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Clinician’s Corner: More on Lyme disease

As we discussed last week, Lyme disease, caused by a bacteria Borrelia burgdorferi, remains the most common vector-borne disease in the United States.  Lyme disease was first described in 1977 as “Lyme arthritis” in studies of a cluster in Connecticut of children who were thought to have juvenile rheumatoid arthritis.  When some of these kids got ear infections, and were treated with amoxicillin the “arthritis” went away. Of course, amoxicillin doesn’t treat arthritis, so the researchers looked for an infectious agent.

The problem with Lyme disease isn’t so much with the tick we remove, but the one that is never discovered, and the patient gets infected with the bacteria Borrelia burgdorferi . Only about 25 percent of patients with “bullseye rash” recall the tick bite that transmitted Lyme disease. The characteristic rash erythema migrans (the “bullseye” rash) occurs in 70 to 80% of the cases.   We can also say that 20-30% of the time patients do not get the rash.  Here is what happens if Lyme disease remains undiagnosed and progresses.

Early Disseminated Lyme disease

Occurs days to weeks after tick bite and left untreated, the infection may spread and see:

  • Additional rashes appear in other areas of the body
  • Neurological consequences:
    • Loss of muscle tone on one or both sides of the face
    • Severe headaches and neck stiffness due to meningitis (15% of patients)
  • Pain and swelling in muscles and the large joints (such as knees) (60% of patients)
  • Shooting pains that may interfere with sleep
  • Heart palpitations and dizziness due to changes in heartbeat (1% of patients)

Late disseminated Lyme disease

  • Occurs a few months to years after tick bite
  • Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling.
  • Affects Large joints (knees) see pain and significant swelling.

There is lots of information on the CDC website with patient friendly downloads on Lyme disease: http://www.cdc.gov/lyme/toolkit/index.html  (Hey, we pay our taxes, might as well reap some benefits)

As always, your Thompson pharmacist is a great source of information for prevention and treatment of Lyme disease.  Feel free to consult your Thompson Pharmacist—at Thompson Pharmacy it’s all for YOU.