Lyme Cns Infection Mimics Stroke In Teenager
The chameleon qualities of Lyme neuroborreliosis gained another layer with a case report of a teenager with sudden onset of what appeared to be ischemic stroke but turned out to be Borrelia burgdorferi infection. The correct diagnosis was made just in time to avoid the administration of thrombolytic therapy to the teenager.
Arseny A. Sokolov, MD, from the Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, and colleagues reported in an article February 25 in the Annals of Emergency Medicine that the 16-year-old girl presented the morning after a disco party with acute onset of severe headache and confusion. By the time she was evaluated at an urgent care center, she had right-sided face and arm weakness and language deficits. She was transferred by helicopter to a medical center for possible thrombolysis.
“Everything about her symptoms indicated stroke: speech deficits, poor comprehension and right-sided face and arm weakness, so we considered treating her with clot-busting drugs. But a 16 year-old having a stroke, while not unheard of, would be quite rare so we looked at other possibilities and found Lyme,” Dr Sokolov said in a news release.
Drug intoxication and psychogenic origin were ruled out because the patient had been directly observed for at least 16 hours before hospital admission.
The authors have disclosed no relevant financial relationships.
Annals Emerg Med. Published online February 25, 2015. Full text
Who Is At Risk For Lyme Disease
Anyone can get a tick bite. But people who spend lots of time outdoors in wooded, grassy areas are at a higher risk. This includes campers, hikers, and people who work in gardens and parks.
Most tick bites happen in the summer months when ticks are most active and people spend more time outdoors. But you can get bitten in the warmer months of early fall, or even late winter if temperatures are unusually high. And if there is a mild winter, ticks may come out earlier than usual.
What’s The Best Way To Prevent A Tick Bite
Ticks can’t fly or jump. But they live in shrubs and bushes and can grab onto you when you pass by. To avoid getting bitten:
- Wear pants and socks in areas with lots of trees and when you touch fallen leaves.
- Wear a tick repellent on your skin and clothing that has DEET, lemon oil, or eucalyptus.
- For even more protection, use the chemical permethrin on clothing and camping gear.
- Shower within 2 hours after coming inside. Look for ticks on your skin, and wash ticks out of your hair.
- Put your clothing and any exposed gear into a hot dryer to kill whatever pests might be on them.
How do you know if you’ve been bitten?
Since ticks are so small, you’ve got to have pretty good eyes to see them.
If you have a small, red bump on your skin that looks like a mosquito bite, it could be a tick bite. If it goes away in a few days, itâs not a problem. Remember, a tick bite doesnât necessarily mean you have Lyme disease.
If you notice a rash in the shape of a bull’s-eye, you might have a tick bite. Talk to your doctor about treatment.
If you have an allergic reaction to ticks, you’ll notice a bite right away.
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Confirming Lyme Disease In The Age Of Covid
The current COVID-19 pandemic is posing a new challenge in the diagnosis of Lyme disease. The two conditions have a lot of overlapping symptoms, such as fever, malaise, generalized pain and lack of energy. During these times, its advisable to rule out COVID-19 first before embarking on any other test.
Asking focused questions about personal lifestyle may help guiding the diagnosis of Lyme disease. Some key questions include:
- Any outdoor activities in areas already identified as having high prevalence of ticks?
- Any recollection of tick bites or removal of ticks from the body?
- Any skin rashes? ,
- Do you live in an endemic region for Lyme disease? If youre not sure, you can check public health websites. Knowing if one lives in an endemic region for Lyme disease is essential, as these recommendations should be encouraged in all emergency departments and family doctors offices in areas of high prevalence.
Why And How Lyme Disease And Tbrf Affect Mental Health
Lyme disease and TBRF can wreak havoc on a patients mental health in the following ways:
- Direct effects As with syphilis, the bacteria that causes Lyme disease and TBRF can invade the central nervous system and cause neurological and psychiatric symptoms that are organic in origin. This is what doctors call neurological Lyme disease or Lyme neuroborreliosis.
- Indirect effects The discomforts and challenges of living with and/or being treated for Lyme disease or TBRF can lead to anxiety, depression, and other mental health conditions that are not necessarily caused by the bacteria, but are indirectly caused or exacerbated .
Of course, these effects are not either/or, but rather can coexist and compound one another. Learn more about each below.
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What Is Neurologic Lyme Disease
Neurologic symptoms of Lyme disease occur when the Lyme disease bacteria affect the peripheral or central nervous systems.
- Cranial nerve involvement: When the cranial nerves are affected, facial palsy can occur on one or both sides of the face.
- Peripheral nerve involvement: When the peripheral nerves are affected, patients can develop radiculoneuropathy which can cause numbness, tingling, shooting pain, or weakness in the arms or legs.
- Central nervous system involvement: When the central nervous system is affected, Lyme meningitis can cause fever, headache, sensitivity to light, and stiff neck.
Out of every 100 patients whose cases are reported to CDC, 9 have facial palsy, 4 have radiculopathy, and 3 have meningitis or encephalitis. Because of reporting practices, this statistic may overestimate how often these manifestations are seen by clinicians.
