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331 lines
13 KiB
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(word processor parameters LM=8, RM=78, TM=2, BM=2)
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Taken from KeelyNet BBS (214) 324-3501
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Sponsored by Vangard Sciences
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PO BOX 1031
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Mesquite, TX 75150
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July 8, 1990
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The National Organization for Rare Disorders (NORD),
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P.O. Box 8923, New
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Fairfield, CT 06812,
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(203) 746-6518
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this file courtesy of Double Helix at 212-865-7043
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Lyme Disease
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Lyme Arthritis
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General Discussion
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--------------------------------
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** REMINDER **
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The information contained in the Rare Disease Database is provided
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for educational purposes only. It should not be used for diagnostic
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or treatment purposes. If you wish to obtain more information about
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this disorder, please contact your personal physician and/or the
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agencies listed in the "Resources" section of this report.
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Lyme disease is a tick-transmitted inflammatory disorder
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characterized by an early focal skin lesion, and subsequently a
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growing red area on the skin (erythema chronicum migrans or ECM).
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The disorder may be followed weeks later by neurological, heart or
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joint abnormalities.
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Symptomatology
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--------------------------------
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The first symptom of Lyme disease is a skin lesion. Known as
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erythema chronicum migrans, or ECM, this usually begins as a red
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discoloration (macule) or as an elevated round spot (papule).
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The skin lesion usually appears on an extremity or on the trunk,
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especially the thigh, buttock or the under arm. This spot expands,
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often with central clearing, to a diameter as large as 50 cm (c. 12
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in.).
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Approximately 25% of patients with Lyme disease report having
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been bitten at that site by a tiny tick 3 to 32 days before onset of
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ECM.
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The lesion may be warm to touch. Soon after onset nearly half the
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patients develop multiple smaller lesions without hardened centers.
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ECM generally lasts for a few weeks.
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Other types of lesions may subsequently appear during resolution.
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Former skin lesions may reappear faintly, sometimes before recurrent
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Page 1
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attacks of arthritis. Lesions of the mucous membranes do not occur
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in Lyme disease.
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The most common symptoms accompanying ECM, or preceding it by a few
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days, may include malaise, fatigue, chills, fever, headache and
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stiff neck. Less commonly, backache, muscle aches (myalgias),
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nausea, vomiting, sore throat, swollen lymph glands, and an enlarged
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spleen may also be present.
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Most symptoms are characteristically intermittent and changing, but
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malaise and fatigue may linger for weeks.
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Arthritis is present in about half of the patients with ECM,
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occurring within weeks to months following onset and lasting as long
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as 2 years.
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Early in the illness, migratory inflammation of many joints
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(polyarthritis) without joint swelling may occur. Later, longer
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attacks of swelling and pain in several large joints, especially the
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knees, typically recur for several years.
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The knees commonly are much more swollen than painful; they are often
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hot, but rarely red. Baker's cysts (a cyst in the knee) may form and
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rupture.
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Those symptoms accompanying ECM, especially malaise, fatigue and low-
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grade fever, may also precede or accompany recurrent attacks of
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arthritis. About 10% of patients develop chronic knee involvement
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(i.e. unremittent for 6 months or longer).
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Neurological abnormalities may develop in about 15% of patients with
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Lyme disease within weeks to months following onset of ECM, often
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before arthritis occurs. These abnormalities commonly last for
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months, and usually resolve completely. They include:
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1. lymphocytic meningitis or meningoencephalitis
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2. jerky involuntary movements (chorea)
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3. failure of muscle coordination due to dysfunction of the
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cerebellum (cerebellar ataxia)
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4. cranial neuritis including Bell's palsy (a form of facial
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paralysis)
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5. motor and sensory radiculo-neuritis (symmetric weakness,
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pain, strange sensations in the extremities, usually
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occurring first in the legs)
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6. injury to single nerves causing diminished nerve response
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(mononeuritis multiplex)
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7. inflammation of the spinal cord (myelitis).
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Abnormalities in the heart muscle (myocardium) occur in approximately
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8% of patients with Lyme disease within weeks of ECM.
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They may include fluctuating degrees of atrioventricular block and,
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less commonly, inflammation of the heart sack and heart muscle
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(myopericarditis) with reduced blood volume ejected from the left
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ventricle and an enlarged heart (cardiomegaly).
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When Lyme Disease is contracted during pregnancy, the fetus may or
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may not be adversely affected, or may contract congenital Lyme
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Page 2
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Disease. In a study of nineteen pregnant women with Lyme Disease,
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fourteen had normal pregnancies and normal babies.
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If Lyme Disease is contracted during pregnancy, possible fetal
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abnormalities and premature birth can occur.
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Etiology
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--------------------------------
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Lyme disease is caused by a spirochete bacterium (Borrelia
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Burgdorferi) transmitted by a small tick called Ixodes dammini.
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The spirochete is probably injected into the victim's skin or
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bloodstream at the time of the insect bite. After an incubation
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period of 3 to 32 days, the organism migrates outward in the skin,
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is spread through the lymphatic system or is disseminated by the
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blood to different body organs or other skin sites.
