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Central Nervous System Lyme Disease

A bite that packs a punch – Lyme disease

Central nervous system Lyme disease is diagnosed by 2-tiered testing using peripheral blood samples because all patients with this infectious manifestation should have mounted an adequate IgG response in the blood.

B cells migrate to and proliferate inside the central nervous system, leading to intrathecal production of anti-Borrelia antibodies. An index of cerebrospinal fluid to serum antibody greater than 1 is thus also indicative of neuroborreliosis. Thus, performing lumbar puncture to detect intrathecal production of antibodies may support the diagnosis of central nervous system Lyme disease however, it is not necessary.

Antibodies persist in the central nervous system for many years after appropriate antimicrobial treatment.

How To Avoid Tick Bites

To reduce the chance of being bitten:

  • cover your skin while walking outdoors and tuck your trousers into your socks
  • use insect repellent on your clothes and skin products containing DEET are best
  • stay on clear paths whenever possible
  • wear light-coloured clothing so ticks are easier to see and brush off

When Should I Go See My Doctor

Anyone who has been bitten by a black-legged deer tick is at risk for Lyme disease. The highest risk groups include those living in or visiting endemic areas, especially people who spend significant time outdoors such as gardeners, hikers, or outdoor workers.

Patients should seek advice from their doctor if they have a suspicious round expanding red skin lesion, and/or show signs of summer-flu, particularly during Lyme disease season, which is highest-risk late spring through July/August. If those circumstances apply or symptoms persist it is very important to go to a physician.

For the west coast and other more temperate regions Lyme disease can be a year-round concern.

In the later disseminated stages, Lyme disease can be a much more insidious and complex illness. An individual should seek medical care if experiencing symptoms such as prolonged fevers, unexplained fatigue, painful joints, new or unusual headache, or heart or neurologic symptoms. If unexplained viral-like symptoms last for more than 1-2 weeks, please seek the advice of a physician.

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Recent Progress In Lyme Disease And Remaining Challenges

Lyme disease is the most common vector-borne disease in the United States with an estimated 476,000 cases per year. While historically, the long-term impact of Lyme disease on patients has been controversial, mounting evidence supports the idea that a substantial number of patients experience persistent symptoms following treatment. The research community has largely lacked the necessary funding to properly advance the scientific and clinical understanding of the disease, or to develop and evaluate innovative approaches for prevention, diagnosis, and treatment. Given the many outstanding questions raised into the diagnosis, clinical presentation and treatment of Lyme disease, and the underlying molecular mechanisms that trigger persistent disease, there is an urgent need for more support. This review article summarizes progress over the past 5 years in our understanding of Lyme and tick-borne diseases in the United States and highlights remaining challenges.

What Are The Signs And Symptoms Of Lyme Disease


The disease can be divided into three stages according to the extent of the infection.

333 days after a tick bite
  • Erythema migrans
  • ‘Flu-like illness with low-grade fever, chills, fatigue and joint pain
  • Borelial lymphocytoma red to blue patch on the earlobe, nipple or scrotum,
Early disseminated Lyme diseaseDays to weeks after a tick bite
  • Multiple eythema migrans, smaller than initial patch
  • Early neuroborreliosis
  • Facial or Bell palsy one sided paralysis of the facial muscles
  • Aseptic meningitis fever, severe headaches and neck stiffness
  • Polyradiculitis numbness and pain in arms or legs
  • Other cranial nerve palsies, mild encephalitis, peripheral neuritis
  • Arthritis painful and swollen large joints
  • Carditis abnormal heart rate
  • Progression is gradual over months to years
  • Progression is gradual over months to years
  • Late Lyme disease
    • Chronic Lyme arthritis in one or more large joints, mostly knee
    • Chronic neurological disorders such as:
    • Disorientation, confusion, dizziness, lack of concentration, short-term memory loss
    • Shooting pain, numbness extending to hands/arms and feet/legs.

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    What Are The Second Stage Signs And Symptoms Of Lyme Disease

    The symptoms of second stage, early disseminated, Lyme disease can be difficult to attribute. Symptoms include severe fatigue, fever, pain, intermittent weakness and achiness of the muscles and joints, numbness in arms and legs, vision changes, and cognitive dysfunction such as short-term memory difficulties and problems multitasking. These symptoms are not specific for Lyme disease and can make the diagnosis of second stage Lyme disease very challenging.

    More recognizable Lyme disease nervous system manifestations include facial paralysis , or meningitis with severe headache and stiff neck. Notable cardiac manifestations include passing out or feeling faint from an abnormally slow heart rate, irregular heart palpitations, or unexplained difficulty tolerating exercise. Meningitis and carditis are both potentially serious Lyme disease conditions and warrant immediate medical attention.

    Can I Catch Lyme Disease From My Dog

    Dogs are not a direct source of infection for people. Lyme disease cant be transmitted from one pet to another, nor from pets to humans, except through tick bites. However, a carrier tick could come into your house on your dogs fur and get on you.

