Lyme disease is a tick-borne infection caused by the gram-negative spirochete Spirochete Treponema is a gram-negative, microaerophilic spirochete. Owing to its very thin structure, it is not easily seen on Gram stain, but can be visualized using dark-field microscopy. This spirochete contains endoflagella, which allow for a characteristic corkscrew movement. Treponema Borrelia Borrelia Borrelia are gram-negative microaerophilic spirochetes. Owing to their small size, they are not easily seen on Gram stain but can be visualized using dark-field microscopy, Giemsa, or Wright stain. Spirochetes are motile and move in a characteristic spinning fashion due to axial filaments in the periplasmic space. Borrelia burgdorferi. Lyme disease is transmitted by the black-legged Ixodes tick (commonly known as a deer tick Deer tick Borrelia), which is only found in specific geographic regions. Patient presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor can vary depending on the stage of the disease and may include a characteristic erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion migrans rash Rash Rocky Mountain Spotted Fever. Neurologic, cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR), ocular, and joint manifestations are also common in later stages. Diagnosis relies on clinical findings and tick exposure Exposure ABCDE Assessment, and is supported by serological testing. Antibiotics are used for treatment. Avoidance of tick exposure Exposure ABCDE Assessment is key to prevention in endemic areas.
Last updated: Jan 21, 2022
The majority of Lyme disease cases are reported in Northeastern and upper Midwestern regions in the United States, according to the Centers for Disease Control and Prevention (CDC) in 2017.
Image: “Lyme disease reported cases” by CDC. License: Public DomainThe black-legged tick ( Ixodes scapularis Ixodes scapularis Borrelia) is the primary vector for Lyme disease.
Image: “The blacklegged tick” by Liza Gross. License: CC BY 2.5The incubation Incubation The amount time between exposure to an infectious agent and becoming symptomatic. Rabies Virus period for Lyme disease is 3–30 days ( mean Mean Mean is the sum of all measurements in a data set divided by the number of measurements in that data set. Measures of Central Tendency and Dispersion of 7 days). The clinical manifestations of Lyme disease are broken down into 3 stages: early localized disease, early disseminated disease, and late disease.
Symptoms appear in 1–5 weeks and resolve in approximately 30 days.
The classic “bull’s-eye” ( erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion migrans) rash Rash Rocky Mountain Spotted Fever of Borrelia Borrelia Borrelia are gram-negative microaerophilic spirochetes. Owing to their small size, they are not easily seen on Gram stain but can be visualized using dark-field microscopy, Giemsa, or Wright stain. Spirochetes are motile and move in a characteristic spinning fashion due to axial filaments in the periplasmic space. Borrelia burgdorferi
Image: “Classic bull’s eye EM” by Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. License: CC BY 2.0Erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion migrans
Image by James Gathany. License: Public DomainSymptoms develop in weeks to months in untreated patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship.
A patient with facial nerve Facial nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. The 12 Cranial Nerves: Overview and Functions palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies: This is the most common neurologic manifestation of Lyme disease.
Image: “Facial palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies” by Department of Otorhinolarnygology, University Jena, Lessingstrasse 2, Jena, Germany. License: CC BY 2.0Lymphadenosis cutis benigna, also known as a lymphocytoma, of a patient’s ear: This is a rare cutaneous finding in early disseminated Lyme disease.
Image: “ Lymphocytoma” by Department of General and Visceral Surgery, Augusta Kranken Anstalt, Academic Teaching Hospital of the Ruhr-University Bochum, Germany. License: CC BY 2.0Electrocardiogram Electrocardiogram An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG) ( ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG)) demonstrating 3rd-degree atrioventricular block Atrioventricular block Atrioventricular (AV) block is a bradyarrhythmia caused by delay, or interruption, in the electrical conduction between the atria and the ventricles. Atrioventricular block occurs due to either anatomic or functional impairment, and is classified into 3 types. Atrioventricular block (AV block): This is 1 of the cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) manifestations of early disseminated Lyme disease.
Image: “ Electrocardiogram Electrocardiogram An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG)” by Maxwell Eyram Afari et al AL Amyloidosis. License: CC BY 4.0Symptoms develop in months to years in untreated patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship.
Bilateral knee swelling Swelling Inflammation and arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis in a pediatric patient with Lyme disease
Image: “Bilateral knee arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis” by Krzysztof Orczyk et al AL Amyloidosis. License: CC BY 4.0Acrodermatitis chronica atrophicans
Image: “Acrodermatitis chronica atrophicans” by Giuseppe Stinco et al AL Amyloidosis. License: CC BY 3.0Common symptoms of Lyme disease can be remembered by the mnemonic phrase “a key Lyme pie to the FACE.”
Diagnostic algorithm for Lyme disease
ELISA
ELISA
An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed.
St. Louis Encephalitis Virus: enzyme-linked immunosorbent assay
Laboratory tests are only significant in conjunction with the clinical history due to a high false-positive and false-negative rate.
Western blotting
Western Blotting
Identification of proteins or peptides that have been electrophoretically separated by blot transferring from the electrophoresis gel to strips of nitrocellulose paper, followed by labeling with antibody probes.
Blotting Techniques of B. burgdorferi.
A, B, and C: positive controls for specific monoclonal
antibodies
Antibodies
Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution.
Immunoglobulins: Types and Functions
D and E: seropositive
patients
Patients
Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.
Clinician–Patient Relationship for
IgM
IgM
A class of immunoglobulin bearing mu chains (immunoglobulin mu-chains). Igm can fix complement. The name comes from its high molecular weight and originally being called a macroglobulin.
Immunoglobulins: Types and Functions
F: positive control
G: negative control
H: white control
MW: molecular weight
Oral antibiotics:
Intravenous (IV) antibiotics:
Additional considerations:
Clinical manifestations | Management |
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Asymptomatic patient with a tick bite requires no prophylactic treatment unless:
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If meets criteria, then must receive prophylactic doxycycline within 72 hours of bite |
Early disseminated disease:
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Facial nerve Facial nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. The 12 Cranial Nerves: Overview and Functions palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies or joint involvement |
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Cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) and neurologic manifestations | Intravenous ceftriaxone Ceftriaxone A broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears. Cephalosporins |
Reinfection | Same antibiotic as recommended for a primary infection Primary infection Herpes Simplex Virus 1 and 2 |
Doxycycline prophylaxis Prophylaxis Cephalosporins is indicated if all the following criteria are met MET Preoperative Care: