Lyme disease is a tick-borne infection caused by the gram-negativespirocheteSpirocheteTreponema 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.TreponemaBorrelia burgdorferiBorrelia burgdorferiA specific species of bacteria, part of the borrelia burgdorferi group, whose common name is lyme disease spirochete.Borrelia. Lyme disease is transmitted by the black-leggedIxodes tick (commonly known as adeer tickDeer tickBorrelia), which is only found in specific geographic regions. Patient presentation can vary depending on the stage of the disease and may include a characteristicerythemaErythemaRedness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.Chalazion migransrashRashRocky Mountain Spotted Fever. Neurologic, cardiac, ocular, and joint manifestations are also common in later stages. Diagnosis relies on clinical findings and tick exposure, and is supported by serological testing. Antibiotics are used for treatment. Avoidance of tick exposure is key to prevention in endemic areas.
First recognized in 1977 as “LymearthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis” in Connecticut
Most common tick-borne infection in North America and Europe
United States endemic areas: Northeast and Midwest regions, and some parts of the South and West
European endemic areas: central and eastern European countries
Geographic distribution appears to be increasing and may be related to:
Climate change
Land-use practices
Increasing virulent strains
> 60,000 cases reported in the United States in 2022, with cases increasing since 1991
5%–35% ofIxodesticksTicksBlood-sucking acarid parasites of the order ixodida comprising two families: the softbacked ticks (argasidae) and hardbacked ticks (ixodidae). Ticks are larger than their relatives, the mites. They penetrate the skin of their host by means of highly specialized, hooked mouth parts and feed on its blood. Ticks attack all groups of terrestrial vertebrates. In humans they are responsible for many tick-borne diseases, including the transmission of rocky mountain spotted fever; tularemia; babesiosis; african swine fever; and relapsing fever.Coxiella/Q Fever are infected withBorreliaBorreliaBorrelia 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.
Infection can occur from March to October and peaks around June–July.
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.
SpirocheteSpirocheteTreponema 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 (gram-negative bacterium)
Most common species in North America:Borrelia burgdorferiBorrelia burgdorferiA specific species of bacteria, part of the borrelia burgdorferi group, whose common name is lyme disease spirochete.Borrelia
ReservoirReservoirAnimate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers.Escherichia coli hosts:
Small mammals (white-footed mouse, orPeromyscus leucopus)
White-tailed deer
Vector for transmission:Ixodestick
Transmission occurs throughsalivaSalivaThe 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 injection during feeding
Longer attachment is associated with a higher risk of transmission (typically 36–72 hours)
At-risk groups:
Hikers
Woodworkers
Campers
Outdoor workers (such as landscapers)
PetPETAn imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session.Nuclear Imaging owners
Lifecycle, reservoirs, and vector transmission ofB. burgdorferi
Image by Lecturio.
The black-legged tick (Ixodes scapularis) is the primary vector for Lyme disease.
Image: “The blacklegged tick” by Liza Gross. License:CC BY 2.5
Pathophysiology
Tick attachment and feeding →BorreliaBorreliaBorrelia 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 (found insalivaSalivaThe 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) is injected into theskinSkinThe skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.Skin: Structure and Functions:
May be eliminated by theimmune systemImmune systemThe body’s defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components.Primary Lymphatic Organs
Otherwise, will produce anerythemaErythemaRedness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.Chalazion migransskinSkinThe skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.Skin: Structure and Functions lesion
SpirochetesSpirochetesAn order of slender, flexuous, helically coiled bacteria, with one or more complete turns in the helix.Treponema then spread to the blood and regionallymph nodesLymph NodesThey are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system.Lymphatic Drainage System: Anatomy within days to weeks.
Manifestations are secondary to the host’s immune response:
Induction ofautoantibodiesAutoantibodiesAntibodies that react with self-antigens (autoantigens) of the organism that produced them.Blotting Techniques against neuronal and glial antigens
Cross-reactivity ofBorreliaBorreliaBorrelia 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.BorreliaantibodiesAntibodiesImmunoglobulins (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 with neural andconnective tissueConnective tissueConnective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix.Connective Tissue: Histology
TheincubationIncubationThe amount time between exposure to an infectious agent and becoming symptomatic.Rabies Virus period for Lyme disease is 3–30 days (mean of 7 days). The clinical manifestations of Lyme disease are broken down into 3 stages: early localized disease, early disseminated disease, and late disease.
