Untitled Essay, Research Paper
Lyme Disease Lyme Arthritis ~~~~~~~~~~~~~~ Lyme disease is a tick-transmitted inflammatory upset characterized by an early focal tegument lesion, and later a turning ruddy country on the tegument ( erythema chronicum migrans or ECM ) . The upset may be followed hebdomads subsequently by neurological, bosom or joint abnormalcies. Symptomatology ~~~~~~~~~~~~~~ The first symptom of Lyme disease is a skin lesion. Known as erythema chronicum migrans, or ECM, this normally begins as a ruddy stain ( macula ) or as an elevated unit of ammunition topographic point ( papule ) . The skin lesion normally appears on an appendage or on the bole, particularly the thigh, cheek or the under arm. This topographic point expands, frequently with cardinal glade, to a diameter every bit big as 50 centimeter ( c. 12 in. ) . Approximately 25 % of patients with Lyme disease study holding been bitten at that site by a bantam tick 3 to 32 yearss before oncoming of ECM. The lesion may be warm to touch. Soon after onset about half the patients develop multiple smaller lesions without hard-boiled centres. ECM by and large lasts for a few hebdomads. Other types of lesions may later look during declaration. Former skin lesions may re-emerge faintly, sometimes before perennial onslaughts of arthritis. Lesions of the mucose membranes do non happen in Lyme disease. The most common symptoms attach toing ECM, or predating it by a few yearss, may include unease, weariness, icinesss, febrility, concern and stiff cervix. Less normally, backache, musculus achings ( myodynia ) , sickness, purging, sore pharynx, conceited lymph secretory organs, and an hypertrophied lien may besides be present. Most symptoms are characteristically intermittent and changing, but unease and weariness may linger for hebdomads. Arthritis is present in about half of the patients with ECM, happening within hebdomads to months following oncoming and permanent every bit long as 2 old ages. Early on in the unwellness, migratory redness of many articulations ( polyarthritis ) without joint puffiness may happen. Later, longer onslaughts of swelling and hurting in several big articulations, particularly the articulatio genuss, typically recur for several old ages. The articulatio genuss normally are much more conceited than painful ; they are frequently hot, but seldom ruddy. Baker & # 8217 ; s cysts ( a cyst in the articulatio genus ) may organize and rupture. Those symptoms attach toing ECM, particularly unease, weariness and low-grade febrility, may besides predate or attach to perennial onslaughts of arthritis. About 10 % of patients develop chronic articulatio genus engagement ( i.e. unremittent for 6 months or longer ) . Neurological abnormalcies may develop in approximately 15 % of patients with Lyme disease within hebdomads to months following oncoming of ECM, frequently before arthritis occurs. These abnormalcies normally last for months, and normally decide wholly. They include: 1. lymphocytic meningitis or cerebromeningitis 2. jerked meat nonvoluntary motions ( chorea ) 3. failure of musculus coordination due to disfunction of the cerebellum ( cerebellar ataxy ) 4. cranial neuritis including Bell & # 8217 ; s paralysis ( a signifier of facial palsy ) 5. motor and centripetal radiculo-neuritis ( symmetric failing, hurting, unusual esthesiss in the appendages, normally happening foremost in the legs ) 6. hurt to individual nervousnesss doing diminished nervus response ( mononeuritis multiplex ) 7. redness of the spinal cord ( myelitis ) . Abnormalities in the bosom musculus ( myocardium ) occur in about 8 % of patients with Lyme disease within hebdomads of ECM. They may include fluctuating grades of auriculoventricular block and, less normally, redness of the bosom poke and bosom musculus ( myopericarditis ) with reduced blood volume ejected from the left ventricle and an hypertrophied bosom ( megalocardia ) . When Lyme Disease is contracted during gestation, the foetus may or may non be adversely affected, or may contract inborn Lyme Disease. In a survey of 19 pregnant adult females with Lyme Disease, 14 had normal gestations and normal babes. If Lyme Disease is contracted during gestation, possible foetal abnormalcies and premature birth can happen. Etiology ~~~~~~~~ Lyme disease is caused by a spirochete bacteria ( Borrelia Burgdorferi ) transmitted by a little tick called Ixodes dammini. The spirochaete is likely injected into the victim & # 8217 ; s tegument or blood stream at the clip of the insect bite. After an incubation period of 3 to 32 yearss, the being migra
