What Are The Possible Outcomes Of This Disease
The outcomes of treatment of patients with Lyme disease are excellent, with virtually all patients making a full recovery. The most common reason for failure of treatment is misdiagnosis: the patient did not have Lyme disease. Treatment is generally safe and highly effective. Families should be cautioned about the large amount of inaccurate information about Lyme disease, which can be frightening, on the Internet.
Can Lyme Disease Be Prevented
People aren’t able to become immune to Lyme disease. So even if you’ve had Lyme disease, you can get it again. No vaccine is available currently to prevent the disease.
The FDA approved a Lyme vaccine called LYMErix in 1998. The vaccine was not 100% effective, however. The FDA still recommended preventing the disease in other ways. In 2002, the company that made LYMErix said it would no longer offer the vaccine.
To help prevent Lyme disease, follow these guidelines.
Some Visible Signs Of Lyme Disease Are Easily Missed Or Mistaken
- University of Medicine and Dentistry of New Jersey
- With Lyme disease season now beginning, doctors are urged to consider Lyme disease as the underlying cause when presented with skin lesions that resemble conditions such as contact dermatitis, lupus, common skin infections, or insect or spider bites, especially where Lyme disease is endemic. New analysis establishes patients with those symptoms, rather than the classic Lyme “bulls-eye” lesion, to have been infected with the Lyme bacterium.
When a person contracts Lyme disease, quick diagnosis and treatment are essential to avoiding long term complications. But the diagnostic process may be delayed if a physician does not recognize a skin rash caused by Lyme disease because it does not have the bull’s-eye appearance that is best known to physicians and the public. In a Research Letter just published in the journal Emerging Infectious Diseases, a prominent research team led by Steven E, Schutzer, MD, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, confirms findings of Lyme disease in patients with skin lesions that more closely resemble the classic signs of conditions such as contact dermatitis, lupus, common skin infections, or insect or spider bites. Based on these findings they urge doctors to consider Lyme disease as the cause when presented with such lesions, particularly when the patient was in an area where Lyme disease is endemic.
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An Illness That Does Not Go Away
Scleroderma is chronic. This means that it lasts for your lifetime. However, like diabetes, high blood pressure, heart disease, and psoriasis, scleroderma can be treated and the symptoms managed. The cause of scleroderma is unknown and there is currently no cure, but there are treatments that can effectively prevent or limit the damage caused by this chronic disease.
Rocky Mountain Spotted Fever
Rocky Mountain Spotted Fever is a bacterial infection transmitted by ticks. It is relatively rare, but can cause serious damage to the heart, lungs, and brain. The difficulty lies in diagnosis because many people are unaware that they have been bitten by a tick. Three types of ticks transmit the Rickettsia rickettsii bacteria:
- Dog ticks, usually in the Eastern part of the country.
- Wood ticks, usually in the Rocky Mountain states.
- Lone star ticks, usually on the West coast.
Rocky Mountain Spotted Fever is characterized by a rash that begins as small red spots or blotches on the wrists, ankles, palms, or soles of the feet. It spreads up the arms and legs to the trunk of the body. These symptoms take between one and two weeks to appear following a tick bite. The rash is often accompanied by fever, chills, muscle ache, red eyes, light sensitivity, excessive thirst, loss of appetite, diarrhea, nausea, vomiting, and/or fatigue. While there are lab tests your doctor can use to diagnose the disease, they take time to complete, so you may be placed on a course of antibiotic treatment right away.
The best way to prevent Rocky Mountain Spotted Fever is to avoid tick-infested areas. If you spend any time in areas with woods, tall grasses, or shrubs, wear long sleeves and pants. Tuck pants legs into socks. Wear closed shoes, not sandals. Do a visual check of each member of your family upon returning home. And dont forget to check your dog for ticks .
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What Are The Clinical Features Of Acrodermatitis Chronica Atrophicans
Acrodermatitis chronica atrophicans typically presents as a unilateral violet discolouration of the extensor parts of the upper or lower limbs, especially the dorsum of the hand, elbow, instep, ankle, or knee. However, it can appear anywhere on the body and can be bilateral.