Early localized disease
Symptoms appear in 1–5 weeks and resolve in approximately 30 days.
ErythemaErythemaRedness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.Chalazion chronicum migrans (EM)
Occurs in approximately 80% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship
FeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever
HeadacheHeadacheThe symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.Brain Abscess
AnorexiaAnorexiaThe lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa.Anorexia Nervosa
FatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia
LymphadenopathyLymphadenopathyLymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease.Lymphadenopathy
The classic “bull’s-eye” (erythema migrans) rash ofBorrelia burgdorferi
Image: “Classic bull’s eye EM” by Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. License:CC BY 2.0
Symptoms develop in weeks to months in untreatedpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship.
Cardiac (approximately 8% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship):
MyocarditisMyocarditisMyocarditis is an inflammatory disease of the myocardium, which may occur alone or in association with a systemic process. There are numerous etiologies of myocarditis, but all lead to inflammation and myocyte injury, most often leading to signs and symptoms of heart failure.Myocarditis
InflammationInflammationInflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.Inflammation to themyocardiumMyocardiumThe muscle tissue of the heart. It is composed of striated, involuntary muscle cells connected to form the contractile pump to generate blood flow.Heart: Anatomy, which affects the muscle and electrical system of the heart
Manifests as chestpainPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways andshortness of breathShortness of breathDyspnea is the subjective sensation of breathing discomfort. Dyspnea is a normal manifestation of heavy physical or psychological exertion, but also may be caused by underlying conditions (both pulmonary and extrapulmonary).Dyspnea
Can lead to congestiveheart failureHeart FailureA heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (ventricular dysfunction), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as myocardial infarction.Total Anomalous Pulmonary Venous Return (TAPVR)
PericarditisPericarditisPericarditis 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
InflammationInflammationInflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.Inflammation of thepericardiumPericardiumA conical fibroserous sac surrounding the heart and the roots of the great vessels (aorta; venae cavae; pulmonary artery). Pericardium consists of two sacs: the outer fibrous pericardium and the inner serous pericardium. The latter consists of an outer parietal layer facing the fibrous pericardium, and an inner visceral layer (epicardium) resting next to the heart, and a pericardial cavity between these two layers.Heart: Anatomy
Secondary tomyocarditisMyocarditisMyocarditis is an inflammatory disease of the myocardium, which may occur alone or in association with a systemic process. There are numerous etiologies of myocarditis, but all lead to inflammation and myocyte injury, most often leading to signs and symptoms of heart failure.Myocarditis
Most common cardiac manifestation
Neurologic (approximately 15% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship):
Facial nerveFacial nerveThe 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 FunctionspalsyPalsyparalysis of an area of the body, thus incapable of voluntary movementCranial Nerve Palsies (Bell’spalsyPalsyparalysis of an area of the body, thus incapable of voluntary movementCranial Nerve Palsies)
Unilateral facial paralysis, but can be bilateral (occurring at the same time or in succession)
Most common neurologic manifestation
Other cranial nervepalsyPalsyparalysis of an area of the body, thus incapable of voluntary movementCranial Nerve Palsies (e.g.,abducens nerveAbducens nerveThe 6th cranial nerve which originates in the abducens nucleus of the pons and sends motor fibers to the lateral rectus muscles of the eye. Damage to the nerve or its nucleus disrupts horizontal eye movement control.The 12 Cranial Nerves: Overview and Functions)
Meningoradiculitis (Bannwarth syndrome):
RadiculopathyRadiculopathyDisease involving a spinal nerve root which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root.Rheumatoid Arthritis and paresthesia
PolyneuropathyPolyneuropathyPolyneuropathy is any disease process affecting the function of or causing damage to multiple nerves of the peripheral nervous system. There are numerous etiologies of polyneuropathy, most of which are systemic and the most common of which is diabetic neuropathy.Polyneuropathy
LymphocyticmeningitisMeningitisMeningitis 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
EncephalitisEncephalitisEncephalitis is inflammation of the brain parenchyma caused by an infection, usually viral. Encephalitis may present with mild symptoms such as headache, fever, fatigue, and muscle and joint pain or with severe symptoms such as seizures, altered consciousness, and paralysis.Encephalitis
