Overview
Lyme disease is an infectious disease caused by the bacteria *Borrelia*, which is transmitted to humans through tick bites. It can affect various organs, including the skin, brain, peripheral nerves, heart, and musculoskeletal system.
Medical Fields
This condition is typically treated by specialists in infectious diseases and pediatric medicine, as it can affect both adults and children.
Definition
Lyme disease is an infection caused by the *Borrelia* bacterium, which enters the body through the bite of an infected tick. In its early stages, patients often experience fever, headaches, fatigue, and a distinctive skin rash known as erythema migrans, characterized by a bullseye appearance with a red outer ring and a paler center. If left untreated, the bacteria can spread to various organs, causing complications such as encephalitis, peripheral neuropathy, myocarditis, arrhythmias, and joint pain. Chronic Lyme disease is difficult to treat, particularly if early antibiotic intervention is not provided.
Primary Affected Areas
The infection primarily targets the skin, brain, peripheral nervous system, heart, and musculoskeletal system.
Causes
Lyme disease is caused by spiral-shaped, Gram-negative bacteria of the *Borrelia* genus. The most common species responsible for Lyme disease is *Borrelia burgdorferi*, particularly in North America and Europe.
Symptoms
The progression of Lyme disease is categorized into three stages:
1) Early Localized Infection:
After a tick bite, Lyme disease incubates for about 3–32 days. A typical sign of infection is erythema migrans, a bullseye-shaped skin rash that expands over time, with red edges and a lighter center. The skin may appear red, raised, and inflamed.
2) Early Disseminated Infection:
Within days or weeks of the bite, the bacteria spread through the bloodstream to multiple areas. Symptoms may include additional skin rashes, severe headaches, neck stiffness, fever, chills, fatigue, and muscle or joint pain. These symptoms often shift from one part of the body to another, primarily affecting joints, tendons, muscles, and bones. Inflammation of the lymph nodes, spleen enlargement, sore throat, dry cough, conjunctivitis, or testicular swelling can occur. Neurological complications, such as meningitis or encephalitis, as well as cardiac issues like arrhythmias, are also possible.
3) Late Persistent Infection:
Months after the initial infection, Lyme disease can cause chronic joint inflammation, particularly in large joints like the knees. Some patients experience memory problems, mood disorders, sleep disturbances, or spinal root pain.
Diagnosis
Diagnosis is primarily based on medical history and a physical examination. Blood tests and cerebrospinal fluid analysis are often used to confirm infection, although bacterial cultures are rarely successful due to the challenging nature of *Borrelia* growth. Serological tests, such as enzyme-linked immunosorbent assay (ELISA), are commonly used, followed by Western blot tests to confirm uncertain results. In late-stage cases, polymerase chain reaction (PCR) testing may be used to detect bacterial DNA in joint fluid.
Treatment
Early Lyme disease with erythema migrans is typically treated with oral antibiotics like doxycycline (200 mg/day), amoxicillin (1.5 g/day), or cefuroxime (1 g/day) for 10 to 21 days. Doxycycline is not recommended for pregnant women, breastfeeding mothers, or children under 8. While some patients may continue to experience symptoms after treatment, extended antibiotic use is not usually necessary.
Macrolide antibiotics are less effective and not preferred, and first-generation cephalosporins are ineffective against Lyme disease.
For early disseminated Lyme disease with symptoms like facial paralysis or mild heart block, oral antibiotics can treat the condition over 2–3 weeks. However, severe heart complications or meningitis may require intravenous antibiotics, such as ceftriaxone, cefotaxime, or penicillin G, for 2–3 weeks.
If arthritis develops without neurological symptoms, a 4-week course of antibiotics is recommended. In cases where neurological symptoms or persistent arthritis occur, an additional 2–4 weeks of antibiotic treatment may be necessary.
For children under 8, amoxicillin (50 mg/kg/day) is recommended. When penicillin or tetracycline cannot be used, cefuroxime or, as a secondary option, macrolides may be administered. Asymptomatic patients who test positive serologically do not require antibiotics but should be monitored.
Treatment failure may occur with any antibiotic, necessitating retreatment in some cases.
Complications and Prognosis
When treated early, Lyme disease is usually curable. However, delayed diagnosis or inadequate antibiotic therapy can lead to long-term complications, especially in individuals with weakened immune systems or other coexisting conditions. In such cases, fatigue, musculoskeletal pain, and neurological symptoms may persist for years, and in rare cases, the disease can be fatal.
Diet and Lifestyle
There are no specific dietary restrictions for individuals with Lyme disease. However, maintaining a healthy lifestyle and managing symptoms through appropriate medical care is crucial for recovery.
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