    If your dog is diagnosed with Lyme disease, you and any other pets have probably been in the same outdoor environment and may also be at risk, so it is a good idea to consult with your physician and veterinarian to see whether you should test other pets or family members.

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    Key Points For Healthcare Providers

  • In patients with facial palsy who are unable to close one or both eyes, eye drops or an eye patch may be needed to prevent dry eyes.
  • Neurologic symptoms do not necessarily indicate central nervous system infection in a patient with Lyme disease.
  • Two-step serologic testing for Lyme disease is the recommended diagnostic test for neurologic Lyme disease.
  • Cerebral spinal fluid analysis is not necessary to diagnose Lyme meningitis, but can help exclude other causes of illness, such as bacterial meningitis.
  • Consider Lyme radiculoneuritis in patients who report severe limb or truncal radicular pain without preceding trauma who live in or who have traveled to Lyme-endemic areas.
  • But Why Is Lyme Disease So Unique

    Think the Lyme Disease Rash is Always a Bull’s-eye? Think Again! | Johns Hopkins Rheumatology

    Why is Lyme Disease so unique? Partly, because its a really unique pathogen with a tremendous defense system. But a major reason why Lyme Disease is so unique has to do with those in control of the medical community who will not back down.

    The IDSA, or Infectious Diseases Society of America, based in Arlington, Virginia, declared that Lyme Disease is only in a relatively small area of the United States and southern Ontario, is easily recognized, has very accurate blood tests, is very easy to treat, and does not become chronic. All of those statements are false, having been proven false by very good science carried out by some very distinguished scientists.

    There is no known reason for the denial of long term or chronic Lyme Disease by the IDSA. However, in the face of an overwhelming body of scientific evidence that says they are wrong, it can only be surmised that their continued denial has something to do with pride and maybe a fear of being sued.

    The fallout from their continued denial is a rapidly growing number of infected people all across Canada and the United States, as well as many other countries, who are not getting the treatment they need.

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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.

    What Are The First Signs And Symptoms Of Lyme Disease

    In the first early localized stage of Lyme disease the skin at the site of the tick bite becomes infected with Borrelia burgdorferi bacteria which can cause an expanding round or oval red skin lesion called erythema migrans. This may or may not be associated with flu-like symptoms within days to a month after the tick bite such as achiness, chills, fever, sweats, fatigue, malaise, headache, stiff neck, muscle soreness, joint pain, swollen lymph nodes, and sore throat. The combination of the skin lesion and flu-like symptoms are the primary manifestations of acute stage Lyme disease. Acute Lyme disease is not associated with typical cold-like symptoms of runny nose, prominent cough, or prominent diarrhea.

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    Who Should Not Be Tested

    The American College of Physicians recommends against testing in patients:

    • Presenting with nonspecific symptoms without objective signs of Lyme disease

    • With low pretest probability of infection based on epidemiologic exposures and clinical features

    • Living in Lyme-endemic areas with no history of tick exposure

    • Presenting less than 1 week after tick exposure

    • Seeking a test of cure for treated Lyme disease.

    Can Lyme Disease Be Prevented Or Avoided

    erythema multiforme vs lyme disease

    The best way to prevent Lyme disease is to avoid being bitten by ticks. When you are outdoors, follow these guidelines:

    • Avoid areas that are wooded, brushy, or have tall grass.
    • Walk in the center of trails.
    • Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Dont apply it to the face or hands of children.
    • Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.
    • Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
    • Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.

    After you get home, check everything and everyone for ticks.

    • Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
    • Check your entire body for ticks. Use a mirror for places you cant see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
    • Check any gear you used, including coats, backpacks, or tents.

    Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.

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    History Of Lyme Disease

    Ticks and Lyme disease have been around for thousands of years. In fact, a recent autopsy on a 5,300-year-old mummy indicated the presence of the bacteria which causes Lyme disease. A German physician, Alfred Buchwald, first described the chronic skin rash, or erythema migrans, of what is now known to be Lyme disease more than 130 years ago. However, Lyme disease was only recognized in the United States in the 1960s and 1970s. And the bacteria that causes itBorrelia burgdorferiwasnt officially classified until 1981.

    What Is Lyme Disease

    Lyme disease is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours. If you remove the tick within 48 hours, you probably wonât get infected.

    When you do get infected, the bacteria travel through your bloodstream and affect various tissues in your body. If you donât treat Lyme disease early on, it can turn into an inflammatory condition that affects multiple systems, starting with your skin, joints, and nervous system and moving to organs later on.

    The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long the tick was attached to you. Youâre most likely to get Lyme disease if you live in the Northeastern United States. The upper Midwest is also a hot spot. But the disease now affects people in all 50 states and the District of Columbia.

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    Interpreting The Igm Western Blot Test: The 1

    If clinical symptoms and signs of Lyme disease have been present for more than 1 month, IgM reactivity alone should not be used to support the diagnosis, in view of the likelihood of a false-positive test result in this situation. This is called the 1-month rule in the diagnosis of Lyme disease.

