Diagnosis treatment Lyme disease
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Lyme disease, a deer tick-born infectious disease, caused by the organism Borrelia burgdorferi, is treated with antibiotics.
Roughly 3 to 32 days after a tick bite, about 80 per cent of patients will develop the classic skin lesion of erythema chronicum migrans (ECM)- a target-shaped lesion occurring in the axilla, thigh, or groin area.
This is accompanied by headache, neck stiffness, fever, chills, myalgias, arthralgias,, fatigue, and malaise.
Less common manifestations include swollen lymph nodes, enlarged spleen, hepatitis, sore throat, unproductive cough, conjunctivitis, and swelling of the testicles.
Patients who are diagnosed early and who have the skin rash only can be managed with a course of oral antibiotics such as doxycycline, cefuroxime axetil, or amoxicillin, given for a four to six weeks. These drugs often speed the healing of the rash and prevent the development of systemic disease.
Those who develop severe arthritis, neurological, or cardiac manifestations require intravenous antibiotics. The intravenous antibiotic regimen is constantly changing. The most up to date recommendations can be found at the CDC website.
Patients with arthritis will also often be treated with anti inflammatory medications, joint aspiration, or arthroscopic removal of the inflamed lining of the joint. The arthritis symptoms may take several weeks or months to improve. Some patients will have symptoms that become chronic.
Following treatment some patients will have chronic issues with muscle aching, memory and concentration, as well as fatigue.
Doctors who treat Lyme disease are usually primary care physicians, rheumatologists, or infectious disease specialists.
When patients develop neurological symptoms (15 per cent), neurology consultation is indicated. Neurological symptoms include: mood changes, memory deficit, and sleep disturbance. These are felt to be due to encephalopathy. Spinal fluid protein is elevated, and the white cell count may also be elevated. Antibody production to the spirochete may be increased. Nerve root pain may develop as a result of generalized nerve inflammation (polyneuropathy.) Bell’s palsy is also a symptom. Severe central nervous system involvement can also occur but it is rare.
Patients with cardiac problems need to be evaluated by a cardiologist. The reason is that rarely, patients develops heart block and they will need a temporary pacemaker inserted.Eight per cent develop cardiac problems but these are usually not severe.
Laboratory diagnosis is still problematic because of the variability of analytic assays. Polymerase chain reaction appears to be the definitive technique of choice in patients who have a suspicious Western Blot.
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