. In most cases, this should be a Western blot. Most commercial laboratories will perform both IgG and IgM Western blots. If the patient has been in Europe, where different strains ofBorrelia are more common, a C6 peptide ELISA is a more accurate confirmatory test than the Western blots, which have been developed to B burgdorferi, which is the strain found in the United States. The C6 peptide is less expensive than the Western blots and is as sensitive and specific for B burgdorferi; it is a reasonable alternative for the Western blots, but has not replaced it as the usual confirmatory test in the United States.
Other studies that may be used are as follows:
- Joint aspiration – To exclude other causes of effusion (eg, septic arthritis, gout, pseudogout)
- CSF analysis – In patients with meningitis
- ECG – To identify Lyme carditis
The antibiotic selection of therapy for Lyme disease depend on stage, symptoms, concomitant medical conditions and any allergy.
Treatment of Lyme disease:
- To treat erythema migrans is better to use cefuroxime axetil, Doxycycline or amoxicillin
- Kids under 8 years old and nursing or pregnant women are allow to use cefuroxime axetil or amoxicillin
Treatment of Lyme arthritis is as follows:
- Oral antibiotics for 1 month
- for refractory cases re-treatment with 4 antibiotics
- for mild residual joint swelling re-treatment with oral antibiotics
Lyme carditis is treated by antibiotic for 2 weeks.
Hospitalization is advised, if:
- 1st-degree heart block with prolongation of the PR interval
- 2nd-degree or 3rd-degree Athrio Ventrical block
- Associated symptoms