    In early localized infection, Western blot is only half as sensitive as ELISA testing. Since the overall sensitivity of a 2-step algorithm is equal to that of its least sensitive component, 2-tiered testing is not useful in early disease.

    Although currently considered the most specific test for confirmation of Lyme disease, Western blot has limitations. It is technically and interpretively complex and is thus not universally available. The blots are scored by visual examination, compromising the reproducibility of the test, although densitometric blot analysis techniques and automated scanning and scoring attempt to address some of these limitations. Like the ELISA, Western blot can have false-positive results in healthy individuals without tick exposure, as nonspecific IgM immunoblots develop faint bands. This is because of cross-reaction between B burgdorferi antigens and antigens from other microorganisms. Around 50% of healthy adults show low-level serum IgG reactivity against the FlaB antigen, leading to false-positive results as well. In cases in which the Western blot result is indeterminate, other etiologies must be considered.

    Lyme Disease Basicsanswers To The Most Commonly

    Lyme Disease symptoms
    • Email
    • QWhat is Lyme disease?
    • ALyme disease is a bacterial infection, most commonly contracted from a tick bite, that may initially cause a flu-like sickness. Untreated, or inadequately treated, it may cause long-term, persistent illness that can affect many systems of the body. Other tick-borne diseases are often contracted at the same time.
    • QHow do you get it?
    • A

      Lyme Disease is spread primarily through the bite of the deer tick in the eastern U.S., and the black-legged tick in the western U.S. The Lone Star tick, prevalent in the South and Midwest and spreading elsewhere, has also been associated with Lyme disease.

      Some researchers believe that other ticks and some biting insects such as mosquitoes, fleas, biting flies, and lice may also transmit LD. Babies may be born infected if the mother is infected, or possibly acquire it through breast milk. A blood transfusion with Lyme- infected blood may transmit the disease to the recipient. Some specialist medical researchers believe that Lyme, or other tick-borne diseases, can be sexually transmitted, although there has never been any research to confirm or deny it. Lyme spirochetes have been found in many bodily fluids.

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    Stage : Early Localized Disease

    Symptoms of Lyme disease usually start 1 to 2 weeks after the tick bite. One of the earliest signs of the disease is a bulls-eye rash.

    The rash occurs at the site of the tick bite, usually, but not always, as a central red spot surrounded by a clear spot with an area of redness at the edge. It may be warm to the touch, but it isnt painful and doesnt itch. This rash will gradually fade in most people.

    The formal name for this rash is erythema migrans. Erythema migrans is said to be characteristic of Lyme disease. However, many people dont have this symptom.

    Some people have a rash thats solid red, while people with dark complexions may have a rash that resembles a bruise.

    The rash can occur with or without systemic viral or flu-like symptoms.

    Other symptoms commonly seen in this stage of Lyme disease include:

    How Is Lyme Disease Treated

    With early-stage Lyme disease, youâll take antibiotics for about 10 days to 3 weeks. The most common ones are amoxicillin, cefuroxime, and doxycycline. The antibiotics will almost always cure your infection. If they donât, you might get other antibiotics either by mouth or as a shot.

    If you donât treat your Lyme infection, you might need oral antibiotics for symptoms like weakened face muscles and irregular heartbeat. You may need antibiotics if you have meningitis, inflammation in your brain and spinal cord, or more severe heart problems.

    If your Lyme is late stage, the doctor might give you antibiotics either by mouth or as a shot. If it causes arthritis, youâll get arthritis treatment.

    Thereâs no therapy for post-treatment Lyme disease syndrome.

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    Learn The Stages Of Lyme Disease

    Lyme disease occurs in three stages: early localized, early disseminated and late disseminated. However the stages can overlap and not all patients go through all three. A bulls-eye rash is usually considered one of the first signs of infection, but many people develop a different kind of rash or none at all. In most cases, Lyme symptoms can start with a flu-like illness. If untreated, the symptoms can continue to worsen and turn into a long-lived debilitating illness.

    Stage 1: Early Localized Disease

    Symptoms with early localized Lyme disease may begin hours, a few days or even weeks after a tick bite. At this point, the

    infection has not yet spread throughout the body. Lyme is the easiest to cure at this stage.

    Symptoms may include:

    • skin rash, which may or may not look like a bulls eye
    • flu-like illness, including chills and fever
    • fatigue
    • muscle soreness and joint pain
    • swollen lymph nodes
    • sore throat
    Stage 2: Early Disseminated Lyme

    Early disseminated Lyme may occur several weeks or months after the tick bite. Bacteria are beginning to spread throughout the body. In addition to flu-like symptoms, this stage is often characterized by increase in symptoms such as:

    • chills
    • pain, weakness or numbness in the arms, legs
    • vision changes
    • heart problems, such as palpitations, chest pain
    • rash may appear on body
    • facial paralysis
    Stage 3: Late Disseminated Lyme Disease

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