Enfermedad de Lyme

Descripción General

Epidemiología

• Reconocida por primera vez en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 1977 como “artritis de Lyme” en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Connecticut
• La infección más común transmitida por garrapatas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Norteamérica y Europa
  • Zonas endémicas de Estados Unidos: Regiones del noreste y del medio oeste
  • Zonas endémicas europeas: países de Europa central y oriental
  • La distribución geográfica parece estar aumentando y puede estar relacionada con:
    • Cambio climático
    • Prácticas de uso del suelo
    • Aumento de las cepas virulentas
• > 30 000 casos reportados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos cada año
• El 5%–35% de las garrapatas Ixodes están infectadas con 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.
• La infección puede producirse de marzo a octubre y alcanza su punto máximo alrededor de junio–julio.

Etiología

• Organismo causante:
  • Espiroqueta ( bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology gramnegativa)
  • Especie más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Norteamérica: Borrelia burgdorferi Borrelia burgdorferi A specific species of bacteria, part of the borrelia burgdorferi group, whose common name is lyme disease spirochete. Borrelia
  • Especie más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Europa:
    • B. afzelii B. afzelii Borrelia
    • B. garinii B. garinii Borrelia
• Huéspedes reservorios:
  • Mamíferos pequeños (ratón de patas blancas)
  • Ciervo de cola blanca
• Vector de transmisión: garrapata Ixodes
  • La transmisión se produce a través de la inyección de saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy durante la alimentación
  • La adhesión más prolongada se asocia con un más alto riesgo de transmisión (típicamente 36–772 horas)
• Grupos de riesgo:
  • Excursionistas
  • Carpinteros

Fisiopatología

• Fijación y alimentación de las garrapatas → 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 (que se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy) es inyectada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel:
  • Puede ser eliminado por el sistema inmunológico
  • De lo contrario, producirá una lesión cutánea de eritema migratorio
• A continuación, las espiroquetas son diseminadas a la sangre y a los LOS Neisseria ganglios linfáticos regionales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuestión de días o semanas.
• Posible propagación a múltiples órganos (e.g., corazón, articulaciones, sistema nervioso central, ojos)
• Las manifestaciones son secundarias a la respuesta inmunitaria del huésped:
  • Inducción de autoanticuerpos contra antígenos neuronales y gliales
  • Reactividad cruzada de los LOS Neisseria anticuerpos 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 con el tejido neural y conectivo
  • Respuesta inmunitaria mediada por células T
• Puede haber una actividad débil similar a la endotoxina.

Presentación Clínica

El periodo de incubación de la enfermedad de Lyme es de 3–30 días (media de 7 días). Las manifestaciones clínicas de la enfermedad de Lyme se dividen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 3 etapas: enfermedad temprana localizada, enfermedad temprana diseminada y enfermedad tardía.

Enfermedad temprana localizada

Los LOS Neisseria síntomas aparecen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 1–5 semanas y se resuelven en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aproximadamente 30 días.

• Eritema crónico migratorio
  • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aproximadamente el 80% de los LOS Neisseria pacientes
  • La clásica erupción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de “ojo de buey” con un anillo rojo que se expande lentamente y un aclaramiento central
    • El aclaramiento central suele producirse tras unos días de enfermedad.
    • La lesión puede ser homogénea (no tener aclaramiento central) hasta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 59% de los LOS Neisseria casos.
• Aparece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lugar de la picadura de la garrapata
• Fiebre
• Mialgia
• Artralgia
• Fatiga
• Linfadenopatía

Enfermedad temprana diseminada

Los LOS Neisseria síntomas se desarrollan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum semanas o meses en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes no tratados.

