Summary of the first 100 patients seen at a Lyme disease referral center

Article Abstract:

Lyme disease is a recurrent inflammatory disorder characterized by skin lesions, diffuse skin redness, joint disease, and involvement of the heart and nervous system. The disease commonly develops in the summer and starts as a skin lesion accompanied by fever, fatigue, malaise, headache, and a stiff neck lasting several weeks. These symptoms are followed by joint disorders, neurological symptoms, and heart abnormalities. Lyme disease is caused by the spirochete microorganism, Borrelia burgdorferi, which is transmitted by ticks called Ixodes dammini. This disease is treated with antibiotics and anti-inflammatory agents, such as salicylates and nonsteroidal anti-inflammatory drugs. In certain areas of the United States, there is increased anxiety about Lyme disease, and the wrong diagnosis may result in unnecessary antibiotic therapy. Of the first 100 cases referred to the Lyme Disease Center at the Robert Wood Johnson Medical School, Lyme disease was confirmed in only 37 cases. Many patients had another type of joint disease. Twenty-five patients had fibromyalgia, characterized by pain, fatigue, inability to sleep, depression, and tenderness, and stiffness of joints and surrounding structures. Among patients with fibromyalgia, three had active Lyme disease and 17 had a history suggestive of recent Lyme disease. It was estimated that about half of the 91 courses of antibiotic therapy given to the 100 patients were not necessary. The anxiety about Lyme disease has resulted in the diagnosis of this infectious disease by exclusion of other disorders. The persistence of symptoms after Lyme disease has been treated and the misdiagnosis of fibromyalgia and fatigue may lead to additional, unnecessary antibiotic treatment. Physicians should be more aware of patients' anxiety about Lyme disease, especially in endemic areas, and the persistence of muscle and skeletal disorders even after therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy

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We think it's lyme

Article Abstract:

A case is described of a previously healthy 16-year-old boy who initially sought medical attention for aching joints and suspected Lyme disease. This disease is caused by the spirochete bacterium Borrelia burgdorferi, which is carried by ticks. The number of diagnosed cases of Lyme disease has increased from 492 in 1982 to 4,572 in 1988, with 80 percent of cases originating in the Northeast. The boy had developed joint pain in the ankles, knees, wrists, elbows, and shoulders over the past 10 days. The joint pain worsened upon awakening in the morning. The boy had visited Putnam County, New York one month earlier with his aunt and uncle, who themselves had been diagnosed with Lyme disease. The patient also had occasional headaches and weight loss over the past two months, a history of penicillin allergy, and inflammation of the pharynx due to infection with beta-hemolytic Streptococcus three months earlier. He was treated with the antibiotic tetracycline for suspected Lyme disease and erythromycin for beta-hemolytic Streptococcus infection of the throat. The patient developed a fever of 103 degrees Fahrenheit, a rapid pulse, heart murmur, and a diffuse red rash, fluid accumulation, and tenderness of the right ankle. The electrocardiogram was abnormal. The patient was treated with aspirin, erythromycin, and the steroid prednisone, recovered and was released from the hospital after eight days. The patient had developed rheumatic fever, which shares in common with Lyme disease certain symptoms such as fever, arthralgias, rash and/or fatigue. Physicians should be aware of these similarities when considering a diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Rheumatic fever, Diagnosis, Differential, Differential diagnosis

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Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease

Article Abstract:

Lyme disease, an inflammatory disorder, usually occurs in the summer, and starts out with a skin rash, fever, headache, malaise, and a stiff neck lasting several weeks. Inflammation of the joints and nerves and abnormalities of the heart can develop later. The disease is caused by a microorganism, the spirochete Borrelia burgdorferi, and transmitted by the deer tick Ixodes dammini. It can be treated with anti-inflammatory agents such as aspirin and antibiotics such as penicillin. The initial skin rash may not always be present, and diagnosis of Lyme disease requires testing for antibodies to the spirochete; these are natural proteins produced by the body to specifically inactivate a foreign invading substance, and in this case, the spirochete. However, current blood tests have not been reliably able to isolate the B. burgdorferi antigen itself. This study describes the isolation of the spirochete Borrelia burgdorferi from the blood of seven patients with Lyme disease. Four of the seven patients had the skin rash, one had a paralyzed face nerve, and one had flu-like symptoms without a skin rash. Antibodies to the spirochete were not always detected in the blood of these patients. All patients improved with antibiotic therapy and had negative blood cultures indicating elimination of the spirochete. This study shows that culturing blood for Borrelia burgdorferi may be useful in the diagnosis of Lyme disease in some patients.

Evaluation, Testing, Borrelia, Spirochetes, Serodiagnosis, Serologic tests

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