SPIROCHETES INFECTIONS: LYME DISEASE.

            

The spirochetes are spiral-shaped bacteria with axial filaments, and include Borrelia, Leptospira, and Treponema.

Lyme disease is caused by a spirochete, Borrelia Burgdorferi, which is transmitted by the tick bite, from ticks of the genus Ixodes; it is due to systemic infection with B. burgdorferi and the body’s immune response to the infection (Feder, 2008).

Mice are important reservoirs, and the deer required for tick life cycle. (Le, Bhushan, & Grimm, 2011). The patients are generally unaware from the tick bite, because the ticks are tiny and their bites are painless.

The reviewed literature (Meyerhoff, 2011) (Le, 2011) agrees that the manifestations of Lyme disease are divided into 3 stages:

Stage 1: Early localized infection, 1 to 30 day after the tick bite, isolated erythema migrans, patients with an undifferentiated febrile illness, flulike symptoms. Presents with erythema chronicum migrans, an expanding “bull eye” red rash with central clearing, also affected joints, CNS, and heart.

Stage 2: Early disseminated Lyme disease, between weeks to months after the tick bite, it is the secondary, usually hematogenously spread, skin lesion to extracutaneous manifestations. Present neurologic (Bell’s palsy) and cardiac (AV nodal block) manifestations.

Stage 3: Chronic Lyme disease, months to years after infection and may occur after a period of latency, rheumatologic and neurologic manifestation that include subacute encephalopathy, chronic progressive encephalomyelitis, and late axonal neuropathies, as well as symptoms consistent with fibromyalgia; chronic monoarthritis and migratory polyarthritis.

Treatment: The goals of treatment are to cure B burgdorferi infection, to speed the resolution of the clinical manifestations, and to prevent complications.

Lyme disease can be treated with 10 days of Doxycycline (Wormser, et al., 2003), Doxycycline, amoxicillin, or cefuroxime axetil for 10-14 days is indicated for early localized or early disseminated disease associated with erythema migrans in the absence of neurologic involvement or third-degree heart block. (Meyerhoff, 2011).

Bibliography

Feder, H. (2008) ;22(2):315-26,vii). medscape.com. Retrieved from Infect Dis Clin North Am: http://reference.medscape.com/medline/abstract/18452804

Le, T., Bhushan, V., & Grimm, L. (2011). First AID for yhe USMLE step 1. usa: McGraw Hill.

Meyerhoff, J. O. (2011, Sep 27). medscape.com. Retrieved from Lyme Disease Clinical Presentation: http://emedicine.medscape.com/article/330178-clinical

Wormser, G., Ramanathan, R., Nowakowski, J., McKenna, D., Holmgren, D., & Visintainer , P. (2003) ;138(9):697-704). medscape.com. Retrieved from Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intem Med. May 6: http://reference.medscape.com/medline/abstract/12729423