National organization dedicated to the prevention, diagnosis, treatment, and control of lyme disease and other tick-borne infections. The foundation supports critical scientific research and plays a key role in providing reliable and scientifically accurate information about tick-borne diseases.
Children with Lyme disease almost invariably have a positive Lyme titer and a positive Western blot (see Chapter 22). In addition, they have elevated ESRs and white blood cell counts. While the elevated white blood cell count and ESR are commonly present in children with polyarticular-onset arthritis, they are infrequent in children with pauciarticular-onset disease. Some children with Lyme disease have positive tests for antinuclear antibody (ANA). They should not have rheumatoid factor (RF), antibodies to double-stranded DNA, or complement abnormalities. The Lyme titer and Western blot are the standard tests other tests exist but are not as reliable. While a child with a high suspicion for Lyme disease and a positive ELISA but negative Western blot may deserve two weeks of antibiotics, if symptoms persist it is unwise to continue treatment. Such children need a complete and thorough evaluation for other possible causes of their symptoms.
Lyme Disease Foundation (LDF) A nonprofit medical health care agency established in 1988 and dedicated to finding solutions to tick-borne disorders. The LDF is the first and largest organization, with strong ties in the international scientific community. (For contact information, see Appendix I.)
National nonprofit organization created to advance research, treatment, prevention, and public awareness of Lyme Disease throughout the United States. Public and professional education are a major focus of the foundation. The group offers a toll-free information number and an established national physician referral system. In addition, members produce educational videos for both the elementary and junior high school levels. For more information, contact the American Lyme Disease Foundation, Inc., Mill Pond Offices, 293 Route 100, Suite 204, Somers, NY 10589 telephone (914) 277-6970 or (800) 876-LYME fax (914) 277-6974.
Optimal treatment for Lyme disease is dependent on the age of the child, the manifestations of the disease, and whether the child has any allergies to drugs. Young children are typically treated with amoxicillin, while children over the age of ten are typically treated with doxycycline. Doxycycline is not used in younger children because it will become incorporated in the enamel of developing teeth and may cause a permanent grayish stain. Some physicians feel it is acceptable to use doxycycline in children as young as eight years of age if the adult teeth appear to be fully formed in the gums. In children who are allergic to these drugs, consideration may be given to cephalosporins or erythromycin derivatives. This should be discussed carefully with your physician because these drugs differ in how well they reach the central nervous system. The duration of therapy for Lyme disease also depends on the manifestations of disease. The majority of the medical community is in agreement with...
Lyme disease is a typical infection-associated or reactive arthritis. As a result, it can be confused with other infection-associated types of arthritis. The key differences in children with arthritis due to Lyme disease are the absence of a recent infection (most children develop infection-associated arthritis ten to fourteen days following a recognized illness) and the presence of a positive Lyme titer. Systemic lupus erythematosus and other forms of collagen vascular disease may also begin with the rapid onset of arthritis involving the large and small joints. The key to distinguishing these diseases is their different clinical appearance and use of appropriate laboratory testing. In areas where there is a high frequency of exposure to Lyme disease, the situation may be complicated by a positive Lyme test in a child who is suffering from another illness. All children with positive Lyme tests should be treated for Lyme disease, but if there is not There is much debate about the...
Fortunately, serious complications of Lyme disease are rare. The vast majority of children with Lyme-related arthritis recover promptly (within a few weeks) and completely with treatment. In children with Lyme who have large numbers of bands on their Western blot (e.g., nine or more), it is likely the infection has been present for a prolonged period. Some of these children will have continuing arthritis after the first thirty days of antibiotics. It is important to recognize that, like other causes of infection-associated arthritis, Lyme tends to provoke symptoms in those who have an underlying predisposition to arthritis. If the arthritis persists after appropriate treatment for Lyme disease, the emphasis must Some argue that Lyme produces many chronic symptoms in children, including attention deficit disorder and other unexplained conditions. It is important to recognize that Lyme disease is common. Therefore it will be found in a significant number of children with a wide variety...
Lyme disease is a chronic infection by the bacterium Borrelia burgdorferi, which is carried by mammals such as deer and deer mice and spread by very small deer ticks (Ixodes scapularis). The ticks bite an infected animal and pick up the spirochete with their blood meal. They then transfer the spirochete to people or animals they feed on, infecting them with Lyme disease. Lyme disease in humans is often only an acute flu-like illness. However, some adults and children develop rash and arthritis. The key to understanding Lyme arthritis in children is to recognize that it is in many ways a typical infection-associated arthritis. The major difference is that Lyme disease follows a much more protracted course. Typical infection-associated arthritis develops within a few weeks of the original illness. The fever and rash of Lyme disease also occur early. However, the arthritis of Lyme disease usually does not appear until two to four months or more after the initial infection, and if it is...
