Lyme Disease

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Definition/Description

Blacklegged/Deer Tick. Photo from the Hardin Library for the Health Sciences, University of Iowa. Available at http://www.lib.uiowa.edu/HARDIN/MD/cdc/1669.html.

Lyme disease is an infectious disorder caused by the spiral spirochete bacterium Borrelia burgdorferi which is transmitted to humans though the bite of infected ticks in the genus Ixodes (commonly referred to as “black-legged” or “deer” ticks). The ticks that carry the disease are extremely small, generally not larger than 1 to 2 mm (see photo at left).  Species of Borrelia capable of causing the disease occur regularly in the United States, Europe, Asia, and Australia.

 

Prevalence

As of 2008, Lyme Disease ranked as the most commonly reported vector-borne illness in the United States. Between 1992 and 2006, 248,074 cases were reported in the United States including the District of Columbia and the U.S. territories. The number of cases reported annually increased 101% from 9,908 cases in 1992 to 19,931 in 2006, with 93% of those cases occurring in 10 states in New England and the Upper Midwest (Connecticut, Delaware, Massachusetts, Maryland, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). 

File:CDC IncidenceMap 08.jpg

Chart from Lyme Disease Statistics, CDC Division of Vector-Borne Infectious Diseases. Available at http://www.cdc.gov/ncidod/dvbid/Lyme/ld_statistics.htm.

Rates of incidence have continued to rise since 2006, with 27,444 cases reported in 2007 and 28,921 cases in 2008. As of 2008, the rate of incidence was 9.4 cases per 100,000. Children 5 to 14 years of age have the highest rate of incidence with an average of 8.6 cases per 100,000 compared to 3.0 cases per 100,000 for people 20 to 24 and 7.8 cases per 100,000 for ages 55 to 59. Most cases develop during the summer months of May and August when individuals are more likely to visit wooded areas for work or recreation.

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Erythema migrans
88% of patients develop a red skin rash that enlarges over time.  Many patients also report that their rash first presents with a bulls-eye pattern, with redness migrating outward concentrically from a dark central lesion bounded by a band of lighter color (see photo). This symptom generally occurs within a few days of infection, varies widely in severity or be absent altogether, and may or may not be accompanied by other symptoms.) The variability of this symptom, combined with often mild symptoms of the early stages of the disease contributes to the difficulty in early diagnosing. 

Flu-like symptoms
Fever, chills, fatigue, headache, and muscle or joint pain generally develop soon after infection (within several days) if they develop at all. In many cases, individuals who develop flu-like symptoms do not develop a rash. Thus, the presence of flu-like symptoms may represent the only clinical finding when a patient first presents.

Neurological symptoms,
About 15% of patients experience neurological signs and symptoms. The most common presentation is that of aseptic meningitis (http://www.nlm.nih.gov/medlineplus/ency/article/000614.htm) or encephalitis with symptoms including headache, neck stiffness, Bell’s (facial) palsy (8% of patients), radiculopathies (4% of patients), and mild to moderate cognitive changes including an inability to concentrate, forgetfulness, and changes in behavior or personality.

Lyme Arthritis or general arthralgia
33% of patients develop Lyme-related arthritis, which causes swelling (usually unilaterally) in the large joints such as the knees. (CDC) Patients may also have myofascial or bone pain that moves over the course of hours or days.

Cardiac symptoms
4 to 10% of patients present with cardiac signs and symptoms of varying severity such as tachycardia, bradycardia, arrhythmia, conduction block, or myocarditis. Many patients with these findings may also report dizziness, shortness of air, and syncope.

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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