Signs And Symptoms Of Lyme Disease
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Overview
Lyme disease is an underreported, under-researched, and often debilitating disease transmitted by spirochete bacteria. The spiral-shaped bacteria, Borrelia burgdorferi, are transmitted by blacklegged deer ticks. Lymes wide range of symptoms mimic those of many other ailments, making it difficult to diagnose .
The blacklegged ticks can also transmit other disease-causing bacteria, viruses, and parasites. These are known as coinfections . These ticks that transmit Lyme are increasing their geographical spread. As of 2016, they were found in about half the counties in 43 of 50 states in the United States .
Lyme is the fifth most reported of notifiable diseases in the United States, with an estimated 329,000 new cases found annually . Some studies estimate that there are as many as 1 million cases of Lyme in the United States every year .
Most people with Lyme who are treated right away with three weeks of antibiotics have a good prognosis.
But if youre not treated for weeks, months, or even years after infection, Lyme becomes more difficult to treat. Within days of the bite, the bacteria can move to your central nervous system, muscles and joints, eyes, and heart .
Here is a list of 13 common signs and symptoms of Lyme disease.
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What To Do If You Have A Blacklegged Tick Bite
Remove the tick by pulling it directly out with fine-tipped tweezers. Lift upward with slow and even pressure. Dont twist when removing it. Dont crush it or put soap or other substances on it. Dont apply heat to it.
Place the tick in a resealable container. See if you can identify what kind of a tick it is.
Immediately after removing the tick, wash your skin well with soap and water or with rubbing alcohol.
Not all ticks carry Lyme. The Lyme bacteria is transmitted only by blacklegged ticks in their nymph or adult stage.
Save the tick to show your doctor. The doctor will want to determine if its a blacklegged tick and if theres evidence of feeding. Ticks enlarge as they feed. Your risk of getting Lyme from an infected tick increases with the length of time that the tick fed on your blood.
Summary:
Pull the tick out with tweezers and save it in a resealable container for identification.
Skin Examinations And Ecgs
Thorough dermatological examination can clarify difficult cases. This happened in my clinic recently, when a nurse practitioner decided to run a full skin examination and discovered typical bulls-eye rashes on the patients back.
Once the diagnosis is suspected, cardiovascular symptoms such as dizziness, palpitations, fainting or near fainting, chest pain and shortness of breath should be investigated. If the patient reports any of these symptoms, along with any other factors suggesting Lyme disease, a 12-lead ECG should be performed.
Quite recently, a team from the United States did 12-lead ECG to a large series of pediatric patients presenting to the emergency department with high-suspicion of Lyme disease, and discovered that nearly 30 per cent of them had some conduction disturbance. Any evidence of electrical disturbance should prompt admission in hospital for a course of intravenous antibiotics while waiting the results of serological tests.
From the other perspective, any patient presenting with unexpected high-degree atrioventricular block , the way to test for Lyme carditis is by running a risk score called SILC , which was developed at Queens University and is now used worldwide.
SILC score is based on the risk factor acronym COSTAR , which may help in determining the likelihood of early Lyme carditis.
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The Role Of Coinfections
Ticks carry more diseases than just Lyme and TBRF, and its not uncommon for patients to be infected with more than one type of disease-causing bacteria.
Common coinfections such as Babesiosis and Bartonellosis can not only cause neurological and psychiatric symptoms of their own, but they can also complicate the diagnostic process, delaying proper diagnosis and treatment all of which increase the risk of developing emotional, behavioral, or cognitive problems from the infection.
What Do You Do If There’s A Tick Under Your Skin
Use a pair of fine-tipped tweezers to remove it as soon as possible. Pull upward with steady pressure. If parts of the tick are still in your skin, try to get those with the tweezers, too. After everything is out, clean the bite area with rubbing alcohol or soap and water.
You probably wonât get infected if you remove the tick within 36 to 48 hours.
How do you throw away a tick?
Put it in soapy water or alcohol, stick it to a piece of tape, or flush it down the toilet.
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What If A Tick Bites My Dog
The more ticks in your region, the likelier it is that your furry pal will bring them home.
Your dog is much more likely to be bitten by a tick than you are. And where Lyme disease is common, up to 25% of dogs have had it at some point.
About 10% of dogs with Lyme disease will get sick. 7-21 days after a tick bite, your dog might seem like theyâre walking on eggshells. They also might have a fever and enlarged lymph nodes. Plus, they might seem tired. Dogs also get antibiotics for Lyme.
What if my dog brings ticks into my home?
Use a tick control product on your pet to prevent Lyme disease. Also, have your dog vaccinated against Lyme.
Check your dogâs whole body each day for bumps. If you notice a swollen area, see if thereâs a tick there. If you find a tick, wear gloves while you use tweezers to separate it from your dog. Then, put it in soapy water or alcohol, or flush it down the toilet.
