LYME Disease

In the United States, Lyme disease ranks as the most common vector-borne illness despite being frequently missed or misidentified in clinical practice. This tick-borne infection presents in diverse and often nonspecific ways, making early recognition and appropriate management a persistent challenge. From subtle skin changes and flu-like symptoms to joint inflammation and cardiac or neurologic involvement, the disease unfolds across multiple stages that can puzzle even experienced clinicians.

When a patient shows signs of Lyme disease, the primary diagnostic approach is two-tiered serologic testing. The testing includes the Western blot and enzyme-linked immunosorbent assay, which provide indirect diagnosis by detecting antibodies against Borrelia burgdorferi.

Acrodermatitis chronica atrophicans is a skin-related complication that appears in the advanced phase of Lyme disease, typically after prolonged, untreated infection. This condition involves thinning and discoloration of the skin, often on the limbs, and is more frequently seen in Europe than in the United States.

In contrast, fatigue, myalgias, and arthralgias are vague symptoms that can show up at any point during the illness and are not exclusive to the late stage.

In early-stage Lyme disease-associated arthritis, joint inflammation tends to target the knees. This arthritis typically appears with noticeable swelling and fluid buildup in a migratory pattern and affects one or both knees. The shoulders, ankles, and elbows can become involved in late-stage Lyme disease-associated arthritis.

A common symptom of Lyme disease-associated carditis is heart palpitations. Lyme disease-associated carditis occurs in the early phase of Lyme disease and often presents with other symptoms such as lightheadedness, syncope, chest pain, and shortness of breath.

Antibiotics can be considered if the tick has been attached to the skin for more than 36 hours. This approach is based on studies showing that the risk for Lyme disease transmission increases significantly when a tick, particularly I scapularis, remains attached for more than 36 hours.

The 12-hour mark does not reliably predict transmission risk or warrant prophylaxis. Antibiotic prophylaxis is not universally advised for all tick bites, including the I pacificus bite; prophylactic administration of antibiotics carries the risk of promoting antibiotic resistance.

Author

Paddy Kalish OD, JD and B.Arch Author and Blogger