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Lyme Disease was first described in 1909 in European medical
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journals. The first outbreak in the United States occurred in the
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early 1970's in Old lyme, Connecticut.
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An unusually high incidence of juvenile arthritis in the area led
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scientists to investigate and identify the disorder. In 1981, Dr.
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Willy Burgdorfer identified the bacterial spirochete organism
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(Borrelia Burgdorferi) which causes this disorder.
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Affected Population
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Lyme Disease occurs in wooded areas with populations of mice and deer
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which carry ticks, and can be contracted during any season of the
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year.
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Related Disorders
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--------------------------------
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Rheumatoid Arthritis is a disorder similar in appearance to Lyme
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disease. However, the pain in rheumatoid arthritis is usually more
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pronounced.
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Morning stiffness and symmetric joint swelling more commonly occur in
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rheumatoid arthritis, and knotty lumps under the skin may be present
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over bony prominences. Bony decalcification which can be prominent
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in Rheumatoid Arthritis is detected on X-rays.
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Brachial Neuritis, also known as Parsonnage-Turner Syndrome, is a
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common inflammation of a group of nerves that supply the arm,
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forearm, and hand (brachial plexus). It is characterized by severe
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neck pain in the area above the collarbone (supraclavicular) that may
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radiate down the arm and into the hand.
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There also may be weakness and numbness (hyperesthesia) of the
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fingers and hands. Although many cases have no apparent cause, this
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syndrome may occur following an immunization (tetanus or diptheria),
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surgery, or infection with Lyme Disease.
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Page 3
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Therapies: Standard
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--------------------------------
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For adults with Lyme disease the antibiotic tetracycline is the drug
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of choice. Penicillin V and erythromycin have also been used. In
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children penicillin V is recommended rather than tetracycline.
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Penicillin V is now recommended for neurological abnormalities. It
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is not yet clear whether antibiotic treatment is helpful later in
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the illness when arthritis is the most predominant symptom.
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Treatment should be started as soon as the rash appears, even before
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the Enzyme Linked Immunoabsorbent Assay (ELISA) test is completed.
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Results of this test may be inaccurate if patients have had
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antibiotics soon after contracting Lyme Disease, or in those who have
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a weakened immune systems.
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If lyme Disease is contracted during pregnancy, careful monitoring by
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physicians is highly recommended to avoid possible fetal
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abnormalities and/or complications.
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For tense knee joints due to increased fluid flowing in the joint
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spaces (effusions), the use of crutches is often helpful. Aspiration
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of fluid and injection of a corticosteroid may be beneficial.
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If the patient with Lyme disease has marked functional limitation,
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excision of the membrane lining the joint (synovectomy) may be
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performed for chronic (6 months or more despite therapy) knee
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effusions, but spontaneous remission can occur after more than a year
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of continuous knee involvement.
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When Lyme Disease is contracted during pregnancy, treatment with
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penicillin should begin immediately to avoid the possibility of fetal
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abnormalities.
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In 1989 a new Lyme Disease antibody test, manufactured by Cambridge
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Biosciences Corp., was approved by the FDA. This test is being used
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by local laboratories throughout the nation, making tests more
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available to the general population.
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However, it is 97% specific for antibodies to Lyme disease when
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compared to Western blot tests, but it cannot identify the live
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bacteria in patients who have not yet developed the antibodies.
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Therapies: Investigational
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--------------------------------
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Researchers are trying to develop a test that will identify the Lyme
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disease bacteria in patients who have not yet developed the
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antibodies. This would enable doctors to diagnose Lyme disease very
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early in the course of the illness.
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This disease entry is based upon medical information available
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through July 1989. Since NORD's resources are limited, it is not
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possible to keep every entry in the Rare Disease Database completely
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current and accurate. Please check with the agencies listed in the
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Resources section for the most current information about this
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disorder.
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Page 4
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Resources
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--------------------------------
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For more information on Lyme Disease, please contact:
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National Organization for Rare Disorders
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P.O. Box 8923
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New Fairfield, CT 06812
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(203) 746-6518
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Lyme Borreliosis Foundation, Inc.
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P.O. Box 462
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Tolland, CT 06084
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(203) 871-2900
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Lyme Disease Clinic
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Marshfield Clinic
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1000 North Oak Ave.
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Marshfield, WI 54449
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The National Arthritis and Musculoskeletal and Skin Diseases
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Information Clearinghouse
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Box AMS
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Bethesda, MD 20892
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(301) 468-3235
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Lyme Disease Clinic
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Yale New Haven Hospital
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333 Cedar Street
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New Haven, CT 06510
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--------------------------------------------------------------------
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If you have comments or other information relating to such topics as
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this paper covers, please upload to KeelyNet or send to the Vangard
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Sciences address as listed on the first page. Thank you for your
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consideration, interest and support.
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Jerry W. Decker.........Ron Barker...........Chuck Henderson
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Vangard Sciences/KeelyNet
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--------------------------------------------------------------------
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If we can be of service, you may contact
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Jerry at (214) 324-8741 or Ron at (214) 484-3189
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--------------------------------------------------------------------
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FINIS
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Page 5
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