Use alcohol to clean the spot on your dog where the tick was attached. Keep an eye on that spot, and also on your dog to make sure theyâre behaving normally. If you notice any changes, check with your vet.
Show Sources
John Aucott, MD, assistant professor of medicine, Johns Hopkins University School of Medicine director, Johns Hopkins Lyme Disease Clinical Research Center.
CDC.
Morbidity and Mortality Weekly Report: âVital Signs: Trends in Reported Vectorborne Disease Cases — United States and Territories, 2004-2016.â
American College of Rheumatology.
Cardiologists: Know The Signs Of Lyme Disease
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Spring has arrived, and along with warmer weather and blossoming tree buds, a seasonal risk looms, especially for outdoor enthusiasts. The risk for Lyme disease, and the cardiac complications that can be associated with it, increases as people spend more time outdoors.
Lyme disease is an infection caused by a species in the spirochete pathogen Borrelia burgdorferi sensu lato group and is spread through tick bites.
Lyme disease is often overlooked by physicians, but its important to recognize and treat because of the cardiac complications that can occur if left untreated. Every cardiologist should be able to recognize signs and symptoms,Nieca Goldberg, MD, cardiologist in the department of medicine, Leon H. Charney division of cardiology, and director of the Joan H. Tisch Center for Womens Health at NYU Langone Medical Center, told Cardiology Today.
Nieca Goldberg
Often, the first sign is a rash at the site, known as a bulls-eye rash with a red ring and red center, Goldberg said.
According to the CDC, the rash is usually not painful or itchy, so it may be overlooked.
In the early localized stage, symptoms can include a rash, fatigue, chills, fever, headache, swollen lymph nodes and joint aches, similar to symptoms for many other diseases, including influenza or a common cold.
Disclosure: Goldberg reports no relevant financial disclosures.
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What Is Chronic Neurological Lyme Disease
Neurological Lyme disease, also known as Lyme neuroborreliosis, occurs when the Lyme- or TBRF-causing bacteria invade the central nervous system. Some describe neurological Lyme disease as a Lyme infection of the brain. Research has found that up to 15-40% of late-stage Lyme patients develop neurological disorders.
Identical atypical and cystic forms were also observed in the cerebral cortex of the three patients with chronic Lyme neuroborreliosis with concurrent AD. This indicates that Borrelia burgdorferi spirochetes can form resistant cystic forms, which may persist in the brain.
Strokes May Be Linked To Lyme
A dozen cases in Europe linking strokes and Lyme disease suggest that U.S. doctors should test for the tick-borne disease in their patients with unexplained stroke, researchers said.
“I suspect strokes caused by Lyme disease have occurred in the United States, but none has been reported so far,” said Dr. Eugene May, a neurologist at the Walter Reed Army Medical Center here.
The serious brain damage that a stroke can cause “makes it imperative be suspected in any atypical stroke so that prompt, appropriate treatment can be initiated,” May said in a statement issued by the American Heart Association.
Strokes occur when a blood vessel in the brain bursts or is blocked by a blood clot, cutting off the flow of blood to a portion of the brain and killing off brain cells.
Lyme disease is caused by a spirochete bacteria known as Borrelia burgdorferi, which typically is transmitted to humans through the bite of a tick the size of a pinhead.
The tick usually is picked up by humans during a walk in the woods.
The disease initially is easy to treat, but its early signs — including a red rash around the tick bite and flulike symptoms — are easily overlooked or ignored.
If left untreated, however, Lyme disease can cause chronic arthritis and seriously damage the heart and nervous system.
Tests showed he had often gone on field maneuvers and was infected with the bacteria that causes Lyme disease.
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What Is Lyme Disease
Lyme disease is a bacterial infection you get from the bite of an infected tick. At first, Lyme disease usually causes symptoms such as a rash, fever, headache, and fatigue. But if it is not treated early, the infection can spread to your joints, heart, and nervous system. Prompt treatment can help you recover quickly.
What Lyme Disease Does To Your Brain
is a bacterial infection that you catch when an infected deer tick bites you. The first symptoms can appear within a few days or weeks. They include a target-shaped , , fever, , , and . Often, doctors promptly recognize and treat Lyme disease with antibiotics. But when treatment is delayed, the infection can spread to other areas, including the nerves, liver and eyes. It can also spread to the central nervous systemthe brain and spinal cordand cause the following problems.
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When Should You See A Doctor If You Think You Have Lyme
The rash is a pretty good indication that you may have been bitten. Take a photo of the rash and see your doctor. At this stage, treatment with antibiotics will probably work.
If you don’t have the rash but have symptoms like fatigue, fever, and headache but no respiratory symptoms like a cough, you may want to talk to your doctor.
How Is It Treated
Facial palsy is treated with oral antibiotics and Lyme meningitis/radiculoneuritis can either be treated with oral or intravenous antibiotics, depending on severity . Most people with Lyme disease respond well to antibiotics and fully recover. Varying degrees of permanent nervous system damage may develop in people who do not receive treatment in the early stages of illness and who develop late-stage Lyme disease.
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