Cutaneous:
Multiple secondary EM lesions
Due to spirochetemia (presence ofBorreliaBorreliaBorrelia 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 in the blood)
Not from multiple tick bites
Lymphadenosis cutis benigna (also known aspseudolymphomaPseudolymphomaExtranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue (also called maltoma, malt lymphoma, and pseudolymphoma) is a group of non-hodgkin’s lymphomas that have historically been grouped together because they appear to arise from postgerminal center marginal zone B cells and share a similar immunophenotype.MALT Lymphoma or borrelial lymphocytoma)
Rare, more often seen in Europe
Blue-redswellingSwellingInflammation, usually on the earlobe (in children) or near thenippleNippleThe conic organs which usually give outlet to milk from the mammary glands.Examination of the Breast (in adults); often near the previous EM lesion
Ocular:
ConjunctivitisConjunctivitisConjunctivitis is a common inflammation of the bulbar and/or palpebral conjunctiva. It can be classified into infectious (mostly viral) and noninfectious conjunctivitis, which includes allergic causes. Patients commonly present with red eyes, increased tearing, burning, foreign body sensation, and photophobia.Conjunctivitis (10% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship)
Rare manifestations:
KeratitisKeratitisInflammation of the cornea.Herpes Simplex Virus 1 and 2 (inflammationInflammationInflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.Inflammation of thecorneaCorneaThe transparent anterior portion of the fibrous coat of the eye consisting of five layers: stratified squamous corneal epithelium; bowman membrane; corneal stroma; descemet membrane; and mesenchymal corneal endothelium. It serves as the first refracting medium of the eye.Eye: Anatomy)
RetinalvasculitisVasculitisInflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body.Systemic Lupus Erythematosus
UveitisUveitisUveitis is the inflammation of the uvea, the pigmented middle layer of the eye, which comprises the iris, ciliary body, and choroid. The condition is categorized based on the site of disease; anterior uveitis is the most common.Diseases of the Uvea (inflammationInflammationInflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.Inflammation of theuveaUveaThe pigmented vascular coat of the eyeball, consisting of the choroid; ciliary body; and iris, which are continuous with each other.Eye: Anatomy)
A patient with facial nerve palsy: This is the most common neurologic manifestation of Lyme disease.
Image: “Facial palsy” by Department of Otorhinolarnygology, University Jena, Lessingstrasse 2, Jena, Germany. License:CC BY 2.0
Lymphadenosis 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 2.0
Electrocardiogram (ECG) demonstrating 3rd-degree atrioventricular block: This is 1 of the cardiac manifestations of early disseminated Lyme disease.
Image: “ Electrocardiogram” by Maxwell Eyram Afari et al. License:CC BY 4.0
Late disease
Symptoms develop in months to years in untreatedpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship.
Intermittent jointswellingSwellingInflammation andpainPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways
BakercystsCystsAny fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.Fibrocystic Change can form.
Neurologic symptoms:
Rare because of appropriate antibiotic treatment during the early stages
LymeencephalopathyEncephalopathyHyper-IgM Syndrome: subtle cognitive, mood, andsleepSleepA readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility.Physiology of Sleep disturbances
Chronic axonalpolyneuropathyPolyneuropathyPolyneuropathy is any disease process affecting the function of or causing damage to multiple nerves of the peripheral nervous system. There are numerous etiologies of polyneuropathy, most of which are systemic and the most common of which is diabetic neuropathy.Polyneuropathy
DistalparesthesiasParesthesiasSubjective cutaneous sensations (e.g., cold, warmth, tingling, pressure, etc.) that are experienced spontaneously in the absence of stimulation.Posterior Cord Syndrome
AtrophyAtrophyDecrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes.Cellular Adaptation eventually develops and vasculature appears more prominent.
Bilateral knee swelling and arthritis in a pediatric patient with Lyme disease
Image: “Bilateral knee arthritis” by Krzysztof Orczyk et al. License:CC BY 4.0
Acrodermatitis chronica atrophicans
Image: “Acrodermatitis chronica atrophicans” by Giuseppe Stinco et al. License:CC BY 3.0
Mnemonic
Common symptoms of Lyme disease can be remembered by the mnemonic phrase “a keyLyme pie to theFACE.”
Facial nervepalsyPalsyparalysis of an area of the body, thus incapable of voluntary movementCranial Nerve Palsies
PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship with only nonspecific symptoms (fatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia,myalgiaMyalgiaPainful sensation in the muscles.Ion Channel Myopathy)
Laboratory testing
Laboratory tests are only significant in conjunction with the clinical history due to a high false-positive and false-negative rate.
