LYME BORRELIOSIS

LYME DISEASE.

erythema migran

Lyme disease is also known as Lyme borreliosis is an infectious disease caused by a spirochete bacteria, Borrelia burgdorferi sensu lato, which is spread by blacklegged ticks. The illness usually starts with a characteristic signs of erythema migrans and sick lesion  (localized infection) then it spread into other body site after few day to weeks with the following manifestations secondary annular skin lesion, meningitis, cranial neuritis, radiculoneuritis, peripheral neuritis, carditis, atrioventricular nodal block, or migratory musculoskeletal pain (disseminated infection). After periods of latent infection, intermittent or chronic arthritis, chronic encephalopathy or polyneuropathy, acrodermatitis may develop (persistent/chronic infection). The infection may be asymptomatic until it become disseminated or persistent and most patient experience signs during summer.

CAUSES OF LYME DISEASE.

black-legged tick

Lyme disease is caused by a fastidious, microaerophilic bacterium from the genus Borrelia. spirochetes has less protein with biosynthetic activity and depends on its host for its nutritious needs. The human infection Lyme borreliosis is caused by three pathogenic genospecies Borrelia burgdorferi, Borrelia garinii and Borrelia afzelii.

SYMPTOMS AND SIGNS OF LYME BORRELIOSIS

Clinical manifestations of Lyme disease is classified into three stages due to period, spreading and 

severity of the infection. The following are stages of the Lyme disease:

• Early Infection - Stage 1 (localized Infection)

The incubation period of infection is 3 to 32 days that characterized by rashes known as erythema migrans (EM) which appear as red macule or papule that spreads slowly and increase in size to form large annular lesion in the ticks bite site, these rashes may disappear after four weeks.

• Early Infection - Stage 2 (Disseminated Infection) 

Skin involvement is common in disseminated infection associated with systemic manifestations such as persisted headache, fever and chills, neck stiffness, muscle aches, body weakness and fatigue and joint pain also swelling of the lymph nodes (lymphadenopathy), enlargement of the spleen, inflammation of the liver, sore throat, testicular swelling, dry cough and pin-eyes.   

• Late Infection - Stage 3 (Persistent Infection)

Late infection occurs when Lyme disease has not been treated in stage 1 and stage 2, persistent infection occur weeks, months or years after initial ticks bite. Systemic involvement is common in late infection stage characterized by severe headaches, arthritis of one or more large joints, disturbances in heart rhythm, brain disorders (encephalopathy) involving memory, mood, and sleep, short-term memory loss, difficulty concentrating, problems following conversations, numbness in the arms, legs, hands, or feet.

DIAGNOSIS OF LYME DISEASE

Patient health history, physical examination (signs and symptoms) and possible exposure to ticks are essential on diagnosis of Lyme disease. Laboratory tests are useful on patient with signs of Lyme disease, laboratory tests includes:

• ELISA (enzyme-linked immunosorbent assay) is used to detect antibodies against B. burgdorferi.
• Western blot can be used to confirm a positive ELISA test. It checks for the presence of antibodies to specific B. burgdorferi proteins.
• Polymerase chain reaction (PCR) is used to evaluate people with persistent Lyme arthritis or nervous system symptoms. It is performed on joint fluid or spinal fluid.

TREATMENT FOR LYME BORRELIOSIS

For skin involvement (erythema, migrans and acrodematitis), joint involvement (arthritis) and heart involvement (atrioventricular block), Oral antibiotics can be administered, duration for treatment depends on severity and systemic involvement.

• first choice for <9 years old is amoxicillin 50 mg per kilogram once a day
• first choice for >9 (not for pregnant women) doxycycline 100 mg twice a day 
• other antibiotics may be administered includes: cefuroxime axetil and erythromycin

NB: (For dose prescription of these Drugs please see your Doctor)

For nervous system involvement (meningitis, radiculoneuritis, encephalopathy and polyneuropathy), intravenous injection is the choice for treatment.

• first choice is ceftriaxone intravenous injection 2 gram ever day
• second choice is cefotaxime 2 gram every 8 hours 
• other antibiotics such as Na penicillin G can be used to treat nervous system involvement for Lyme disease.

NB: (For dose prescription of these Drugs please see your Doctor)

PREVENTION FOR LYME DISEASE.

Prevention of Lyme borreliosis is by protective measure such as:

• the uses of ticks repellents for ticks
• the use of acaricides (poison for ticks and mice)
• avoid the area that has been infected with ticks
• clearance of ticks in resident area
• the use of vaccine for Lyme borrelosis.