ACA develops in 2 stages. Initial inflammation is followed by progressivefibrosis and cutaneousatrophy over months or years.
Less common features of ACA include fibrous papules and plaques, and skin coloured nodules.
Most patients have a history of tick bite. Some of them may recall a rash consistent with erythema migrans some months or years earlier, often affecting the same limb. Erythema migrans is a ring-like rash that occurs around the site of a Borrelia-infected tick bite.
Clinical features of acrodermatitis chronica atrophicans
How To Stay Safe
The best way to stay safe with eczema during the pandemic is to follow public health guidance to lower the risk of catching COVID-19:
- Continue your eczema medication as prescribed.
- Take steps to avoid and manage flares during the COVID-19 pandemic.
- Support your health by reviewing eczema care basics.
- Take steps to reduce stress, manage itching, and improve your sleep hygiene.
- Wash your hands regularly, avoid close contact with others, and socially distance where possible. You can rewash your hands with your usual emollient to protect the skin and use moisturizer after washing hands and when the skin feels dry, cracked, or sore.
- When washing your hands, wash with soap and water for at least 20 seconds.
- If soap and water are not available, use a hand sanitizer containing 60% alcohol. Apply moisturizer to your hands once hand sanitizer is dry if it is causing our eczema to worsen.
- Wear a face mask in public settings and where social distancing is not possible. Once you are fully vaccinated, wearing a face mask is optional.
- Avoid crowded situations.
- Practice self-monitoring.
- Avoid contact with people who are unwell.
- If someone in your home becomes unwell, follow medical guidance and isolation advice to reduce the risk of spreading the virus in your home.
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How Can Lyme Disease Be Prevented
Antimicrobial prophylaxis to prevent Lyme disease for persons who are bitten by Ixodes ticks is not indicated routinely. However, there is evidence that a single dose of doxycycline may be indicated for persons 8 years of age or older who discover an engorged or at least partially engorged nymphal or adult-stage deer tick on them. Doxycycline should be given with food to minimize nausea.
Risk of Lyme disease from a recognized bite of Ixodes scapularis is low nearly three quarters of ticks that are recognized are removed in less than 48 hours . Most physicians are unable to identify species of tick .
There is no evidence that use of amoxicillin for chemoprophylaxis for tick bites in younger children is effective the pharmacokinetics of amoxicillin make it likely that one dose may not be effective.
No vaccine is available.
Avoiding tick infested areas and, if one does walk through fields and woodlands in endemic areas wearing light-colored long pants tucked into socks and long-sleeved shirts, if possible, will minimize exposure. Insect repellants that contain 30% DEET may be effective, as may spraying of outer clothing with permethrin. After being in tick-infested areas check your body for and remove any ticks.
If You Are Able To Confirm That The Patient Has Lyme Disease What Treatment Should Be Initiated
Treatment options for Lyme disease can be seen in Table I.
|Route of Administration|
|Oral||Doxycycline Amoxicillin Cefuroxime Paxetil||4-8 mg/kgTwice a day50 mg/kg Three times/day30 mg/kg Twice a day||Well absorbedExcellent penetration into CNSAlternative for patients allergic to beta-lactam antimicrobialsInexpensiveTwice daily administrationMay cause nausea, especially when administered without foodNot recommended for children < 8 y because of small risk of staining of permanent teethWell tolerated with small risk of minor diarrheaCan administer to young childrenThree times daily administrationCan be given to young childrenTwice daily administrationMore expensive than amoxicillin or doxycyclineBroad spectrum of antimicrobial activity not necessary|
|Intravenous||CeftriaxoneCefotaximePenicillin G||50-75 mg/kg Once daily 150-200 mg/kg every 8 h200,000-400,000 U/kg divided every 4 h||Good CNS penetrationOnce daily administrationMust be administered parenterallyGood CNS penetrationExpensiveMust be administered parenterally three times daily Few side effectsMust be administered very frequently because of short half-life|
*Total and maximum daily dosages and frequency of administration/day
Up to 200 mg/dose for neuroborreliosis
CNS = central nervous system
The bacterium is highly susceptible to antimicrobial agents and there are no reports of resistance to such recommended agents.