Antibody testing
Enzyme-linked immunosorbent assay (ELISAELISAAn 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)
Initial test
DetectsantibodiesAntibodiesImmunoglobulins (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 through a coupled enzyme-antibody complex, which produces a color change
False-positives can occur due to otherinfectionsInfectionsInvasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases.Chronic Granulomatous Disease (e.g.,syphilisSyphilisSyphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary.Syphilis) or autoimmune disease.
False-negatives can occur in the early stage; thus,ELISAELISAAn 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 is not done if the characteristic EMrashRashRocky Mountain Spotted Fever is seen.
Western blot
Confirmation test if theELISAELISAAn 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 is positive
DetectsantibodiesAntibodiesImmunoglobulins (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 to individual protein components ofB. burgdorferi usingelectrophoresisElectrophoresisAn electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current.Blotting Techniques
Polymerase chain reactionPolymerase chain reactionPolymerase 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) (PCRPCRPolymerase 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))
May be performed oncerebrospinal fluidCerebrospinal FluidA watery fluid that is continuously produced in the choroid plexus and circulates around the surface of the brain; spinal cord; and in the cerebral ventricles.Ventricular System: Anatomy and synovial fluid for those who present withmeningitisMeningitisMeningitis 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 orarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis. (Note: AlthoughPCRPCRPolymerase 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) is an option, serum antibody testing is still preferred.)
High false-negative rate
Can remain positive for years after treatment
Western blotting ofB. burgdorferi. A, B, and C: positive controls for specific monoclonal antibodies D and E: seropositive patients for IgM F: positive control G: negative control H: white control MW: molecular weight
Image: “Western blotting of B. burgdorferi” by Department of Biomedicine and Biotecnology, Alcalá University, 28871 Alcalá de Henares, Spain. License:CC BY 3.0
Management
Treatment
Oral antibiotics:
Doxycycline
AmoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins
Cefuroxime
Used in all stages of Lyme disease
Intravenous (IV) antibiotics:
CeftriaxoneCeftriaxoneA broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears.Cephalosporins
Early disseminated disease withmeningitisMeningitisMeningitis 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, encephalomyelitis, or severe cardiac manifestations (3rd-degreeAV blockAV blockAtrioventricular (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))
Late disease with neurologic manifestations
RecurrentarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis despite oral therapy
Additional considerations:
3rd-degreeAV blockAV blockAtrioventricular (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)
May require temporary pacing
AV blockAV blockAtrioventricular (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) is usually short-lived with treatment.
Jarisch-Herxheimer reaction
Seen in 15% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship with early Lyme disease
Transient worsening of symptoms during the initial 24 hours of treatment
Due to an immune response to the antigens released by dyingspirochetesSpirochetesAn order of slender, flexuous, helically coiled bacteria, with one or more complete turns in the helix.Treponema
Table: Summary of the management of the different clinical manifestations of Lyme disease
Clinical manifestations
Management
Asymptomatic patient with a tick bite requires no prophylactic treatment unless:
If meets criteria, then must receive prophylactic doxycycline within 72 hours of bite
ErythemaErythemaRedness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.Chalazion migrans (localized disease)
Doxycycline
AmoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins
Cefuroxime
Early disseminated disease:
ErythemaErythemaRedness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.Chalazion migrans lesions (multiple)
Doxycycline
AmoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins
Cefuroxime
Facial nerveFacial nerveThe 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 FunctionspalsyPalsyparalysis of an area of the body, thus incapable of voluntary movementCranial Nerve Palsies
MeningitisMeningitisMeningitis 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
Radiculoneuropathy
Doxycycline
AmoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins
Cefuroxime
Cardiac and severe neurologic manifestations
IntravenousceftriaxoneCeftriaxoneA broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears.Cephalosporins
Late disease:
Joint involvement (arthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis)
Doxycycline
AmoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins
Post-Lyme disease syndrome (PLDS) and chronic Lyme disease
Description:
Previous history of Lyme disease (early or late)
Manifestations of Lyme disease resolved or stabilized after being treated with an accepted regimen.
Subjective symptoms (e.g.,fatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia, widespread musculoskeletalpainPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways, reports of cognitive difficulties):
Started within 6 months after the diagnosis of Lyme disease
Persist (continuously or relapsing) for ≥ 6 months after completing treatment
Symptoms are severe enough to cause substantial reduction of activities.
