Summer 2015 — Lyme Disease

Lyme disease is an infection caused by a bacterial spirochete (Borrelia burgdorferi). This bacteria is transmitted by the deer tick or Ixodes species which is commonly found in the Eastern and Midwestern United States. Lyme disease is a complex disease that is often difficult to diagnosis. The symptoms of Lyme disease overlap with the symptoms of other inflammatory or autoimmune diseases.

The classic clinical presentation is a rash called erythema chronicum migrans (ECM). This rash develops a target-like appearance as an expanding lesion with central clearing. Following or concurrent with the rash, the patient may develop fever, arthritis, cardiac or neural involvement. If a patient develops the classic rash and has a concerning clinical history, treatment is started and no testing is needed.

In questionable cases, testing for Lyme disease will often not be positive until 2 to 4 weeks following the infection. Even with chronic cases or patients already on antibiotic therapy, tests may negative and repeat testing may be indicated. If there is continued clinical suspicion, fresh tissue, joint fluid and cerebral spinal fluid may be sent for DNA testing.

A positive test result must also be interpreted with caution. In addition to Borrelia burgdorfi, positive results have also been associated with other disease conditions including autoimmune and other infectious disease.

Lyme disease can be difficult to diagnose. To make the diagnosis, a thorough clinical history and physical examination by your health care provider is needed often with supportive testing. Rapid and appropriate diagnosis with effective therapy is the best way to avoid the long-term consequences of this infection.

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