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What Causes This Disease And How Frequent Is It
Approximately 20,00030,000 cases of Lyme disease are reported each year in the United States . Nearly three quarters of these cases occur in fewer than 70 counties in the United States.
The great majority of cases of Lyme disease in the United States occur in southern New England and the eastern mid-Atlantic states, with a smaller number of cases in the northern midwestern states and even fewer cases on the Pacific Coast. In the most highly endemic areas of the United States, such as Connecticut, the incidence is about 1 cases/1000 persons but can be substantially higher in local areas.
The incidence is highest in children 510 years of age, nearly twice as high as the incidence among adults.
Lyme disease is transmitted by the bite of Ixodid ticks. B. burgdorferi live in the gut of infected ticks the tick needs to feed for a substantial length of time and become engorged with blood for the bacteria to migrate to the salivary glands of the tick and then be inoculated into the human host.
The tick has a three-stage , 2-year life cycle and feeds once at each stage of the cycle.
Lyme disease is a zoonosis. The major reservoirs for the bacteria are a variety of small mammals and birds. Larval ticks are uninfected when they hatch but become infected by feeding on infected animal reservoirs, such as the mice.
Achy Stiff Or Swollen Joints
Joint pain and stiffness, often intermittent, are early Lyme symptoms. Your joints may be inflamed, warm to the touch, painful, and swollen. You may have stiffness and limited range of motion in some joints .
Pain may move around. Sometimes your knees may hurt, whereas other times its your neck or your heels. You may also have bursitis . Bursae are the thin cushions between bone and surrounding tissue.
The pain may be severe, and it may be transitory. More than one joint may be affected. Most often the large joints are involved .
People often attribute joint problems to age, genetics, or sports. Lyme should be added to that list, as these statistics indicate:
- One study estimates that 80 percent of people with untreated Lyme have muscle and joint symptoms .
- Fifty percent of people with untreated Lyme have intermittent episodes of arthritis .
- Two-thirds of people have their first episode of joint pain within six months of the infection .
- Use of anti-inflammatory drugs may mask the actual number of people with joint swelling .
Joint pain that comes and goes, or moves from joint to joint, could be a sign of Lyme.
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Are You Sure Your Patient Has Lyme Disease What Are The Typical Findings For This Disease
The most common manifestation is the rash, termed erythema migrans .
Single erythema migrans occurs 721 days after tick bite . It is an expanding erythematous macular rash that without treatment persists for weeks . Although central clearing may occur, nearly two thirds of erythema migrans rashes are uniformly erythematous only. Erythema migrans often is asymptomatic but it may be pruritic or, rarely, painful, and can have central vesicles on occasion.
Erythema migrans rash.
Early disseminated disease occurs when there is dissemination from the skin to other sites through spirochetemia . This early disease is manifested as the following:
Multiple erythema migrans
Multiple erythema migrans.
Facial nerve palsy
Meningitis : presents like aseptic meningitis but is typically of longer duration and may be associated with papilledema and increased intracranial pressure
Carditis : usually manifests as heart block, most often not serious but rarely can present with syncope from transient complete heart block
Late Lyme disease
Arthritis : Typically subacute with mild to moderate pain associated with frank arthritis sometimes may mimic acute bacterial arthritis
Lyme Disease: More Common And More Dangerous Than You Think
Lyme disease outbreaks are already being reported this spring, and experts say theres a long way to go before we grasp the scope and impact of this serious tick-borne illness.
In the early 1990s, Dr. Neil Spector began experiencing odd symptoms.
At times, his heart would beat 200 times a minute. He also suffered crippling fatigue and had brain fog so intense he once gave a lecture and had no recollection of it.
Blood tests showed his body was producing high levels of antibodies, but specialists couldnt determine what was triggering his immune systems response.