• Hallazgos musculoesqueléticos:
  • Artralgias migratorias
  • Mialgias
• Cardíacos (aproximadamente el 8% de los LOS Neisseria pacientes):
  • Miocarditis
    • Inflamación del miocardio, que afecta al AL Amyloidosis músculo y al AL Amyloidosis sistema eléctrico del corazón
    • Se manifiesta como dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el pecho y dificultad para respirar
    • Puede provocar insuficiencia cardíaca congestiva
  • Pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis
    • Inflamación del pericardio
    • Se manifiesta como una aparición súbita de dolor Dolor Inflammation torácico agudo
  • Bloqueo auriculoventricular
    • Secundaria a la miocarditis
    • La manifestación cardíaca más común
• Neurológicos (aproximadamente el 15% de los LOS Neisseria pacientes):
  • Parálisis del nervio facial (parálisis de Bell)
    • Por lo general, es bilateral
    • La manifestación neurológica más común
  • Parálisis de otros nervios craneales (e.g., nervio abducens)
  • Meningoradiculitis Meningoradiculitis Lyme Disease (síndrome de Bannwarth):
    • Radiculopatía y parestesia
    • Sigue una distribución de dermatomas
  • Polineuropatía
  • Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis linfocítica
  • Encefalitis
• Cutáneos:
  • Múltiples lesiones secundarias de eritema crónico migratorio
    • Debido a la espiroquetemia (presencia de 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 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sangre)
    • No por múltiples picaduras de garrapatas
  • Linfadenosis cutis benigna (también conocida como pseudolinfoma o linfocitoma borrelial)
    • Poco común, se ve VE Ventilation: Mechanics of Breathing más a menudo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Europa
    • Hinchazón de color rojo azulado, generalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lóbulo de la oreja o cerca del pezón
• Oculares:
  • Conjuntivitis (10% de los LOS Neisseria pacientes)
  • Manifestaciones poco comunes:
    • Queratitis (inflamación de la córnea)
    • Vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus retiniana
    • Neuropatía óptica
    • Uveítis (inflamación de la úvea)

Enfermedad tardía

Los LOS Neisseria síntomas se desarrollan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum meses o años en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes no tratados.

• Poliartritis migratoria (60% de los LOS Neisseria pacientes)
  • Articulaciones grandes, especialmente la rodilla
  • Inflamación y dolor Dolor Inflammation articular intermitente
  • Pueden formarse quistes de Baker.
• Síntomas neurológicos:
  • Raro debido al AL Amyloidosis tratamiento antibiótico adecuado durante las primeras etapas
  • Encefalopatía de Lyme: sutiles alteraciones cognitivas, del estado de ánimo y del sueño
  • Polineuropatía axonal crónica
    • Dolor Dolor Inflammation radicular espinal
    • Parestesias distales
  • Encefalomielitis crónica
    • Paraparesia espástica
    • Neuropatía craneal
    • Deterioro cognitivo
• Acrodermatitis crónica atrofiante
  • Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Europa debido a B. afzelii B. afzelii Borrelia
  • Comienza con una decoloración unilateral rojo-azulada e hinchazón
  • Con el tiempo se desarrolla una atrofia y la vasculatura aparece más prominente.

Mnemotecnia

Los LOS Neisseria síntomas comunes de la enfermedad de Lyme pueden recordarse con la frase mnemotécnica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés “a key Lyme pie to the FACE” (un pastel de limón en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cara).

• Parálisis del nervio Facial
• Artritis
• Bloqueo Cardíaco
• Eritema migratorio

Diagnóstico

Algoritmo de diagnóstico

• El diagnóstico de la enfermedad de Lyme se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadro clínico y se apoya en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las pruebas serológicas.
• Los LOS Neisseria síntomas clínicos dependen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gran medida del estadío de la enfermedad.
• Las pruebas de Lyme no están justificadas para:
  • Tamizaje de pacientes asintomáticos
  • Pacientes que sólo presentan síntomas inespecíficos (fatiga, mialgia)

Pruebas de laboratorio

Las pruebas de laboratorio sólo son significativas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum conjunción con la historia clínica debido a una alta tasa de falsos positivos y falsos negativos.