Chronic subjective symptoms are not thought to be due to persistent infection.
PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship should be reevaluated since this may be due to:
Incorrect Lyme diagnosis
Coinfection with another tick-borne disease (BabesiaBabesiaBabesiosis 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)
Another concurrent condition (fibromyalgiaFibromyalgiaFibromyalgia is a chronic pain syndrome characterized by widespread body pain, chronic fatigue, mood disturbance, and cognitive disturbance. It also presents with other comorbid symptoms such as migraine headaches, depression, sleep disturbance, and irritable bowel syndrome.Fibromyalgia, depression)
Permanent tissue damage (particularly from neurologic involvement)
No proven benefit to additional antibiotics
No proven treatment
Prevention and Prophylaxis
If the tick is removed within the first 12 hours, the infection risk is very low.
Do not assume immunity is developed after a previous infection.
For persons from non-endemic areas, there is no need for prophylactic antibiotics, but the tick site should be observed.
Precautions againstticksTicksBlood-sucking acarid parasites of the order ixodida comprising two families: the softbacked ticks (argasidae) and hardbacked ticks (ixodidae). Ticks are larger than their relatives, the mites. They penetrate the skin of their host by means of highly specialized, hooked mouth parts and feed on its blood. Ticks attack all groups of terrestrial vertebrates. In humans they are responsible for many tick-borne diseases, including the transmission of rocky mountain spotted fever; tularemia; babesiosis; african swine fever; and relapsing fever.Coxiella/Q Fever
Protective clothing
Repellents
Scanning the body forticksTicksBlood-sucking acarid parasites of the order ixodida comprising two families: the softbacked ticks (argasidae) and hardbacked ticks (ixodidae). Ticks are larger than their relatives, the mites. They penetrate the skin of their host by means of highly specialized, hooked mouth parts and feed on its blood. Ticks attack all groups of terrestrial vertebrates. In humans they are responsible for many tick-borne diseases, including the transmission of rocky mountain spotted fever; tularemia; babesiosis; african swine fever; and relapsing fever.Coxiella/Q Fever after being outside
RemovingticksTicksBlood-sucking acarid parasites of the order ixodida comprising two families: the softbacked ticks (argasidae) and hardbacked ticks (ixodidae). Ticks are larger than their relatives, the mites. They penetrate the skin of their host by means of highly specialized, hooked mouth parts and feed on its blood. Ticks attack all groups of terrestrial vertebrates. In humans they are responsible for many tick-borne diseases, including the transmission of rocky mountain spotted fever; tularemia; babesiosis; african swine fever; and relapsing fever.Coxiella/Q Fever from bite sites as soon as possible with a tweezer
Rate ofB. burgdorferi infection ofticksTicksBlood-sucking acarid parasites of the order ixodida comprising two families: the softbacked ticks (argasidae) and hardbacked ticks (ixodidae). Ticks are larger than their relatives, the mites. They penetrate the skin of their host by means of highly specialized, hooked mouth parts and feed on its blood. Ticks attack all groups of terrestrial vertebrates. In humans they are responsible for many tick-borne diseases, including the transmission of rocky mountain spotted fever; tularemia; babesiosis; african swine fever; and relapsing fever.Coxiella/Q Fever in the area is ≥ 20%.
BabesiosisBabesiosisBabesiosis 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: a tick-borne infection caused byBabesiaBabesiaBabesiosis 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.PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship can be asymptomatic or developfeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,fatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia,malaiseMalaiseTick-borne Encephalitis Virus, and arthralgias. Asplenic,immunocompromisedimmunocompromisedA human or animal whose immunologic mechanism is deficient because of an immunodeficiency disorder or other disease or as the result of the administration of immunosuppressive drugs or radiation.Gastroenteritis, and elderlypatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship are at risk for severe disease, causinghemolytic anemiaHemolytic AnemiaHemolytic 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,thrombocytopeniaThrombocytopeniaThrombocytopenia occurs when the platelet count is< 150,000 per microliter. The normal range for platelets is usually 150,000-450,000/µL of whole blood. Thrombocytopenia can be a result of decreased production, increased destruction, or splenic sequestration of platelets. Patients are often asymptomatic until platelet counts are< 50,000/µL.Thrombocytopenia,hepatosplenomegalyHepatosplenomegalyCytomegalovirus,renal failureRenal failureConditions in which the kidneys perform below the normal level in the ability to remove wastes, concentrate urine, and maintain electrolyte balance; blood pressure; and calcium metabolism. Renal insufficiency can be classified by the degree of kidney damage (as measured by the level of proteinuria) and reduction in glomerular filtration rate.Crush Syndrome, and death. Diagnosis is confirmed with aperipheral blood smearPeripheral Blood SmearAnemia: Overview and Types, serologic testing, andPCRPCRPolymerase 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). Treatment includes antibiotics, such asatovaquoneAtovaquoneA hydroxynaphthoquinone that has antimicrobial activity and is being used in antimalarial protocols.Antimalarial Drugs plusazithromycinAzithromycinA semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis.Macrolides and Ketolides.
