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Mycotoxins and Tick-Borne Disease
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Lyme disease is traditionally described as having three forms: early localized Lyme disease (3–30 days from the bite), early disseminated Lyme disease (3–5 weeks from the bite), and late Lyme disease.8 In early localized Lyme disease, patients may present with (or without) a known tick bite and a characteristic rash (erythema migrans). They may also have some constitutional symptoms such as a headache, myalgias, neck stiffness, and a fever. In the early disseminated form, patients may have multiple erythema migrans rashes, cranial nerve palsies (like bell’s palsy), carditis with cardiac arrhythmia, or meningitis. Conjunctivitis is seen as well. In late Lyme disease, patients often develop monoarticular arthritis of a large joint. Even after treatment with antibiotics, some patients with Lyme arthritis continue to have pain. It has been proposed that an autoimmune mechanism is responsible.10 Encephalitis, encephalopathy, and polyneuropathy may be seen as well. The original paper11 describing these entities notes the fact that patients may improve with antibiotics and that later the symptoms may reoccur. It is the pattern of persistent, multi-system, and recurring symptoms in some patients which has resulted in Lyme disease being called “the great imitator.”
Encephalitis and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Borreliella burgdorferi infection, transmitted virtually exclusively by bites of hard shelled Ixodes ticks, often begins with a typically asymptomatic skin lesion at the site of inoculation, known as erythema migrans (EM). Prevalent in areas of the northeast and upper Midwest United States [7], as well as much of temperate Europe, this is a multisystem infectious disease that involves the nervous system in 10%–15% of untreated patients [8]. Meningitis occurs in up to 10% of patients, who also can develop cranial neuritis and peripheral nerve involvement. Only rarely is the brain or spinal cord parenchyma directly involved, although many patients with systemic infection may develop a “toxic metabolic” encephalopathy as a result of the systemic inflammatory response [9–11].
Infectious Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Vas Novelli, Delane Shingadia, Huda Al-Ansari
The clinical presentations of Lyme borreliosis vary widely and are often divided into different stages, namely early localised, early disseminated and late disease. Early localised disease usually has a distinctive rash called erythema migrans (EM) occurring at the site of a recent tick bite. The typical EM lesion begins as a red macule at the site of the tick bite with a slow expansion over weeks with central clearing (Fig. 3.18). Other features that may accompany the rash include fever, malaise, headache, neck stiffness, myalgia and arthalgia. Early disseminated disease is characterised by multiple erythematous skin lesions usually accompanied by other features including cranial nerve palsies, lymphocytic meningitis and conjunctivitis. Late disease is characterised by relapsing arthritis, most commonly pauciarticular and affecting the large joints.
The Utility of Lyme Testing in the Workup of Ocular Inflammation
Published in Ocular Immunology and Inflammation, 2021
Lana M. Rifkin, Julie Vadboncoeur, Caroline C. Minkus, Evan N. Dunn, Ramana S. Moorthy, Nirali Bhatt, H. Nida Sen, Michael G. Taggart, Albert T. Vitale, Debra A Goldstein
Lyme disease, the most commonly reported tick-borne disease in the United States,2 is a multi-system disorder which can affect the joints, heart, and central nervous system. The most common manifestation of Lyme in the United States is a characteristic erythema migrans skin rash. Other manifestations include cranial nerve palsies, meningitis, myalgia, arthralgia, headache, and fatigue.3 The Centers for Disease Control and Prevention (CDC) advocates testing for patients with pathognomonic symptoms and possible exposure to infected black-legged ticks.4 Nevertheless, countless patients with uveitis and no history of tick exposure or erythema migrans undergo serological testing for Lyme disease. The widespread use of this diagnostic testing is controversial, as many of the patients thought to have Lyme-associated uveitis may have been misdiagnosed due to over-testing of patients with non-specific symptoms and clinical findings and false-positive laboratory tests.5 Furthermore, many patients with presumed Lyme-associated uveitis are also treated with corticosteroids, which are effective in the treatment of other forms of uveitis, making a response to treatment an inadequate way to conclude Lyme was the cause of inflammation.
The many manifestations of a single disease: neuroborreliosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sajida Zulfiqar, Anum Qureshi, Ranadheer Dande, Chahat Puri, Kia Persaud, Shankar Awasthi
Lyme disease is a tick-borne illness caused by a spirochete; Borrelia burgdorferi. It is commonly found in North America and Europe. Clinically, the presentation is variable, most common being facial nerve paralysis. Other presentations include localized skin infection; erythema migrans, one of the first signs of Lyme disease. Early-disseminated disease can present as atrioventricular nodal blockade, carditis, neuritis (seventh nerve palsy or Bell’s palsy) and meningitis. Late Lyme disease can present as arthralgias, peripheral neuropathy and rarely, encephalopathy. Here, we present a case of a Lyme disease with classic seventh cranial nerve palsy ileus and SIADH.
Lyme Neuroborreliosis Presenting as Multiple Cranial Neuropathies
Published in Neuro-Ophthalmology, 2022
Aishwarya Sriram, Samantha Lessen, Kevin Hsu, Cheng Zhang
The disease is classified into three stages, namely, localised, disseminated, and persistent. The localised and disseminated stages are part of early infection, while the persistent stage is indicative of chronic infection. In the first stage, the disease often presents with an erythema migrans rash. This rash is found in 70% to 80% of cases and appears at the site of the tick bite as an enlarging, erythematous skin lesion that may be homogenous or targetoid. In addition to the rash, patients may experience flu-like symptoms, such as fever, myalgias, or headache. However, nearly 30% of patients with the erythema migrans rash will have no additional symptoms.1