• Pruebas de anticuerpos
  • Ensayo inmunoabsorbente ligado a enzimas ( 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, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • Prueba inicial
    • Detecta los LOS Neisseria anticuerpos mediante un complejo acoplado de enzima-anticuerpo, que produce un cambio de color
    • Pueden producirse falsos positivos debido a otras infecciones (por ejemplo, sífilis) o a enfermedades autoinmunes.
    • Pueden producirse falsos negativos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la fase inicial; por lo tanto, no se realiza la prueba 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 si se observa la erupción eritema crónico migratorio característico.
  • Western blot
    • Prueba de confirmación si el 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 es positivo
    • Detecta anticuerpos contra componentes proteicos individuales de B. burgdorferi mediante electroforesis
• Reacción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cadena de la polimerasa ( PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR))
  • Puede realizarse a partir de líquido cefalorraquídeo y líquido sinovial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el caso de quienes presentan meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis o artritis (Nota: Aunque la PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) es una opción, se sigue prefiriendo la determinación de anticuerpos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero).
  • Alta tasa de falsos negativos
  • Puede seguir siendo positivo durante años después del tratamiento

Tratamiento

Tratamiento

Antibióticos orales:

• Doxiciclina
• Cefotaxima
• Penicilina G
• Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todas las etapas de la enfermedad de Lyme

Antibióticos intravenosos:

• Ceftriaxona
• Se utiliza para:
  • Aquellos que no toleran los LOS Neisseria antibióticos orales
  • Enfermedad temprana diseminada con meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis, encefalomielitis o manifestaciones cardíacas graves (bloqueo atrioventricular de 3er grado)
  • Enfermedad tardía con manifestaciones neurológicas
  • Artritis recurrente a pesar del tratamiento oral

Consideraciones adicionales:

• Bloqueo atrioventricular de 3er grado
  • Puede requerir una estimulación temporal
  • El bloqueo atrioventricular suele durar poco con el tratamiento.
• Reacción Jarisch-Herxheimer
  • Se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 15% de los LOS Neisseria pacientes con enfermedad de Lyme temprana
  • Empeoramiento transitorio de los LOS Neisseria síntomas durante las primeras 24 horas de tratamiento
  • Debido a una respuesta inmunitaria a los LOS Neisseria antígenos liberados por las espiroquetas que están muriendo

Síndrome postenfermedad de Lyme y enfermedad de Lyme crónica

• Descripción:
  • Antecedentes de enfermedad de Lyme (temprana o tardía)
  • Manifestaciones de enfermeda de Lyme resuelta o estabilizada tras se tratada con un regimen aceptable.
  • Síntomas sugestivos (e.g., fariga, dolor Dolor Inflammation musculoesquelético diseminado, reportes de dificultades cognitivas):
    • Comenzó dentro de los LOS Neisseria 6 meses posteriores al AL Amyloidosis diagnóstico de la enfermedad de Lyme
    • Persisten (de forma continua o con recaídas) durante ≥ 6 meses después de finalizar el tratamiento
• Los LOS Neisseria síntomas son lo suficientemente graves como para causar una reducción sustancial de las actividades.
• No se cree que los LOS Neisseria síntomas crónicos subjetivos se deban a una infección persistente.
• Los LOS Neisseria pacientes deben ser reevaluados ya que esto puede ser debido a:
  • Diagnóstico incorrecto de Lyme
  • Coinfección con otra enfermedad transmitida por garrapata ( Babesia Babesia Babesiosis is an infection caused by a protozoa belonging to the genus, Babesia. The most common Babesia seen in the United States is B. microti, which is transmitted by the Ixodes tick. The protozoa thrive and replicate within host erythrocytes. Lysis of erythrocytes and the body’s immune response result in clinical symptoms. Babesia/Babesiosis, Anaplasma)
  • Otra afección concurrente (fibromialgia, depresión)
  • Daño tisular permanente (especialmente por afectación neurológica)
• No se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia demostrado el beneficio de los LOS Neisseria antibióticos adicionales
• No se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia demostrado efectividad de ningún tratamiento

Prevención y Profilaxis

• Si la garrapata se retira en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las primeras 12 horas, el riesgo de infección es muy bajo.
• No hay que asumir que se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia desarrollado inmunidad tras una infección previa.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el caso de las personas procedentes de zonas no endémicas, no es necesario administrar antibióticos profilácticos, pero debe observarse el lugar donde se encuentra la garrapata.

