Infectious disease caused by a spirochete with
significant immune response possibly leading to neurologic problems.
Erythema Migrans Disease; Tick-Borne Disease.
Named after the town of Lyme, Connecticut, USA, where a
mysterious clustering of arthritis cases was reported in 1970.
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.
None (infectious disorder).
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
Clinical evidence of erythema chronicum migrans together
with symptoms of influenza or meningitis.
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.
Full history of disease progression
and any antibiotic therapy. Assessment of cardiac, hepatic, and respiratory
function must be obtained. Coagulation profile should be obtained.
Cardiac abnormalities are present in
approximately 10% of patients and include atrioventricular block,
myopericarditis, and left ventricular dysfunction. Temporary cardiac pacing
may be required.
No known specific pharmacological
Doughty RA: Lyme disease. Pediatr Rev 6:20, 1984.
Montiel NJ, Baumgarten JM, Sinha AA: Lyme disease—Part II: Clinical
features and treatment. Cutis