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Infectious disease caused by a spirochete with significant immune response possibly leading to neurologic problems.

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Erythema Migrans Disease; Tick-Borne Disease.

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Named after the town of Lyme, Connecticut, USA, where a mysterious clustering of arthritis cases was reported in 1970.

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0.15-4.4:1000 population. Lyme disease is the most common disease transmitted by an insect in the United States. It is also prevalent in Europe and Asia.

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None (infectious disorder).

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Results from both direct infection and the host's immune response to the spirochete Borrelia burgdorferi, which is carried by the tick Ixodes dammini. The spirochete is injected into the bloodstream through the saliva of the tick or deposited on the skin with fecal material. After incubation period of 3 to 32 days, which the spirochete may migrate to the skin, causing erythema chronicum migrans, or it may enter the bloodstream, thereby migrating to other organs. The first clinical sign of the disease can be a facial nerve palsy, followed by arthritis and a meningitis-like symptom. The late complications are probably caused by a direct effect of infection with viable organisms and the immunologic response to them. The arthritis is thought to be a result of localization of immune complexes to the synovium, resulting in joint inflammation. The B-cell alloantigen HLA-DR4 is common in patients with severe and prolonged illness, particularly arthritis or neurologic disease.

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Clinical evidence of erythema chronicum migrans together with symptoms of influenza or meningitis.

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Skin lesions are prominent in the first stage of the disease, with cardiac and neurologic abnormalities occurring in the second stage. Arthritis is most common in the third stage. Hepatitis, myositis, eosinophilic lymphadenitis, respiratory distress syndrome, and facial nerve palsies may occur.

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Full history of disease progression and any antibiotic therapy. Assessment of cardiac, hepatic, and respiratory function must be obtained. Coagulation profile should be obtained.

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Cardiac abnormalities are present in approximately 10% of patients and include atrioventricular block, myopericarditis, and left ventricular dysfunction. Temporary cardiac pacing may be required.

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No known specific pharmacological implications.

Doughty RA: Lyme disease. Pediatr Rev 6:20, 1984.
Hayes E: Lyme disease. Clin Evid 7:652, 2002.  [PubMed: 12230693]
Montiel NJ, Baumgarten JM, Sinha AA: Lyme disease—Part II: Clinical features and treatment. Cutis 69:443, 2002.  [PubMed: 12078846]

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