It said my body was mounting a defense against something, Spector told Healthline. They just kept chalking it up to stress.
More symptoms began appearing slow heartbeat, arthritis pain, and burning in his heels but experts dismissed Spectors theory that they could be signs of Lyme disease, the most common vector-borne infection in humans.
Spectors symptoms began right after he moved from Boston to Miami, but Lyme disease is uncommon in Florida. Spector said he doesnt remember ever having the trademark bulls-eye rash of Lyme disease.
Spector, an associate professor of oncology at the Duke University School of Medicine, had no formal training in Lyme disease, but that changed as he searched for an explanation for his symptoms.
I dont think I have Lyme disease anymore, but the damage to my heart was already done by the time I was diagnosed, he said.
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What Are My Treatment Options For Rashes
Treatment options depend on the cause of the red rash on the skin.
It could be any medical condition, and proper treatment can only be received when you visit your doctor and let them know about your symptoms.
The diagnosis may differ depending on the kind of rash, how long it has lasted, and its appearance.
You may be told to follow a series of self-care treatments followed by taking the right medication or avoiding certain things causing the rash to appear in the first place.
Its best not to treat this skin rash on your own and visit your dermatologist when you first start seeing the signs.
A delayed visit can cause more harm by causing the condition to become severe.
Sometimes, when you see an immediate reaction of rashes accompanied by other signs, it could also be an intense allergic reaction, so its best to visit a doctor if youre having trouble breathing or see the rash spreading too quickly.
Knowing The Symptoms To Look For Can Help Diagnose Lyme Disease Early On When It’s Easily Treatable
Karen Pallarito tells stories grounded in science and backed by solid reporting. As Senior Conditions Editor for Health, she covers COVID-19 plus umpteen other health and wellness topics. Her freelance portfolio includes pieces for The Washington Post, U.S. News & World Report, Working Mother, Westchester Magazine, and the news syndicate HealthDay, among others. Karen started her career as a health policy reporter in the nation’s capital, where she covered congressional hearings on Medicare and Medicaid. From the late 90s to the early aughts, she reported on health business for Reuters Health and contributed to its medical and consumer health newswires. Prior to that, she was Modern Healthcare’s New York Bureau Chief. A fellow of the Association of Health Care Journalists’ 2019 class on Comparative Effective Research, Karen is committed to helping people understand the benefits and harms of clinical interventions and exposing racial/ethnic disparities in healthcare. When not on deadline, you might find her whipping up something in the kitchen, working out, bingeing on cable news, or indulging in some form of mind candy .
Its super important that we think of all the tick-borne diseasesnot just Lyme, Dr. Flanagan tells Health. Babesia, a parasite that causes babesiosis, is treated differently than Borrelia, for example.
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What Are The Common Findings
Approximately one-quarter of the children with erythema migrans will have multiple erythema migrans, which is a sign that the bacteria have spread through the bloodstream and “seeded” other sites in the skin. The “secondary” rashes are usually smaller than the primary rash, and fever pains in the muscles, joints, or neck headache and/or fatigue often accompany them. Multiple erythema migrans is a manifestation of “early disseminated” Lyme Disease.
Another finding in the “early disseminated” stage of the disease is paralysis of the facial nerve. Rarely, patients may have meningitis or arrhythmia of the heart.
The common manifestation of late Lyme Disease is arthritis. The knee is usually affected , but any joint may be involved. Although the joint is swollen, it may be either very painful or it may be associated with relatively little pain, and the patient sometimes is able to pursue most normal activities with little impairment. Fever and other signs, such as headache or fatigue, may or may not be present.
It is important to realize that although patients with Lyme Disease often have non-specific symptoms, such as headache, fever, fatigue, or muscle pain, these symptoms are virtually always accompanied by specific signs of Lyme Disease, such as the characteristic rash, facial palsy, or a swollen knee. These non-specific symptoms, when present without more specific signs of Lyme Disease, are virtually never caused by Lyme Disease.