Dr. Stafford Tick Management Handbook - Newtown, CT

StaffordThe Connecticut Agricultural Experimentation Stationchanging. Nonspeci. c viral-like symptoms generally mark early-disseminated infection and upto a fourth of patients may develop multiple secondary rashes. Days or weeks after the bite of aninfected tick, migratory joint and muscle pain (also brief, intermittent arthritic attacks), debilitatingmalaise and fatigue, neurologic or cardiac problems may occur. The symptoms appear to be froman in. ammatory response to active infection. Multiple EM, headache, fatigue, and joint pain arethe most common clinical manifestations noted in early-disseminated disease in children. Multiplecomponents of the nervous system can be affected by B. burgdorferi. Early neurologic symptomsdevelop in 10-15% of untreated patients and these include cranial neuropathies, the most commonmanifestations (e.g., Bell’s palsy or paralysis of facial muscles), radiculoneuropathy (pain inaffected nerves and nerve roots, can be sharp and jabbing or deep), and meningitis (fever, stiffneck, and severe headache). Children present less often with facial palsy and more commonlywith fever, muscle and joint pain, and arthritis (primarily the knee). Lyme carditis (various degreesof intermittent atrioventricular heart block) and rhythm abnormalities may occur in 4-10% ofuntreated patients and require hospitalization. Ocular manifestations are uncommon and mayinclude conjunctivitis and other in. ammatory eye problems. Infection produces an active immuneresponse and antibodies to B. burgdorferi are detectable in the vast majority of patients during thesemanifestations. The immune response appears to eradicate most B. burgdorferi and symptoms mayresolve even without antibiotic treatment. However, the organism may still survive in localized sites.Late disseminated and persistent infectionDetection and treatment for Lyme disease early after infection appearsto have reduced the incidence of later arthritic and late neurologicmanifestations of disease. Lyme arthritis is an intermittent chronicarthritis that typically involves swelling and pain of the large joints,especially the knee. If not treated, episodes of arthritis may last weeksto months with spontaneous remissions over a period of several years.Approximately 50-60% of untreated individuals may develop arthritisand about 10% of these may have chronic joint in. amation. Jointswelling may persist after complete or near complete elimination of thespirochete from the joint with antibiotic therapy. Late neurologic Lymedisease may present as numbness or tingling of the extremities, sensoryloss, weakness, diminished re. exes, disturbances in memory, moodor sleep, cognitive function de. cits. Late encephalomyelitis may beconfused with multiple sclerosis.The course and severity of Lyme disease is variable. Mild symptoms may go unrecognized orundiagnosed and some individuals may be asymptomatic (no early illness). The EM rash orsubsequent arthritic, cardiac or nervous system problems may be the . rst or only sign of Lymedisease. Most symptoms eventually disappear, even without treatment, although resolution maytake months to over a year. The disease can also be chronic and debilitating with occasionalpermanent damage to nerves or joints. Chronic Lyme disease or post-Lyme disease syndromes,similar to chronic fatigue syndrome and . bromyalgia, are a controversial and unclear constellationof symptoms related to or triggered by infection with B. burgdorferi. Both persistent infection andinfection-induced autoimmune processes have been proposed to account for ongoing problemsdespite antibiotic therapy. Disease persistence might be due to a slowly resolving infection, residualtissue damage, in. ammation from remains of dead spirochetes, immune-mediated reactions in theabsence of the spirochete, co-infection with other tick-borne pathogens, or an alternative diseaseprocess that is confused with Lyme disease.5324Bulletin No. 1010