Part II is about discovering whether you have fibromyalgia, and part of that process is ruling out medical problems that may be impostors for your real problem of fibromyalgia. These conditions include chronic fatigue syndrome, myofascial pain syndrome, thyroid disease, forms of arthritis, and a few other illnesses that may surprise you, such as Lyme disease, lupus, and Raynaud's phenomenon (all discussed in Chapter 6). Then I move into diagnosing fibromyalgia. A good doctor is crucial to diagnosing and treating fibromyalgia, and I discuss the important role that doctors play in Chapter 7. I also offer advice on working with your regular doctor and, if that doesn't work, finding a new doc. Then I cover what actually happens (or should happen) during your physical exam to find out whether you have fibromyalgia.
Symptoms Syndromes and the Value of Psychiatric Diagnostics in Patients Who Have Functional Somatic Disorders
Proliferation of diagnostic testing has yielded a burgeoning number of false positive results that may be linked mistakenly to nonspecific symptoms. One example is the attribution of low back pain to disc abnormalities that are seen on MRI, a diagnosis that is complicated by the fact that 40 of asymptomatic controls had some degree of disc abnormality on MRI 8 . In fact, radiographic abnormalities in an important fraction of the general population has led to a new term, incidentaloma 9,10 . Other examples include the overdiagnosis of Lyme disease in a patient who has fatigue, musculoskeletal pain, and low-level antibody titers 11,12 or subclinical hypothyroidism'' in a patient who has vague symptoms and borderline elevations of thyroid-stimulating hormone. Meador 13 warned of the overinterpretation of laboratory (as well as physical) findings in his classic essay, The Art and Science of Nondisease.''
Not all communicable diseases must be reported, since they are not all considered to be a danger to society. Some diseases which must be reported include bacterial meningitis, aids, food poisoning, measles, hepatitis, rabies, lyme disease, syphilis, malaria, and tuberculosis.
Infectious diseases produce passive acu-reflex points. Lyme disease is perhaps the most prevalent of the infectious diseases associated with myofascial pain. In some patients, intractable widespread muscle pain and chronic fatigue have been positively associated with Lyme disease (in which elevated immunoglobulin G titers and normal immuno-globulin M titers are indicative of past, not recent, exposure). Some affected patients develop joint pain. Post-Lyme disease syndrome is characterized by diffuse joint and muscle pain, fatigue, and subjective cognitive difficulty.13 Other infectious or parasitic diseases also manifest as widespread pain and resemble Lyme disease.
The biological and social phenomenon of Lyme disease, Science 260(June 11,1993) 1610-16. Barthold, S. W. Antigenic stability of borrelia burgdorferi during chronic infections of immunocompetent mice, Infection and Immunity 61 12(Dec. 1993) 4955-61. Fikrig, E. Barthold, et al. Protection of mice against the Lyme disease agent by immunizing with recombinant OSPA, Science 250(0ct. 26,1990) 553-56. Kantor, Fred S. Disarming Lyme disease, Scientific American 271 3(September 1994) 34-39.
Lyme disease A recently identified tick-borne illness whose hallmark symptom is a bull's-eye red rash surrounding the tick bite. Untreated, Lyme disease can cause a host of problems, including arthritis and disorders of the heart and central nervous system. It is most commonly found in the northeast coastal states from Maine to Maryland, in the upper Midwest, and on the Pacific coast. It is most often contracted 'in the late spring or early summer when ticks are abundant, although it may occur whenever the temperature is above 40 F for several consecutive days. recent studies indicate that many people who think they have Lyme disease actually have other conditions. By the late 1970s, Yale researchers Allen Steere and Stephen Malawista found that many patients they studied were afflicted with a mysterious disease that produced a variety of symptoms, in addition to the joint swelling. They determined the cause was apparently a microorganism transmitted by at least one species of tick...
Babesiosis (babesiasis) A rare, occasionally fatal, disease caused by a tick-borne microorganism similar to both LYME DISEASE and human granulocytic ehrlichiosis (HGE). Also known as Nantucket Fever, it is most often seen in the elderly and those with impaired immune systems. Severe cases have been diagnosed in those who have had their spleen removed prior to exposure. borrelia See RELAPSING FEVER. Borrelia burgdorferi A species of large parasitic spirochete bacteria (in the genus Borrelia) that cause LYME DISEASE. The species B. dut-tonii, B. persica, and B. recurrentis cause RELAPSING FEVER.