Precauciones contra las garrapatas

• Ropa de protección
• Repelentes
• Exploración del cuerpo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum busca de garrapatas después de estar al AL Amyloidosis aire libre
• Retirar las garrapatas de los LOS Neisseria lugares de la picadura lo antes posible con una pinza

Profilaxis con doxiciclina

La profilaxis con doxiciclina está indicada si se cumplen todos los LOS Neisseria criterios siguientes:

• La garrapata se identifica como Ixodes scapularis Ixodes scapularis Borrelia.
• La garrapata ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia estado adherida durante ≥ 36 horas.
• La profilaxis se iniciará en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las 72 horas siguientes a la retirada de la garrapata.
• La tasa de infección por B. burgdorferi de las garrapatas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la zona es ≥ 20%.
• La doxiciclina no está contraindicada.

Diagnóstico Diferencial

• Babesiosis Babesiosis Babesiosis is an infection caused by a protozoa belonging to the genus, Babesia. The most common Babesia seen in the United States is B. microti, which is transmitted by the Ixodes tick. The protozoa thrive and replicate within host erythrocytes. Lysis of erythrocytes and the body’s immune response result in clinical symptoms. Babesia/Babesiosis: infección transmitida por garrapatas y causada por Babesia Babesia Babesiosis is an infection caused by a protozoa belonging to the genus, Babesia. The most common Babesia seen in the United States is B. microti, which is transmitted by the Ixodes tick. The protozoa thrive and replicate within host erythrocytes. Lysis of erythrocytes and the body’s immune response result in clinical symptoms. Babesia/Babesiosis. Los LOS Neisseria pacientes pueden ser asintomáticos o desarrollar fiebre, fatiga, malestar y artralgias. Los LOS Neisseria pacientes asplénicos, inmunocomprometidos y de edad avanzada corren el riesgo de padecer una enfermedad grave, causando anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica, trombocitopenia, hepatoesplenomegalia, insuficiencia renal y muerte. El diagnóstico se confirma con un frotis de sangre periférica, pruebas serológicas y PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR). El tratamiento incluye antibióticos, como la atovacuona más la azitromicina.
• Erliquiosis y anaplasmosis Anaplasmosis Anaplasmosis is a tick-borne bacterial infection. The most common causative species include Anaplasma phagocytophilum, which infect and multiply within granulocytes. The clinical presentation can vary widely, but often includes fever, malaise, headache, myalgia, and arthralgias. Ehrlichiosis and Anaplasmosis: infecciones transmitidas por garrapatas causadas por Ehrlichia chaffeensis Ehrlichia chaffeensis A species of gram-negative bacteria that is the causative agent of human ehrlichiosis. This organism was first discovered at fort chaffee, arkansas, when blood samples from suspected human ehrlichiosis patients were studied. Ehrlichiosis and Anaplasmosis y Anaplasmosis Anaplasmosis Anaplasmosis is a tick-borne bacterial infection. The most common causative species include Anaplasma phagocytophilum, which infect and multiply within granulocytes. The clinical presentation can vary widely, but often includes fever, malaise, headache, myalgia, and arthralgias. Ehrlichiosis and Anaplasmosis phagocytophilum, respectivamente. Los LOS Neisseria síntomas incluyen fiebre, cefalea y malestar general. La erupción es poco frecuente, pero puede ser petequial o maculopapular Maculopapular Dermatologic Examination. El diagnóstico se realiza con una prueba PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR). El tratamiento de ambas enfermedades es con doxiciclina.
• Fiebre de las Montañas Rocosas: enfermedad causada por Rickettsia rickettsii Rickettsia rickettsii A species of gram-negative, aerobic bacteria that is the etiologic agent of rocky mountain spotted fever. Its cells are slightly smaller and more uniform in size than those of rickettsia prowazekii. Rickettsiaque se presenta con fiebre, fatiga, cefalea y sarpullido tras la picadura de una garrapata. Sin embargo, esta enfermedad está asociada a la garrapata Dermacentor Dermacentor A widely distributed genus of ticks, in the family ixodidae, including a number that infest humans and other mammals. Several are vectors of diseases such as tularemia; rocky mountain spotted fever; colorado tick fever; and anaplasmosis. Rickettsia, y la erupción comienza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las extremidades distales y se extiende centralmente. El diagnóstico se realiza con base en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las características clínicas, la biopsia de la erupción y las pruebas serológicas. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la administración de antibióticos, incluida la doxiciclina.
