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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Best fit. Lyme disease is the only tick-borne disease in this list. It takes its name from Lyme, Connecticut, USA. It is an occupational zoonosis (i.e., an infectious disease transmitted from animals to humans and contracted in the course of employment). It is caused by bacterium Borrelia burgdorferri which is transmitted by the tick Ixodes ricinus. It is characterised by erythema chronicum migrans—an area of redness spreading out from the site of the bite. The tick is usually associated with deer. Neurological symptoms such as facial nerve neuritis, myelitis, encephalitis and meningitis may all occur as may a myocarditis. Chronic polyarthritis may also be found. Risk of contracting Lyme disease can be reduced by covering skin when outdoors, using insect repellent, inspecting clothes and body for ticks and having good personal hygiene.
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Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Lyme disease is caused by the spirochete bacterium Borrelia burgdorferi. B. burgdorferi is transferred to humans via the hard tick Ixodes dammini, which feeds on animals infected with the bacterium. Introduction of the bacterium into the human bloodstream via tick saliva occurs during a tick bite. Patients may recall this tick bite and the resultant macular lesion that appears at the site of the bite. This lesion then expands over the course of a week and develops into the characteristic rash of Lyme disease: erythema chronicum migrans. While this is occurring the patient may suffer from a prodromal phase in which there is fever and general malaise. The appearance of the typical rash should raise suspicions and trigger appropriate investigations that may include serology (to look for antibodies against the bacterium) and culture from appropriate fluid or tissue. Untreated, there is a significant risk of developing the late manifestations of Lyme disease, which include neurological abnormalities (e.g. meningitis, cranial neuropathy, peripheral neuropathy), heart disease (e.g. myocarditis, pericarditis, atrioventricular block) and rheumatological disease such as arthritis and fatigue. Rarely, the eyes, liver, spleen and testicles may also be involved. Doxycycline is the first-choice antibiotic. Summer forest walkers should be advised to cover up well and remove attached ticks promptly. Q fever is another bacterial zoonosis caused by the bacterium Coxiella burnetii.
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.”
Double vision in adults
Published in Journal of Binocular Vision and Ocular Motility, 2018
Three subjects in this study were diagnosed with Lyme disease. One subject presented with acute divergence insufficiency ET, one with oculomotor palsy, and the last developed acute Lyme meningitis. The subject with Lyme meningitis developed a right facial palsy and right facial numbness. This subject had already begun treatment with intravenous antibiotics 4 weeks prior to his ocular examination. At the time of his examination for our study, this subject had 25 PD of ET at distance, which was comitant, and 8 PD of intermittent ET at near. There was no papilledema at the time of his ocular examination. The etiology for his strabismus is unclear but may be related to abducens nerve weakness either from increased intracranial pressure or direct damage to the nerve in the subarachnoid space.
Diagnosis and management of Lyme neuroborreliosis
Published in Expert Review of Anti-infective Therapy, 2018
While tick bites, much like mosquito bites, are commonly followed immediately by a local pruritic reaction, the rash of Lyme disease typically occurs several days to weeks after the bite. Often asymptomatic, this rash reflects the centrifugal migration of spirochetes through the skin from the site of inoculation. This rash expands slowly day by day, ultimately potentially becoming many inches in diameter – sometimes involving much of a limb or the trunk. The slow expansion (a minimum diameter of 5 cm is required for case definition purposes) led to the original name, ‘erythema chronica migrans’, now shortened to ‘erythema migrans’. This rash occurs in 90% of infected children [3]; estimates in adults are typically lower, probably because, if asymptomatic and involving a part of the body that is not readily observed, it simply goes unnoticed.
Lyme Neuroborreliosis Presenting as Multiple Cranial Neuropathies
Published in Neuro-Ophthalmology, 2022
Aishwarya Sriram, Samantha Lessen, Kevin Hsu, Cheng Zhang
Lyme disease is caused by the bacterial spirochaete Borrelia burgdorferi and is transmitted by the Ixodes tick in the United States. It is the most frequently transmitted tick-borne infection in the United States, with a high prevalence in the Northeastern and upper Midwestern regions. In such regions, the incidence is approximately 40 per 100,000 people, with most infections occurring during the late spring, summer, and early fall.1 The diagnosis of Lyme disease is largely clinical, and requires a likely exposure, a clinical finding with a high positive predictive value (such as erythema migrans) and positive laboratory testing (typically, positive enzyme-linked immunosorbent assay [ELISA], and Western blot).2