{"id":8300,"date":"2013-03-19T14:41:12","date_gmt":"2013-03-19T18:41:12","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=8300"},"modified":"2013-03-19T15:27:07","modified_gmt":"2013-03-19T19:27:07","slug":"lyme-disease","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2013\/03\/lyme-disease\/","title":{"rendered":"Lyme Disease"},"content":{"rendered":"
Lyme disease is an<\/p>\n
1)<\/strong> infection with Borrelia burgdorferi via tick bite <\/p>\n Stage I<\/em><\/p>\n 1)<\/strong> characteristic expanding annular rash with central clearing (“bull’s eye or “target” rash) that occurs in only 40% of infections<\/p>\n Stage II<\/em><\/p>\n 2)<\/strong> multiple secondary annular skin lesions Stage III<\/em><\/p>\n 11) encephalopathy Laboratory<\/em><\/p>\n 1)<\/strong> elevated sed rate Radiology<\/em><\/p>\n 4)<\/strong> brain lesions indistinguishable from multiple sclerosis on MRI<\/p>\n 1)<\/strong> fastidious microaerophilic organism 1)<\/strong> diagnosis of Lyme disease mandates testing for babesiosis, ehrlichiosis, anaplasmosis, and Bartonella 1)<\/strong> presence of immune complexes 1)<\/strong>\u00c2\u00a0Lyme disease occurs in all 50 states, Europe, and Asia 1)<\/strong> treatment for Lyme disease \u00c2\u00a0is highly controversial and the source of much rancor within the provider and patient communities Lyme disease is a clinical diagnosis and should NEVER<\/strong>\u00c2\u00a0be ruled out by absence of primary target rash, secondary erythema migrans, recognized tick bite, or negative serologic blood tests.<\/p>\n","protected":false},"excerpt":{"rendered":" Pathophysiology of Lyme Disease Lyme disease is an 1) infection with Borrelia burgdorferi via tick bite 2) previous thinking held tick vector was Ixodes but transmission is now thought by some experts to be possible with additional tick species 3) occurs in stage I and stage II days to weeks after infection and in stage […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5123],"tags":[5365,5528,5530,5529,5527,5532,5369,5531,5370],"yoast_head":"\n
\n2)<\/strong> previous thinking held tick vector was Ixodes but transmission is now thought by some experts to be possible with additional tick species
\n3)<\/strong> occurs in stage I and stage II days to weeks after infection and in stage III months to years after infection (usually with preceding latency period<\/p>\nSigns and Symptoms<\/h4>\n
\n3)<\/strong> migratory musculoskeletal pain
\n4)<\/strong> heart block
\n5)<\/strong> shortness of breath
\n6)<\/strong> meningitis
\n7)<\/strong> headache
\n8)<\/strong> cranial and peripheral neuritis
\n9)<\/strong> abdominal pain
\n10)<\/strong> urinary dysuria and frequency<\/p>\n
\n12) acrodermatitis
\n13) arthropathy
\n14) psychiatric disturbances (depression, hostile behavior)<\/p>\nCharacteristic Test Findings<\/h4>\n
\n2)<\/strong> anti-Lyme antibodies (40%)
\n3)<\/strong> increased TNF and cytokines (organism is intensely proinflammatory)<\/p>\nHistology and Gross Pathology<\/h4>\n
\n2)<\/strong> grows best on Barbour, Stoenner, Kelly medium
\n3)<\/strong> microvasculitis<\/p>\nAssociated Conditions<\/h4>\n
\n2)<\/strong> some experienced Lyme clinicians also test for mycoplasma, EBV, and herpes viruses
\n3)<\/strong> some patients experience Jarisch-Herxheimer reaction (worsening of symptoms) with introduction of antibiotics and other treatment modalities and at 28 days of treatment
\n4)<\/strong> clinical signs of hypothyroidism in setting of normal laboratory values (dubbed Wilson’s Syndrome by patients and some clinicians)
\n5)<\/strong> some clinicians feel coinfection with parasites and Rocky Mountain Spotted Fever is possible with Lyme infection<\/p>\nBiochemistry<\/h4>\n
\n2)<\/strong> “neurotoxin” release when organism dies has been postulated by some clinicians without firm laboratory confirmation<\/p>\nInheritance and Epidemiology<\/h4>\n
\n2)<\/strong> United States CDC estimates true incidence is 10 times number of cases that fit reporting criteria
\n3)<\/strong> tick vectors are infectious at all life stages (nypmh, larva, and adult)
\n4)<\/strong> transmission of microbes occurs when tick regurgitates on starting a blood meal (not with engorgement of tick 24 hours later
\n5)<\/strong> some clinicians believe that microbe can cross placenta and infect fetuses
\n6)<\/strong> microbe has been isolated in saliva, breast milk, semen, and contaminated blood products<\/p>\nTreatment<\/h4>\n
\n2)<\/strong> some physicians feel that the disease even in Stage III can be treated adequately with a relatively short course of antibiotics and remaining symptoms are “post-Lyme syndrome” unrelated to any existing microbes
\n3)<\/strong> other physicians believe continuing symptoms are a sign of continuing active infection and advocate years long use of antimicrobials and other modalities
\n4)<\/strong> many dozens of alternative medicine protocols have arisen with very little evidence based support other than anecdotal reports
\n5)<\/strong> phyisicans who believe in the chronic active infection hypothesis, amoxicillin, Augmentin, doxycycline, metronidazole (kills the cyst form supposedly), azithromycin, Ceftin, Rochephin, penicillin are among antibiotics used in combination over months to years
\n6)<\/strong> hyperbaric oxygen<\/a>
\n7)<\/strong> “detox” stategies beyond the scope of this discussion<\/p>\nTips for USMLE<\/h4>\n