Lyme Disease Essay, Research Paper

Lyme Disease Lyme Arthritis ~~~~~~~~~~~~~~ Lyme disease is a

tick-transmitted inflammatory disorder characterized by an early focal

skin lesion, and subsequently a growing red area on the skin (erythema

chronicum migrans or ECM). The disorder may be followed weeks later

by neurological, heart or joint abnormalities. Symptomatology

~~~~~~~~~~~~~~ The first symptom of Lyme disease is a skin lesion.

Known as erythema chronicum migrans, or ECM, this usually begins as a

red discoloration (macule) or as an elevated round spot (papule). The

skin lesion usually appears on an extremity or on the trunk, especially the

thigh, buttock or the under arm. This spot expands, often with central

clearing, to a diameter as large as 50 cm (c. 12 in.). Approximately 25%

of patients with Lyme disease report having been bitten at that site by a

tiny tick 3 to 32 days before onset of ECM. The lesion may be warm to

touch. Soon after onset nearly half the patients develop multiple smaller

lesions without hardened centers. ECM generally lasts for a few weeks.

Other types of lesions may subsequently appear during resolution. Former

skin lesions may reappear faintly, sometimes before recurrent attacks of

arthritis. Lesions of the mucous membranes do not occur in Lyme

disease. The most common symptoms accompanying ECM, or preceding

it by a few days, may include malaise, fatigue, chills, fever, headache and

stiff neck. Less commonly, backache, muscle aches (myalgias), nausea,

vomiting, sore throat, swollen lymph glands, and an enlarged spleen may

also be present. Most symptoms are characteristically intermittent and

changing, but malaise and fatigue may linger for weeks. Arthritis is present

in about half of the patients with ECM, occurring within weeks to months

following onset and lasting as long as 2 years. Early in the illness,

migratory inflammation of many joints (polyarthritis) without joint swelling

may occur. Later, longer attacks of swelling and pain in several large

joints, especially the knees, typically recur for several years. The knees

commonly are much more swollen than painful; they are often hot, but

rarely red. Baker’s cysts (a cyst in the knee) may form and rupture. Those

symptoms accompanying ECM, especially malaise, fatigue and low-grade

fever, may also precede or accompany recurrent attacks of arthritis.

About 10% of patients develop chronic knee involvement (i.e. unremittent

for 6 months or longer). Neurological abnormalities may develop in about

15% of patients with Lyme disease within weeks to months following

onset of ECM, often before arthritis occurs. These abnormalities

commonly last for months, and usually resolve completely. They include:

1. lymphocytic meningitis or meningoencephalitis 2. jerky involuntary

movements (chorea) 3. failure of muscle coordination due to dysfunction

of the cerebellum (cerebellar ataxia) 4. cranial neuritis including Bell’s

palsy (a form of facial paralysis) 5. motor and sensory radiculo-neuritis

(symmetric weakness, pain, strange sensations in the extremities, usually

occurring first in the legs) 6. injury to single nerves causing diminished

nerve response (mononeuritis multiplex) 7. inflammation of the spinal cord

(myelitis). Abnormalities in the heart muscle (myocardium) occur in

approximately 8% of patients with Lyme disease within weeks of ECM.

They may include fluctuating degrees of atrioventricular block and, less

commonly, inflammation of the heart sack and heart muscle

(myopericarditis) with reduced blood volume ejected from the left

ventricle and an enlarged heart (cardiomegaly). When Lyme Disease is

contracted during pregnancy, the fetus may or may not be adversely

affected, or may contract congenital Lyme Disease. In a study of nineteen

pregnant women with Lyme Disease, fourteen had normal pregnancies

and normal babies. If Lyme Disease is contracted during pregnancy,

possible fetal abnormalities and premature birth can occur. Etiology

