Chapter 19

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1

Most US lyme disease cases remain concentrated in the

northeastern

north central

pacific costal regions

2

In at least 60 to 80% of US patients Lyme diseases begins with a slowly expanding skin

lesion EM, which occurs at the site of tick bite.

The skin lesion is frequently accomapiened by flu like symptoms

3

The CDC clinical case definition for Lyme disease includes

the presence of EM or at least one objective late manifesting sign for musculoskeletal, neurologic or cardiovascular disease

a positive serological tests for antibody to B burdorferi.

4

many misdiagnosed patients actually have chronic fatigue syndrome or fibromyalgia,

both of which can causes similar symptoms such as joint stiffness or pain , fatigue and sleep disturbance

5

In the united states approximately 20 to 30 % of patients with lyme disease have

positive responses usually IgM isotype during this period.

6

However by covalence 2 to 4 weeks later about 70 to 80% have

seroreactivity even after antibiotic treatment.

7

After about 1 month, most patient with active infection have

IgG antibody responses

8

After antibiotic treatment antibody titers

fall slowly but IgG and IgM responses persists for many years after treatment

9

IgM response cannot be interpreted as a manifestations of a recent infection or

reinfection unless the appropriate clinical features are present .

10

antibody formed includeL

cryoglobulins, immune complexes, antibodies specific for B burgdorferi and anticardiolopin antibodies .

11

elevated titers for IgM are noted in

early diseases.

12

In the US the diagnosis is usually based on the

recognition of the characteristics clinical findings

history of exposure in an area in which the disease is endemic and except in patients with EM, an antibody response to B burgdorferi by enzyme--linked immunosorbent assay ELISA and western blot.

13

testing becomes important when the telltale bull's eye rash or

other characteristics of lyme diseases do not appear.

14

lyme disease is caused by

spirochete borrelia burgdorferi, transmitted by ixodid tick

deer tick l

15

lyme disease usually occurs in the

summer months and begins with a slowly expanding skin lesion

EM

16

EM

erythema chronic migrans

bull's eye rash

accompanied by flulike symptoms

17

the cdc case definition of lyme disease includes

the presence of EM or at least one objective late manifestation of sign of musculoskeletal neurologic or cardiovascular disease and a positive serologic test for antibody to B burdorferi

18

after skin lesions ( weeks to months later) we can see

cardiac or neurologic disease. this can be followed by arthritis and chronic neurologic disease ( weeks to years after onset)

19

serodiagnostic tests are insensitive during the first

several weeks of infection

20

specific IgM or IgG antibodies are usually not detectable in patients serum

unless symptoms have been present for at least 2-4 weeks .

21

in cases of lyme arthritis tests for antinuclear antibodies

rheumatoid factor and VDRL are generally negative , but there should be IgG specific antibodies to B burdoferi

22

lyme disease diagnosis is now based on the

relative value determined from diagnostic criteria as a score of 7 or greater makes lyme disease very likely

23

in the US diagnosis is usually based on the recognition of clinical findings

bulls eye rash

history of exposure in an area endemic to lyme disease except in patients with em

an antibody response to B burgdorferi by ELISA or western blotting

24

ELISA is at the

standard method most widely available and most commonly performed test method

25

PCR is the most

USEFUL in diagnosis early lyme disease the patient is still seronegative.

26

western blot can be used to verify

borderline or weak positive results