EhrlichiosisEhrlichiosisEhrlichiosis is a tick-borne bacterial infection. The most common causative species include Ehrlichia chaffeensis, which infect and multiply within monocytes. The clinical presentation can vary widely, but often includes fever, malaise, headache, myalgia, and arthralgias.Ehrlichiosis and Anaplasmosis andanaplasmosisAnaplasmosisAnaplasmosis 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: tick-borneinfectionsInfectionsInvasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases.Chronic Granulomatous Disease caused byEhrlichia chaffeensisEhrlichia chaffeensisA 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 andAnaplasmosisAnaplasmosisAnaplasmosis 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, respectively. Symptoms includefeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,headacheHeadacheThe symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.Brain Abscess, andmalaiseMalaiseTick-borne Encephalitis Virus. ArashRashRocky Mountain Spotted Fever is uncommon, but can appear petechial ormaculopapularMaculopapularDermatologic Examination. The diagnosis is made with aPCRPCRPolymerase 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) test. Treatment of both diseases is with doxycycline.
Rocky Mountain spottedfeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever: a disease caused byRickettsia rickettsiiRickettsia rickettsiiA 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.Rickettsia that presents withfeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,fatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia,headacheHeadacheThe symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.Brain Abscess, and arashRashRocky Mountain Spotted Fever following a tick bite. However, this disease is associated with theDermacentorDermacentorA 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 tick, and therashRashRocky Mountain Spotted Fever begins on the distal extremities and spreads centrally. Diagnosis is made based on the clinical features,biopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma of therashRashRocky Mountain Spotted Fever, and serologic testing. Treatment involves antibiotics, including doxycycline.
Epidemic typhusEpidemic TyphusEpidemic typhus is a febrile illness caused by the obligate intracellular gram-negative bacterium, Rickettsia prowazekii. Epidemic typhus is also known as louse-borne typhus or jail fever, and its symptoms include high fever, headache, myalgias, dry cough, delirium, stupor, and rash.Epidemic Typhus: a disease caused byRickettsia prowazekiiRickettsia prowazekiiA species of gram-negative, aerobic bacteria that is the etiologic agent of epidemic typhus fever acquired through contact with lice as well as brill’s disease.Rickettsiathat presents withmyalgiaMyalgiaPainful sensation in the muscles.Ion Channel Myopathy,arthralgiaArthralgiaPain in the joint.Rheumatic Fever,rashRashRocky Mountain Spotted Fever, andencephalitisEncephalitisEncephalitis is inflammation of the brain parenchyma caused by an infection, usually viral. Encephalitis may present with mild symptoms such as headache, fever, fatigue, and muscle and joint pain or with severe symptoms such as seizures, altered consciousness, and paralysis.Encephalitis. ArashRashRocky Mountain Spotted Fever starts on the trunk and spreads outward to the extremities.Epidemic typhusEpidemic TyphusEpidemic typhus is a febrile illness caused by the obligate intracellular gram-negative bacterium, Rickettsia prowazekii. Epidemic typhus is also known as louse-borne typhus or jail fever, and its symptoms include high fever, headache, myalgias, dry cough, delirium, stupor, and rash.Epidemic Typhus is transmitted to humans by lice. Diagnosis is based on the clinical picture,biopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma of therashRashRocky Mountain Spotted Fever, and serologic testing. Treatment involves antibiotics, including doxycycline.
