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Thread: Lyme disease questions?
06-12-2008, 04:43 PM #1
Lyme disease questions?
my sister is doing that bike-and-build across the country right now and she got a rash on her leg. she stopped at the doctor on the way and was diagnosed with lyme disease. got a bunch of anti-biotics and was told to stay out from sunlight. problem is she is like 2000 miles short of her destination (san fransisco) =p. doc said she is okay to keep going.
ive always thought lyme disease is a pretty serious thing? i just started doing some research online and it seems like its curable. figured id ask around if anyone has any experience with it? I think she is only worried about being able to finish the ride, but im nervous that there may be more drastic long-term consequences.
thanks in advance. figured there might be some knowledgeable folks here, while i continue my research online.
06-12-2008, 04:47 PM #2
06-12-2008, 04:53 PM #3
As far as the sunlight thing goes - I'm guessing that is a function of the antibiotics chosen. Again, google for specifics &/or talk to doc who knows the Lyme gig.
This is the "big" local thread on the topic - http://www.tetongravity.com/forums/s...ad.php?t=52390 Search for several others as well...
Last edited by spindrift; 06-12-2008 at 04:56 PM.
06-12-2008, 05:06 PM #4
thanks guys, i searched lyme disease in sprockets only, will read this thread. thanks again!
06-12-2008, 06:21 PM #5Registered User
- Join Date
- Oct 2007
- The west - various spots
Here's some extensive info:
(Long post, I just copy and pasted it from an online medical textbook)
(Lyme borreliosis, Borrelia burgdorferi Infection)
Clinical Manifestations: The clinical manifestations of Lyme disease are divided into 3 stages: early localized, early disseminated, and late disease. Early localized disease is characterized by a distinctive rash, erythema migrans, at the site of a recent tick bite. Erythema migrans begins as a red macule or papule that usually expands over days to weeks to form a large, annular, erythematous lesion that may increase in size to 5 cm or more in diameter, sometimes with partial central clearing. The lesion usually is painless and not pruritic. Localized erythema migrans can vary greatly in size and shape and may have vesicular or necrotic areas in its center and can be confused with cellulitis. Fever, malaise, headache, mild neck stiffness, myalgia, and arthralgia often accompany the rash of early localized disease.
Early disseminated disease manifests most commonly as multiple erythema migrans in approximately 15% of patients. This rash usually occurs several weeks after an infective tick bite and consists of secondary annular, erythematous lesions similar to, but usually smaller than, the primary lesion. These lesions reflect spirochetemia with cutaneous dissemination. Other common manifestations of early disseminated illness (that may occur with or without rash) are palsies of the cranial nerves (especially cranial nerve VII), lymphocytic meningitis, and conjunctivitis. Systemic symptoms, such as arthralgia, myalgia, headache, and fatigue, also are common during the early disseminated stage. Carditis, which usually is characterized by various degrees of heart block, occurs rarely in children. Among infected children who do not receive antimicrobial therapy, approximately 50% develop arthritis, approximately 10% develop central nervous system disease, and less than 5% develop cardiac involvement. Some individuals with early Lyme disease may have concurrent human granulocytic ehrlichiosis or babesiosis, transmitted by the same tick, which may contribute to symptomatology.
Late disease is characterized most commonly by recurrent arthritis that usually is pauciarticular and affects large joints, particularly knees. Arthritis can occur without a history of earlier stages of illness (including erythema migrans). Peripheral neuropathy and central nervous system manifestations also can occur rarely during late disease. Late disease is uncommon in children who are treated with antimicrobial agents in the early stage of disease.
Because congenital infection occurs with other spirochetal infections, there has been concern that an infected pregnant woman could transmit Borrelia burgdorferi to her fetus. No causal relationship between maternal Lyme disease and abnormalities of pregnancy or congenital disease caused by B burgdorferi has been documented conclusively. No evidence exists that Lyme disease can be transmitted via human milk.
Etiology: In the United States, infection is caused by the spirochete B burgdorferi.
Epidemiology: Lyme disease occurs primarily in 3 distinct geographic regions of the United States. Most cases occur in southern New England and in the eastern mid-Atlantic states. The disease also occurs, but with lower frequency, in the upper Midwest, especially Wisconsin and Minnesota, and less commonly on the West Coast, especially northern California. The occurrence of cases in the United States correlates with the distribution and frequency of infected tick vectors—Ixodes scapularis in the East and Midwest and Ixodes pacificus in the West. Reported cases from states without known enzootic risks may have been acquired in states with endemic infection or may be misdiagnoses resulting from false-positive serologic test results. Rash similar to erythema migrans has been reported in states without endemic infection, possibly attributable to other Borrelia species harbored in the Lone Star tick. Most cases occur between April and October; more than 50% of cases occur during June and July. People of all ages may be affected, but incidence in the United States is highest among children 5 to 9 years of age and adults 45 to 54 years of age.
The incubation period from tick bite to appearance of single or multiple erythema migrans lesions ranges from 1 to 55 days with a median of 11 days. Late manifestations occur months to years later.