tes outward in the skin, is spread through the lymphatic system or is disseminated by the blood to different body organs or other skin sites. Lyme Disease was first described in 1909 in European medical journals. The first outbreak in the United States occurred in the early 1970’s in Old lyme, Connecticut. An unusually high incidence of juvenile arthritis in the area led scientists to investigate and identify the disorder. In 1981, Dr. Willy Burgdorfer identified the bacterial spirochete organism (Borrelia Burgdorferi) which causes this disorder. Affected Population ~~~~~~~~~~~~~~~~~~~ Lyme Disease occurs in wooded areas with populations of mice and deer which carry ticks, and can be contracted during any season of the year. Related Disorders ~~~~~~~~~~~~~~~~~ Rheumatoid Arthritis is a disorder similar in appearance to Lyme disease. However, the pain in rheumatoid arthritis is usually more pronounced. Morning stiffness and symmetric joint swelling more commonly occur in rheumatoid arthritis, and knotty lumps under the skin may be present over bony prominences. Bony decalcification which can be prominent in Rheumatoid Arthritis is detected on X-rays. Brachial Neuritis, also known as Parsonnage-Turner Syndrome, is a common inflammation of a group of nerves that supply the arm, forearm, and hand (brachial plexus). It is characterized by severe neck pain in the area above the collarbone (supraclavicular) that may radiate down the arm and into the hand. There also may be weakness and numbness (hyperesthesia) of the fingers and hands. Although many cases have no apparent cause, this syndrome may occur following an immunization (tetanus or diptheria), surgery, or infection with Lyme Disease. Therapies: Standard ~~~~~~~~~~~~~~~~~~~~ For adults with Lyme disease the antibiotic tetracycline is the drug of choice. Penicillin V and erythromycin have also been used. In children penicillin V is recommended rather than tetracycline. Penicillin V is now recommended for neurological abnormalities. It is not yet clear whether antibiotic treatment is helpful later in the illness when arthritis is the most predominant symptom. Treatment should be started as soon as the rash appears, even before the Enzyme Linked Immunoabsorbent Assay (ELISA) test is completed. Results of this test may be inaccurate if patients have had antibiotics soon after contracting Lyme Disease, or in those who have weakened immune systems. If lyme Disease is contracted during pregnancy, careful monitoring by physicians is highly recommended to avoid possible fetal abnormalities and/or complications. For tense knee joints due to increased fluid flowing in the joint spaces (effusions), the use of crutches is often helpful. Aspiration of fluid and injection of a corticosteroid may be beneficial. If the patient with Lyme disease has marked functional limitation, excision of the membrane lining the joint (synovectomy) may be performed for chronic (6 months or more despite therapy) knee effusions, but spontaneous remission can occur after more than a year of continuous knee involvement. When Lyme Disease is contracted during pregnancy, treatment with penicillin should begin immediately to avoid the possibility of fetal abnormalities. In 1989 a new Lyme Disease antibody test, manufactured by Cambridge Biosciences Corp., was approved by the FDA. This test is being used by local laboratories throughout the nation, making tests more available to the general population. However, it is 97% specific for antibodies to Lyme disease when compared to Western blot tests, but it cannot identify the live bacteria in patients who have not yet developed the antibodies. Therapies: Investigational ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Researchers are trying to develop a test that will identify the Lyme disease bacteria in patients who have not yet developed the antibodies. This would enable doctors to diagnose Lyme disease very early in the course of the illness. This disease entry is based upon medical information available through July 1989. Since NORD’s resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder.