Lyme disease: recommendations for diagnosis and treatment

Article Abstract:

Lyme disease is an illness caused by a microorganism transmitted by tick bite. The diagnosis is made by the clinical picture, sometimes confirmed by a blood test confirming exposure to the organism. If a physician has a strong suspicion of Lyme disease, but the blood test is negative, the patient should receive treatment anyway. Treatment consists of antibiotics, oral doxycycline or amoxicillin in the early stages, or ceftriaxone or penicillin intravenously, for the later signs of the disease. Because the tick that transmits the microorganism is so small, many patients never know that they have been bitten. The typical course of the disease begins with an early flu-like illness, often accompanied by a rash known as erythema migrans. This rash is round, red, raised, and often clears to normal skin color in its center. Later symptoms, which appear weeks to months after the tick bite, include cardiac manifestations, with abnormalities in the electrical system of the heart, which might lead to fainting spells or shortness of breath, neurologic abnormalities, such as meningitis, facial palsy (drooping of one side of the face), and arthritis, involving one or more joints. All of these later symptoms are treated with intravenous antibiotics, with varying degrees of effectiveness. While no comprehensive study has shown danger to an unborn child, some birth defects have been described in children born to mothers with Lyme disease. Pregnant women with any signs of the disease should be treated aggressively. Controversy exists over whether to treat people who have found the ticks on their skin. Results of animal research indicate that the ticks must generally remain embedded in the skin for more than 24 hours to transmit the microorganism. Also, studies show that infection rates in untreated people with tick bites are as low as 1 in 20. Therefore, this practice is not recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Diagnosis of Lyme disease based on dermatologic manifestations

Article Abstract:

Lyme disease is an infectious illness, transmitted to humans by the bite of a tick. Lyme disease has many symptoms, including arthritis, neurologic dysfunction, and cardiac disease. The skin is frequently involved; the classic lesion is erythema migrans, which can appear from 3 to 30 days after the tick bite, and is seen in approximately 60 to 80 percent of patients. Erythema migrans is typically round, raised, red, and expands outward from the center, often with clearing of the redness in the middle. A bump or blister may persist in the center at the bite site. While erythema migrans is usually painless, some patients experience pain, itching, or burning. This rash will resolve within a month if untreated, or within days if the patient is given appropriate antibiotics. Secondary erythema migrans lesions appear weeks to months later, and are multiple. Other skin manifestations of Lyme disease are often reported in Europe, but rarely, if ever, recognized in the US. They include Borrelia lymphocytoma, a red bump usually located on the earlobe in children, and on the nipple in adults. Biopsies of this lesion show large numbers of lymphocytes, or white blood cells. Acrodermatitis chronica atrophicans is a late sign of Lyme disease, is typically seen in the elderly, and ultimately appears as glistening, thin skin with a large number of blood vessels. Another late skin lesion is morphea, a round, hard plaque, white or yellow in the center. Other skin lesions noted in Lyme disease are the rashes associated with the antibiotics used to treat the illness. Recognition of these later skin lesions in Lyme disease may lead to more frequent treatment of otherwise unrecognized cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Cutaneous manifestations of general diseases, Skin manifestations

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