Quiz 3- Lyme arthritis

Question 1

Key Points: 6

Answer 1

• Multi-system infection primarily involving skin, joints and nervous system.
• Usually begins with a bulls eye lesion 7-10 days after tick bite (erythema migrans).
• The most common infectious agent is Borrelia burgdorferi.
• Lyme is a slow progressing disease.
• Lyme arthritis usually begins in the late stage – months to years after initial infection.
• Treatment is complicated and progression is difficult to assess.

Question 2

Lyme Etiology: 3

Answer 2

• Tick transmission of Borrelia
• Common animals transmitting ticks: deer, mice and dogs.
• They do not secrete toxins – most symptoms occur because of response from innate and adaptive immune system and release of inflammatory bacterial components.

Question 3

Lyme Clinical Features: 4

Answer 3

• Early disseminated disease – occurs weeks to months after bite
• Neurologic and/or cardiac findings
• Late Lyme disease – months to years after bite
• Intermittent or persistent arthritis

Question 4

Lyme Diagnosis: 4

Answer 4

• In early localized disease, a diagnosis should be made on clinical symptoms only and history of patient:
• Characteristic skin lesion
• Exposure history

•Serologic tests can confirm a diagnosis in early disseminated and late Lyme disease, but should not be used exclusively for diagnosis.

Question 5

Lyme Lab Testing: 5

Answer 5

• Serologic Testing
• Should always be used in combination with clinical sx’s – antibodies can be detected for years after all clinical symptoms are gone.
  
  • NOT elevated in early localized disease
• ELISA or IFA followed by a Western blot test is common practice.
• May detect IgM or IgG reactions to Borellia species
• False positives and negatives are common

Question 6

Conventional Treatment:
Early Disease:
Early Disseminated Disease:
Late Disease:

Answer 6

Early Disease:
•Oral antibiotic therapy: doxycycline, amoxicillin, cefuroxime

Early Disseminated Disease:
•IV and/or oral antibiotics: ceftriaxone, cefotaxime, penicillin

Late Disease:
•IV and/or oral antibiotics: doxycycline, amoxicillin, ceftriaxone

Question 7

General Treatment for Lyme:

Answer 7

• IV glutathione

* Helps reduce herxheimer reaction, improves immune response

Question 8

Herbal Treatments: 4

Answer 8

• Andrographis paniculata
• Polygonum cuspidatum
• Smilax
• Stephania root

Question 9

Early Localized Disease:

Answer 9

•Erythema migrans – bulls eye lesion occurs 7-14 days after bite.

Question 10

Early Disseminated Disease:

• Neurologic symptoms: 4
• Cardiac symptoms (lyme carditis): 2

Answer 10

• Usually occurs weeks to several months after the bite
• This may be the first manifestation of Lyme
• Neurologic symptoms:
  
  • Lymphocytic meningitis
  • Cranial nerve palsies
  • Radiculopathy
  • Peripheral neuropathy
• Cardiac symptoms (lyme carditis):
  
  • AV heart block
  • Myopericarditis

Question 11

Late Lyme Disease:

•Intermittent or persistent arthritis: 6

Answer 11

• Occurs a months to a few years after initial infection.
• May not be preceded by early localized or disseminated disease.
• Intermittent or persistent arthritis:
  
  • Mostly affects large joints (ex: knee)
  • Affects multiple joints
  • Joint becomes swollen and painful, can be warm
  • Attacks can last from several weeks to months
  • Chronic arthritis may cause cartilage erosion and permanent damage.
  • Arthralgia’s can migrate