247 lines
11 KiB
Plaintext
247 lines
11 KiB
Plaintext
ÜÜÜÜÜÜÜÜÜÜÜÜÜ ÜÜÜ ÜÜÜÜ
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ÜÛÛÛÛÛÛÛÛßÛßßßßßÛÛÜ ÜÜßßßßÜÜÜÜ ÜÛÜ ÜÛÛÛÛÛÛÛÛÜÜÜÜÜÛßß ßÛÛ
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ßÛÛÛÛÛÛÛÛÛÛÛÛÛÛÜ ßÛÛ ÜÛÛÛÜÛÛÜÜÜ ßÛÛÛÛÜ ßÛÛÛÛÛÛÛÜÛÛÜÜÜÛÛÝ Ûß
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ßßßÛÛÛÛÛÛÛÛÛÛÜ ÞÝ ÛÛÛÛÛÛÛÛÛÛÛßßÛÜÞÛÛÛ ÛÛÛÛÛÜ ßßÛÛÛÞß
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Mo.iMP ÜÛÛÜ ßÛÛÛÛÛÛÛÝÛ ÞÛÛÛÛÛÛÛÛÛ ÞÛÛÛÛ ÞÛÛÛÛÛÝ ßÛß
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ÜÛÛÛÛÛÛÛ ÛÛÛÛÛÛÛÛÝ ÞÛÛÛÛÛÛÛÛÝ ÛÛÛ ÛÛÛÛÛÛ
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ÜÛÛÛÛÛÛÛÝ ÞÛÛÛÛÛÛÛÛ ÞÛÛÛÛÛÛÛÛ ß ÞÛÛÛÛÛÛÜ ÜÛ
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ÜÛÛÛÛÛÛÛÝ ÛÛÛÛÛÛÛÛ ÛÛÛÛÛÛÛÛÝ ÞÞÛÛÛÛÛÛÛÛÛß
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ÜÛßÛÛÛÛÛÛ ÜÜ ÛÛÛÛÛÛÛÛÝ ÛÛÞÛÛÛÛÛÝ ÞÛÛÛÛÛÛßß
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ÜÛßÛÛÛÛÛÛÜÛÛÛÛÜÞÛÛÛÛÛÛÛÛ ÞÛ ßÛÛÛÛÛ Ü ÛÝÛÛÛÛÛ Ü
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ÜÛ ÞÛÛÛÛÛÛÛÛÛÛß ÛÛÛÛÛÛÛÛÛ ßÛÜ ßÛÛÛÜÜ ÜÜÛÛÛß ÞÛ ÞÛÛÛÝ ÜÜÛÛ
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ÛÛ ÛÛÛÛÛÛÛÛß ÛÛÛÛÛÛÛÛÛÛÜ ßÛÜ ßßÛÛÛÛÛÛÛÛÛß ÜÜÜß ÛÛÛÛÜÜÜÜÜÜÜÛÛÛÛÛß
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ßÛÜ ÜÛÛÛß ßÛÛÛÛÛÛÛÛÛÛÜ ßßÜÜ ßßÜÛÛßß ßÛÛÜ ßßßÛßÛÛÛÛÛÛÛßß
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ßßßßß ßßÛÛß ßßßßß ßßßßßßßßßßßßß
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ARRoGANT CoURiERS WiTH ESSaYS
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Grade Level: Type of Work Subject/Topic is on:
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[ ]6-8 [ ]Class Notes [General Educational Info]
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[ ]9-10 [ ]Cliff Notes [on Lyme's Disease ]
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[ ]11-12 [ ]Essay/Report [ ]
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[x]College [x]Misc [ ]
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Dizzed: 07/94 # of Words:1436 School: ? State: ?
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ÄÄÄÄÄÄÄÄÄ>ÄÄÄÄÄÄÄÄÄ>ÄÄÄÄÄÄÄÄÄ>Chop Here>ÄÄÄÄÄÄÄÄÄ>ÄÄÄÄÄÄÄÄÄ>ÄÄÄÄÄÄÄÄÄ>ÄÄÄÄÄÄÄÄÄ
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The National Organization for Rare Disorders (NORD), P.O. Box 8923, New
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Fairfield, CT 06812, (203) 746-6518
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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 for
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educational purposes only. It should not be used for diagnostic or
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treatment purposes. If you wish to obtain more information about this
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disorder, please contact your personal physician and/or the agencies listed
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in the "Resources" section of this report.
