Lyme disease is the most common vector-borne disease in the United States and Europe and the second most common in the world (malaria being the most common) with peak onset during spring and summer months.
Erythema chronicum migrans (ECM) is the diagnostic skin lesion that occurs at the site of the tick bite.
Disseminated infection can affect the heart, nervous system, and joints.
Diagnosis is confirmed by a positive immunoglobulin G (IgG) Western blot for Borrelia burgdorferi in the serum of a patient with appropriate clinical findings.
Oral antibiotics are effective for prevention and early disease but intravenous antibiotics are necessary for disseminated disease.
Lyme disease has three stages:
• Early localized ECM—skin (ECM), regional lymphadenopathy, flu-like symptoms
• Disseminated infection—nervous and cardiac systems, skin and musculoskeletal (but potentially any organ) system
• Persistent infection (late disease)—musculoskeletal and nervous systems
Organ systems involved in Lyme disease:
The disease is frequently thought of as a “rash-arthritis” complex, even though the arthritis may be a late manifestation. Not all patients have rash or arthritis. In addition, the nervous system (both central and peripheral) and cardiac system may be involved. In the United States, a patient infected with B. burgdorferi who develops the typical skin rash, ECM, and who is not treated with antibiotics has a 1% to 5% chance of developing cardiac manifestations, a 15% chance of developing neurologic manifestations, and a 70% chance of developing arthritis (60% migratory polyarthritis, 10% chronic monoarthritis). In Europe, where all three strains of Borrelia can cause infection, arthritis is less common (15%) but meningoradiculoneuritis as a result of B. garinii is more common.
Western Blot Criteria
Criteria for pos Test
2 from: 23kDa(OspC), 39kDA (BmpA), 41kDa(Fla)
5 from 10: 18, 21, 28, 39, 42, 45, 58 (not GroEL), 77 and 93kDA