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Lyme disease: Treatment, symptoms, advice and help

About Lyme disease

Lyme disease is a bacterial illness caused by a microorganism known as Borrelia burgdorferi which is transmitted to humans by the bite of deer ticks (Ixodes ticks) carrying the organism.

Lyme disease: Incidence, age and sex

Lyme disease has been reported from over 50 countries including Central Europe, especially Germany, Austria and Switzerland. It is the most common vector-borne disease in the USA. In endemic areas, the reported annual incidence ranges from 20 to 100 cases / 100,000 population. The reported incidence is highest among children 5-10 years of age, which is almost twice as high as the incidence among older children and adults.

Signs and symptoms of Lyme disease: Diagnosis

The first symptom of Lyme disease is atypical annular rash, named erythema migrans. The rash usually resolves without treatment after 4 weeks. Several days or even weeks later fever, myalgia, headache, malaise, conjunctivitis and lymphadenopathy may develop. New small evanescent, red, circular lesions continue to appear for several weeks.

Diagnosis: the confirmation of Lyme disease in patients without erythema migrans usually is based on the demonstration of antibodies to B.Burgdorferi in the patient’s serum. The available serologic tests, especially widely used commercial kits, have only fair specificity.

Causes and prevention of Lyme disease

Lyme disease is caused by the spirochaete Borrelia burgdorferi. It is a zoonosis spread by the bite of an infected deer tick of the Ixodes species. Persons with increased occupational, recreational, or residential exposure to tick-infested woods or fields in endemic areas, are at increased risk for developing Lyme disease.

Prevention is by wearing appropriate protective clothing (long pants tucked into socks, long sleeve shirts) when entering tick-infested areas and checking for and removing ticks after spending time in such areas. Insect repellents on the skin (DEET) may provide temporary protection. Permerthrin kill ticks but should only be put on clothing. Daily inspection of the scalp, skin, behind the ears, groin, clothing lines and axilla with removal of ticks is recommended for all children in endemic areas.

Lyme disease: Complications

Aseptic meningitis, focal neurologic findings, carditis and paralysis of the facial (7th) cranial nerve are relatively common in children. The paralysis usually lasts 2-8 weeks and resolves completely in most cases.

Arthritis begins weeks to months after the initial infection. The joint swelling usually resolves within 1-2 week before recurring in other joints. If the disease is not treated, the episodes of arthritis may increase in duration. In adults, chronic demyelinating encephalitis, polyneuritis and impairment of memory have been attributed to Lyme disease.

Lyme disease: Treatment

The drug of choice is doxycycline. Children under 8 years of age should not be treated with doxycycline. Patients who are treated with doxycycline should be alerted to the risk for developing dermatitis in sun-exposed areas while taking the medication. Cefuroxime is licensed for the treatment of Lyme disease and is an alternative for persons who cannot take doxycycline and who are allergic to penicillin.