~~~~~~~~ Lyme disease is caused by a spirochete bacterium (Borrelia

Burgdorferi) transmitted by a small tick called Ixodes dammini. The

spirochete is probably injected into the victim’s skin or bloodstream at the

time of the insect bite. After an incubation period of 3 to 32 days, the

organism migrates outward in the skin, is spread through the lymphatic

system or is disseminated by the blood to different body organs or other

skin sites. Lyme Disease was first described in 1909 in European medical

journals. The first outbreak in the United States occurred in the early

1970’s in Old lyme, Connecticut. An unusually high incidence of juvenile

arthritis in the area led scientists to investigate and identify the disorder. In

1981, Dr. Willy Burgdorfer identified the bacterial spirochete organism

(Borrelia Burgdorferi) which causes this disorder. Affected Population

~~~~~~~~~~~~~~~~~~~ Lyme Disease occurs in wooded areas with

populations of mice and deer which carry ticks, and can be contracted

during any season of the year. Related Disorders

~~~~~~~~~~~~~~~~~ Rheumatoid Arthritis is a disorder similar in

appearance to Lyme disease. However, the pain in rheumatoid arthritis is

usually more pronounced. Morning stiffness and symmetric joint swelling

more commonly occur in rheumatoid arthritis, and knotty lumps under the

skin may be present over bony prominences. Bony decalcification which

can be prominent in Rheumatoid Arthritis is detected on X-rays. Brachial

Neuritis, also known as Parsonnage-Turner Syndrome, is a common

inflammation of a group of nerves that supply the arm, forearm, and hand

(brachial plexus). It is characterized by severe neck pain in the area

above the collarbone (supraclavicular) that may radiate down the arm and

into the hand. There also may be weakness and numbness (hyperesthesia)

of the fingers and hands. Although many cases have no apparent cause,

this syndrome may occur following an immunization (tetanus or diptheria),

surgery, or infection with Lyme Disease. Therapies: Standard

~~~~~~~~~~~~~~~~~~~~ For adults with Lyme disease the antibiotic

tetracycline is the drug of choice. Penicillin V and erythromycin have also

been used. In children penicillin V is recommended rather than

tetracycline. Penicillin V is now recommended for neurological

abnormalities. It is not yet clear whether antibiotic treatment is helpful later

in the illness when arthritis is the most predominant symptom. Treatment

should be started as soon as the rash appears, even before the Enzyme

Linked Immunoabsorbent Assay (ELISA) test is completed. Results of

this test may be inaccurate if patients have had antibiotics soon after

contracting Lyme Disease, or in those who have weakened immune

systems. If lyme Disease is contracted during pregnancy, careful

monitoring by physicians is highly recommended to avoid possible fetal

abnormalities and/or complications. For tense knee joints due to

increased fluid flowing in the joint spaces (effusions), the use of crutches is

often helpful. Aspiration of fluid and injection of a corticosteroid may be

beneficial. If the patient with Lyme disease has marked functional

limitation, excision of the membrane lining the joint (synovectomy) may be

performed for chronic (6 months or more despite therapy) knee effusions,

but spontaneous remission can occur after more than a year of continuous

knee involvement. When Lyme Disease is contracted during pregnancy,

treatment with penicillin should begin immediately to avoid the possibility

of fetal abnormalities. In 1989 a new Lyme Disease antibody test,

manufactured by Cambridge Biosciences Corp., was approved by the

FDA. This test is being used by local laboratories throughout the nation,

making tests more available to the general population. However, it is 97%

specific for antibodies to Lyme disease when compared to Western blot

tests, but it cannot identify the live bacteria in patients who have not yet

developed the antibodies. Therapies: Investigational

~~~~~~~~~~~~~~~~~~~~~~~~~~~ Researchers are trying to

develop a test that will identify the Lyme disease bacteria in patients who

have not yet developed the antibodies. This would enable doctors to

diagnose Lyme disease very early in the course of the illness. This disease

entry is based upon medical information available through July 1989.

Since NORD’s resources are limited, it is not possible to keep every

entry in the Rare Disease Database completely current and accurate.

Please check with the agencies listed in the Resources section for the

most current information about this disorder.