Endemic Lyme disease transmitted by Amblyomma americanum has been reported in Canada, Europe, states of the former Soviet Union, China, and Japan. Clinical manifestations vary somewhat from those seen in the United States.
Diagnostic Tests: During the early stages of Lyme disease, the diagnosis is best made clinically by recognizing the characteristic rash, a singular lesion of erythema migrans, because antibodies against B burgdorferi are not detectable in most individuals within the first few weeks after infection. Although cultures of a biopsy specimen of the perimeter of the skin lesion often yield the organism, cultures of Borrelia species (which require special media) are not available commercially and are not recommended. Diagnosis in patients who possibly have early disseminated or late Lyme disease should be based on clinical findings and serologic tests. Some patients who are treated with antimicrobial agents for early Lyme disease never develop antibodies against B burgdorferi. However, most patients with early disseminated disease and virtually all patients with late disease have antibodies against B burgdorferi. Once such antibodies develop, they persist for many years and perhaps for life. Consequently, tests for antibodies should not be used to assess the success of treatment. The results of serologic tests for Lyme disease should be interpreted with careful consideration of the clinical setting and the quality of the testing laboratory.
A 2-step approach is recommended for serologic diagnosis of B burgdorferi. First, a screening test for serum antibodies should be performed using a sensitive enzyme immunoassay (EIA) or immunofluorescent antibody assay (IFA). Serum specimens that give positive or equivocal results should then be tested by a standardized Western immunoblot for presence of antibodies to B burgdorferi; serum specimens that yield negative results by EIA or IFA do not require immunoblot testing. When testing to confirm early disease, immunoglobulin (Ig) G and IgM immunoblot assays should be performed. To confirm late disease, only an IgG immunoblot assay should be performed, because false-positive results may occur with the IgM immunoblot. A positive result of an IgG immunoblot test requires detection of antibody ("bands") to 5 or more of the following: 18, 23/24, 28, 30, 39, 41, 45, 60, 66, and 93 kDa polypeptides. A positive test result of IgM immunoblot requires detection of antibody to at least 2 of the 23/24, 39, and 41 kDa polypeptides. Two-step testing is needed, because EIA and IFA may yield false-positive results because of the presence of antibodies directed against spirochetes in normal oral flora that cross-react with antigens of B burgdorferi or to cross-reactive antibodies in patients with other spirochetal infections (eg, syphilis, leptospirosis, relapsing fever), certain viral infections (eg, varicella, Epstein-Barr virus), or certain autoimmune diseases (eg, systemic lupus erythematosus).
A licensed serologic test detects antibody to a peptide of the immunodominant conserved region of the variable surface antigen vlsE of B burgdorferi but has not proved to be superior in specificity or sensitivity to the 2-step protocol. This test has clinical utility in distinguishing evidence of infection from vaccine-induced antibody in OspA vaccine recipients. Other marketed tests, including polymerase chain reaction (PCR) for spirochete DNA and urinary antigen detection, have no role in diagnosis.
Suspected central nervous system Lyme disease can be confirmed by demonstration of intrathecal production of antibodies against B burgdorferi. However, interpretation of results of antibody tests of cerebrospinal fluid is complex, and physicians should seek the advice of a specialist experienced in the management of patients with Lyme disease to assist in interpreting results.
The widespread practice of ordering serologic tests for patients with nonspecific symptoms, such as fatigue or arthralgia, who have a low probability of having Lyme disease is not recommended. Almost all positive serologic test results in these patients are false-positive results. Patients with acute Lyme disease almost always have objective signs of infection (eg, erythema migrans, facial nerve palsy, arthritis). Nonspecific symptoms commonly accompany these specific signs but almost never are the only evidence of Lyme disease.
Treatment: See Table 3.31.
Early Localized Disease. Doxycycline is the drug of choice for children 8 years of age and older and, unlike amoxicillin, also treats patients with ehrlichiosis. For children younger than 8 years of age, amoxicillin is recommended. For patients who are allergic to penicillin, the alternative drug is cefuroxime. Erythromycin and azithromycin are less effective. Most experts treat people with early Lyme disease for 14 to 21 days.
Treatment of erythema migrans almost always prevents development of later stages of Lyme disease. Erythema migrans usually resolves within several days of initiating treatment, but other signs and symptoms may persist for several weeks, even in successfully treated patients.
06-12-2008, 06:22 PM #6Registered User
- Join Date
- Oct 2007
- The west - various spots
Early Disseminated and Late Disease. Orally administered antimicrobial agents are recommended for treating multiple erythema migrans and uncomplicated Lyme arthritis. Most experts also recommend oral agents for treatment of facial nerve palsy and do not recommend a lumbar puncture unless other central nervous system involvement, such as signs or symptoms of meningitis or raised intracranial pressure, are present. If cerebrospinal fluid pleocytosis is found, parenterally administered antimicrobial therapy is indicated. Recurrent or persistent arthritis after treatment with a course of oral antibiotic therapy and central nervous system infection should be treated with parenterally administered antimicrobial agents. The optimal duration of therapy for manifestations of early disseminated or late disease is not well established, but there is no evidence that children with any manifestation of Lyme disease benefit from prolonged courses of orally or parenterally administered antimicrobial agents. Accordingly, the maximum duration of a single course of therapy is 4 weeks (see Table 3.31, p 431).