• Tifus epidémico: enfermedad causada por Rickettsia Rickettsia Rickettsiae are a diverse collection of obligate intracellular, gram-negative bacteria that have a tropism for vascular endothelial cells. The vectors for transmission vary by species but include ticks, fleas, mites, and lice. Rickettsia prowazekii que se presenta con mialgias, artralgias, erupciones y encefalitis. La erupción comienza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tronco y se extiende hacia las extremidades. El tifus epidémico se transmite a los LOS Neisseria humanos a través de los LOS Neisseria piojos. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadro clínico, la biopsia de la erupción y las pruebas serológicas. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la administración de antibióticos, incluida la doxiciclina.
• Mononucleosis Mononucleosis Infectious mononucleosis (IM), also known as “the kissing disease,” is a highly contagious viral infection caused by the Epstein-Barr virus. Its common name is derived from its main method of transmission: the spread of infected saliva via kissing. Clinical manifestations of IM include fever, tonsillar pharyngitis, and lymphadenopathy. Mononucleosis infecciosa: enfermedad causada por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de Epstein-Barr que se caracteriza por fiebre, fatiga, linfadenopatía y faringitis. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las características clínicas y las pruebas, como la prueba de anticuerpos heterófilos o la serología. El tratamiento es de soporte. El uso de amoxicilina puede causar una erupción maculopapular Maculopapular Dermatologic Examination característica.
• Artritis idiopática juvenil: grupo de enfermedades reumáticas que causan artritis, fiebre, erupciones, adenopatías, esplenomegalia e iridociclitis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños menores de 16 años. La erupción puede variar, pero puede parecer macular con un claro central. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadro clínico y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un estudio autoinmune, que incluye el factor reumatoide (FR), los LOS Neisseria anticuerpos antinucleares (ANA), los LOS Neisseria anticuerpos del péptido citrulinado anticíclico (anti-CCP) y el antígeno leucocitario humano (HLA)-B27. El tratamiento incluye corticosteroides y medicamentos antirreumáticos modificadores de la enfermedad.
• Artritis reumatoide: enfermedad autoinmune de las articulaciones que provoca una artritis inflamatoria y destructiva. Los LOS Neisseria pacientes suelen tener inflamación y dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las articulaciones periféricas (e.g., manos, muñecas, rodillas, tobillos). Las manifestaciones extraarticulares asociadas incluyen pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis, linfadenopatía, epiescleritis o mononeuritis múltiple. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadro clínico, los LOS Neisseria marcadores inflamatorios, el FR y los LOS Neisseria anti-CCP. El tratamiento suele comenzar con glucocorticoides, antirreumáticos modificadores de la enfermedad y antiinflamatorios no esteroideos (AINE).
• Artritis reactiva: una espondiloartropatía que a menudo se precipita por una infección gastrointestinal o genitourinaria. Los LOS Neisseria pacientes pueden presentar una artritis asimétrica, típicamente de las extremidades inferiores. Esta artritis puede asociarse a fiebre, tendinitis Tendinitis Ankylosing Spondylitis, entesitis, úlceras mucocutáneas y conjuntivitis. El diagnóstico es clínico. El tratamiento incluye AINE, antirreumáticos modificadores de la enfermedad y tratamiento de la infección.
• Meyerhoff, J. O., Steele, R. W., Zaidman, G.W. (2021). Lyme disease Lyme disease Lyme disease is a tick-borne infection caused by the gram-negative spirochete Borrelia burgdorferi. Lyme disease is transmitted by the black-legged Ixodes tick (known as a deer tick), which is only found in specific geographic regions. Patient presentation can vary depending on the stage of the disease and may include a characteristic erythema migrans rash. Lyme Disease. Medscape. Retrieved June 18, 2022, from https://emedicine.medscape.com/article/330178-overview