InfectiousmononucleosisMononucleosisInfectious 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: a disease caused by theEpstein-Barr virusEpstein-Barr VirusEpstein-Barr virus (EBV) is a linear, double-stranded DNA virus belonging to the Herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency.Epstein-Barr Virus that is characterized byfeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,fatigueFatigueThe state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.Fibromyalgia,lymphadenopathyLymphadenopathyLymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease.Lymphadenopathy, andpharyngitisPharyngitisPharyngitis is an inflammation of the back of the throat (pharynx). Pharyngitis is usually caused by an upper respiratory tract infection, which is viral in most cases. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and hoarseness.Pharyngitis. Diagnosis is based on clinical features and testing, such as a heterophile antibody test orserologySerologyThe study of serum, especially of antigen-antibody reactions in vitro.Yellow Fever Virus. Treatment is supportive. The use ofamoxicillinAmoxicillinA broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration.Penicillins can cause a characteristicmaculopapularMaculopapularDermatologic ExaminationrashRashRocky Mountain Spotted Fever.
JuvenileidiopathicIdiopathicDermatomyositisarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis: a group of rheumatic diseases that causearthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis,feverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,rashRashRocky Mountain Spotted Fever, adenopathy,splenomegalySplenomegalySplenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein.Splenomegaly, andiridocyclitisIridocyclitisAcute or chronic inflammation of the iris and ciliary body characterized by exudates into the anterior chamber, discoloration of the iris, and constricted, sluggish pupil. Symptoms include radiating pain, photophobia, lacrimation, and interference with vision.Relapsing Fever in children under 16 years of age. TherashRashRocky Mountain Spotted Fever may vary, but can appear macular with a central clearing. Diagnosis is based on the clinical picture and an autoimmune workup, includingrheumatoid factorRheumatoid factorAntibodies found in adult rheumatoid arthritis patients that are directed against gamma-chain immunoglobulins.Autoimmune Hepatitis (RFRFRheumatoid Arthritis), antinuclearantibodiesAntibodiesImmunoglobulins (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 (ANA), anticyclic citrullinated peptideantibodiesAntibodiesImmunoglobulins (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 (anti-CCP), and human leukocyteantigenAntigenSubstances that are recognized by the immune system and induce an immune reaction.Vaccination (HLA)-B27. Treatment includescorticosteroidsCorticosteroidsChorioretinitis anddisease-modifying antirheumatic drugsDisease-modifying antirheumatic drugsDisease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects.Disease-Modifying Antirheumatic Drugs (DMARDs) (DMARDsDMARDsDisease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects.Disease-Modifying Antirheumatic Drugs (DMARDs)).
RheumatoidarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis: an autoimmune disease of the joints, causing an inflammatory anddestructive arthritisDestructive ArthritisJuvenile Idiopathic Arthritis.PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship typically haveswellingSwellingInflammation andpainPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways of the peripheral joints (e.g., hands, wrists, knees, ankles). Associated extra-articular manifestations includepericarditisPericarditisPericarditis 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,lymphadenopathyLymphadenopathyLymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease.Lymphadenopathy, episcleritis, ormononeuritis multiplexMononeuritis MultiplexChronic Diabetic Complications. Diagnosis is based on the clinical picture, inflammatory markers,RFRFRheumatoid Arthritis, and anti-CCP. Treatment usually starts withglucocorticoidsGlucocorticoidsGlucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs.Glucocorticoids,DMARDsDMARDsDisease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects.Disease-Modifying Antirheumatic Drugs (DMARDs), and nonsteroidal anti-inflammatory drugs (NSAIDsNSAIDSPrimary vs Secondary Headaches).
ReactivearthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis:aspondyloarthropathySpondyloarthropathyAnkylosing Spondylitis that is often precipitated by a gastrointestinal or genitourinary infection.PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship may present with an asymmetricarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis, typically of the lower extremities. ThisarthritisArthritisAcute or chronic inflammation of joints.Osteoarthritis can be associated withfeverFeverFever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.Fever,tendinitisTendinitisAnkylosing Spondylitis,enthesitisEnthesitisAnkylosing Spondylitis, mucocutaneous ulcers, andconjunctivitisConjunctivitisConjunctivitis is a common inflammation of the bulbar and/or palpebral conjunctiva. It can be classified into infectious (mostly viral) and noninfectious conjunctivitis, which includes allergic causes. Patients commonly present with red eyes, increased tearing, burning, foreign body sensation, and photophobia.Conjunctivitis. Diagnosis is clinical. Treatment includesNSAIDsNSAIDSPrimary vs Secondary Headaches,DMARDsDMARDsDisease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects.Disease-Modifying Antirheumatic Drugs (DMARDs), and treatment of the infection.