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Lyme disease is a tick-transmitted inflammatory disorder characterized
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by an early focal skin lesion, and subsequently a growing red area on the
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skin (erythema chronicum migrans or ECM). The disorder may be followed
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weeks later by neurological, heart or 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 erythema
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chronicum migrans, or ECM, this usually begins as a red discoloration
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(macule) or as an elevated round spot (papule). The skin lesion usually
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appears on an extremity or on the trunk, especially the thigh, buttock or
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the under arm. This spot expands, often with central clearing, to a
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diameter as large as 50 cm (c. 12 in.). Approximately 25% of patients with
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Lyme disease report having been bitten at that site by a tiny tick 3 to 32
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days before onset of ECM. The lesion may be warm to touch. Soon after
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onset nearly half the patients develop multiple smaller lesions without
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hardened centers. ECM generally lasts for a few weeks. Other types of
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lesions may subsequently appear during resolution. Former skin lesions may
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reappear faintly, sometimes before recurrent attacks of arthritis. Lesions
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of the mucous membranes do not occur 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 stiff
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neck. Less commonly, backache, muscle aches (myalgias), nausea, vomiting,
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sore throat, swollen lymph glands, and an enlarged spleen may also be
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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, occurring
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within weeks to months following onset and lasting as long 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 attacks
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of swelling and pain in several large joints, especially the knees,
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typically recur for several years. The knees commonly are much more
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swollen than painful; they are often hot, but rarely red. Baker's cysts
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(a cyst in the knee) may form and 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 arthritis.
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About 10% of patients develop chronic knee involvement (i.e. unremittent
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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 before
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arthritis occurs. These abnormalities commonly last for months, and
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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 cerebellum
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(cerebellar ataxia)
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4. cranial neuritis including Bell's palsy (a form of facial paralysis)
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5. motor and sensory radiculo-neuritis (symmetric weakness, pain,
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strange sensations in the extremities, usually occurring first in
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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. They may include
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fluctuating degrees of atrioventricular block and, less commonly,
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inflammation of the heart sack and heart muscle (myopericarditis) with
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reduced blood volume ejected from the left ventricle and an enlarged heart
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(cardiomegaly).
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When Lyme Disease is contracted during pregnancy, the fetus may or may
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not be adversely affected, or may contract congenital Lyme Disease. In a
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study of nineteen pregnant women with Lyme Disease, fourteen had normal
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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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Lyme disease is caused by a spirochete bacterium (Borrelia Burgdorferi)
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transmitted by a small tick called Ixodes dammini. The spirochete is
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probably injected into the victim's skin or bloodstream at the time of the
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insect bite. After an incubation period of 3 to 32 days, the organism
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migrates outward in the skin, is spread through the lymphatic system or is
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disseminated by the blood to different body organs or other skin sites.
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Lyme Disease was first described in 1909 in European medical journals.
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The first outbreak in the United States occurred in the early 1970's in Old
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lyme, Connecticut. An unusually high incidence of juvenile arthritis in the
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area led scientists to investigate and identify the disorder. In 1981, Dr.
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Willy Burgdorfer identified the bacterial spirochete organism (Borrelia
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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 year.
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Related Disorders
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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. Morning stiffness and symmetric joint swelling more commonly
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occur in rheumatoid arthritis, and knotty lumps under the skin may be
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present over bony prominences. Bony decalcification which can be
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prominent 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, forearm, and
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hand (brachial plexus). It is characterized by severe neck pain in the
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area above the collarbone (supraclavicular) that may radiate down the arm
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and into the hand. There also may be weakness and numbness (hyperesthesia)
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of the 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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Therapies: Standard
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For adults with Lyme disease the antibiotic tetracycline is the drug of
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choice. Penicillin V and erythromycin have also been used. In children
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penicillin V is recommended rather than tetracycline. Penicillin V is now
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recommended for neurological abnormalities. It is not yet clear whether
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antibiotic treatment is helpful later in the illness when arthritis is the
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most predominant symptom. Treatment should be started as soon as the rash
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appears, even before the Enzyme Linked Immunoabsorbent Assay (ELISA) test
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is completed. 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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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 abnormalities
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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 of
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fluid and injection of a corticosteroid may be beneficial. If the patient
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with Lyme disease has marked functional limitation, excision of the
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membrane lining the joint (synovectomy) may be performed for chronic (6
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months or more despite therapy) knee effusions, but spontaneous remission
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can occur after more than a year 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 by
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local laboratories throughout the nation, making tests more available to
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the general population. However, it is 97% specific for antibodies to Lyme
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disease when compared to Western blot tests, but it cannot identify the
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live bacteria in patients who have not yet developed the antibodies.
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Therapies: Investigational
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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 antibodies.
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This would enable doctors to diagnose Lyme disease very early in the course
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of the illness.
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This disease entry is based upon medical information available through
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July 1989. Since NORD's resources are limited, it is not possible to keep
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every entry in the Rare Disease Database completely current and accurate.
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Please check with the agencies listed in the Resources section for the most
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current information about this disorder.
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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 Information
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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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