The Jarisch-Herxheimer reaction (an acute febrile reaction accompanied by headache, myalgia, and an aggravated clinical picture lasting less than 24 hours) can occur when therapy is initiated. Nonsteroidal anti-inflammatory agents may be beneficial, and the antimicrobial agent should be continued.
Pregnancy. Tetracyclines are contraindicated. Otherwise, therapy is the same as recommended for nonpregnant people.
Isolation of the Hospitalized Patient: Standard precautions are recommended.
Ticks. See Prevention of Tickborne Infections, p 195.
Chemoprophylaxis. Many people who seek medical attention for a tick bite have been bitten by a species of tick that does not transmit Lyme disease, or the recovered material is not a tick. The overall risk of infection with B burgdorferi after a recognized deer tick bite, even in areas with highly endemic rates of infection, is sufficiently low that prophylactic antimicrobial treatment is not indicated routinely for most people. The risk is extremely low after attachment (eg, a flat nonengorged deer tick is found) and is higher after engorgement, especially if a nymphal deer tick has been attached for at least 72 hours. Analysis of the tick for spirochete infection has a poor predictive value and is not recommended. On the basis of a study of doxycycline for prevention of Lyme disease after a deer tick bite, some experts recommend a single 200-mg dose (4.4 mg/kg for body weight <45 kg) of doxycycline for people 12 years of age (the lower limit of age studied) and older who have been bitten in an area with hyperendemic infection who have found an engorged deer tick, especially if the suspected duration of attachment is ≥72 hours; gastrointestinal tract adverse effects occur commonly. Data are insufficient to recommend amoxicillin prophylaxis.
Blood Donation. Patients with active disease should not donate blood, because spirochetemia occurs in early Lyme disease. Patients who have been treated for Lyme disease can be considered for blood donation.
Vaccines. A Lyme disease vaccine was licensed by the US Food and Drug Administration on December 21, 1998, for people 15 to 70 years of age but subsequently was withdrawn in early 2002 and no longer is available.
Pickering, L. (2006). Redbook: 2006 report on the committee on infectious diseases (27th ed.). American Academy of Pediatrics.
06-16-2008, 11:39 PM #7
What Dr. Crank so helpfully pasted from Merck^^^^ basically says is this: the above posts are correct that your sister was caught early enough that she should have dramatically reduced chances of permanent damage, and yes, avoiding sunlight (or decreasing exposure) is from the drugs. Azithromycin and Erithromycin especially can cause a loss of thermo-regulatory ability, therefore making her more likely to overheat or suffer from heatstroke, and I think that Doxy can have some photo-sensitivity rxns. This means for her...long sleeves and leg coverings, or TONS of sunscreen, but she should be all good with some planning. Hope the epic goes well for her.
06-17-2008, 06:38 AM #8
06-17-2008, 08:39 AM #9
i have been diagnosed twice. It can seriously mess you up. I used to live in Lyme, CT where it first started, so I was always pretty cautious. When I was diagnosed, it was about a month after I pulled off 6 ticks from my back. Hudge headaches, always sore, and my hands would not stay steady. At the time, i was climbing really hard, biking a lot, and paddling. I started on a dose of doxycylin and they told me to stay on it for 2 weeks. Being that my stepfather has some history with lyme disease research, he suggested that I stay on it for a month just in case. I was outside a lot when I was on the medication, and you do get super sensitive to the sun. I would wear long sleeve shirts (UV protection), hats, and put on a ton of sunscreen.
Both times i have gotten it, i have not gotten a rash. The second time I had found a tick and immediately started up the anti-biotics again. I have some creaky joints, but for the most part I am back to normal. It did really suck not being able to use a screwdriver or do pretty much anything requiring very fine motor skills.
06-17-2008, 10:21 AM #10click click boom
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- Nov 2001
06-17-2008, 12:08 PM #11
there is a short course of antibiotics that works for prevention after a tick bite
the last time i had an embedded tick, i researched this a bit and found that a single dose of doxycycline was sufficient AT THAT STAGE.
just a rash does not make lyme disease. its frequently both over and under diagnosed.
the no sun warning is for photosensitivity from the tetracyclines. it does not happen to everyone who takes them...but it did happen to me (not from the single dose, but an earlier different problem)and it was severe.
06-17-2008, 12:33 PM #12
I had it... spotted it early (bulls eye rash) and havent suffered any ill effects to date... Just sayin'
06-17-2008, 12:34 PM #13
And at least as of a couple of years ago - the EM rash was THE gold standard for clinical diagnosis. To the above comments, again as of a few years ago, the ELISA blood test was notorious for both false-positives and false-negatives in the early stages - making it virtually useless for early stage diagnosis of the disease.
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