Any tick can be accurately identified and tested for the presence of the bacteria that cause Lyme disease (Borrelia burgdorferi) at the Tick Research Lab. Tick identification takes only a few minutes. Testing ticks for the presence of Lyme disease spirochetes can also be done with any tick, alive or dead, at any stage of development.
Some experts say that some patients with fibromyalgia may have been previously infected with viruses such as the Epstein-Barr virus (a common virus that causes infectious mononucleosis), human immunodeficiency virus (HIV), parvovirus, or Lyme disease (a tick-borne illness that was originally discovered in Lyme, Connecticut). In the case of Lyme disease patients who develop FMS, their fibromyalgia symptoms typically don't improve with the normal antibiotic regimen that's prescribed for Lyme disease.
The fluid removed is subjected to a number of tests, including measurements of protein and sugar. For the cell count, less than 5,000 cells is considered normal. A cell count of 5,000 to 50,000 is consistent with arthritis but can also be seen with Lyme disease and irritation of the joint. A count of 50,000 to 100,000 may indicate arthritis, Lyme disease, or an infection. More than 100,000 cells indicates probable infection.
Overlap between the two shows that 35 to 70 percent of those with CFIDS have FM, whereas 20 to 70 percent of those with FM report an additional diagnosis of CFIDS. Earlier terms for CFIDS included yuppie flu or chronic Epstein-Barr Syndrome. CFIDS is defined by the Centers for Disease Control as a medically unexplained, persistent, or relapsing fatigue that is not substantially alleviated by rest and which is associated with significant functional impairment, including fatigue that occurs concurrently with four of more of the following cognitive dysfunction, sore throat, tender lymph nodes, muscle pain, joint pain without swelling, headaches, lightheadedness, unrefreshing sleep, and postexertional malaise lasting for at least twenty-four hours. These symptoms must persist at least six consecutive months to be diagnosed as CFIDS. As there is no simple test to confirm CFIDS, diagnosis is based on history and physical exam. Tests are often done to rule out other diseases that might mimic...
Ehrlichiosis, human granulocytic A disease (HGE) identified in 1990 that is spread by the type of ticks that carry lyme disease. Although the disease can be treated with antibiotics, treatment is often delayed because it is confused with a summer flu. If it is treated early and properly, the disease is not associated with brain damage or arthritis. The Centers for Disease Control and Prevention reported at least two deaths in 1990-93 due to the disease in Wisconsin and Minnesota. Some researchers believe this is not a new disease at all, but one of which doctors were simply unaware. New York and New England states are believed to have patients who have had the disease but who have instead been diagnosed with Lyme disease. From 1986 to 1997 health departments and laboratories reported more than 1,200 cases of human ehrlichiosis to the CDC. Although ehrlichiosis is a nationally notifiable disease, not all state health departments have reported cases. Most of the recognized cases have...
When pauciarticular-onset arthritis flares up in a child, he or she should be carefully reinvestigated to exclude other problems. Children may develop Lyme disease, bone infections, or other problems that at first look like a recurrence of the JA. If other problems have been excluded but the child does not respond quickly to reintroducing NSAIDs, he or she probably did not have true pauci-articular-onset arthritis.
The disease most often confused with polyarticular-onset JA is reactive arthritis (also called infection-associated arthritis). Reactive arthritis often begins with the rapid onset of disease involving the large and small joints (see Chapter 7). The key to suspecting this diagnosis is the occurrence of an infection around ten to fourteen days before the onset of arthritis. Children who rapidly develop polyarticular arthritis should be evaluated carefully for evidence of either a recent infection or an infection that is still present and may need to be treated. Parvovirus B19 infection and Lyme disease are just two examples of many infections that may cause an acute reactive arthritis with an elevated sedimentation rate and an ill-appearing child. Reactive arthritis typically resolves over a period of a few weeks to several months, but in some cases it appears that an infection that is known to cause reactive arthritis initiates chronic polyarticular arthritis in a susceptible...
Uveitis occurs in a wide variety of systemic diseases including those described herein and in other chapters of this book. Several associated diseases are of primary clinical interest, although individually they are relatively uncommon or even rare in the usual practice of a head and neck specialist. Sarcoidosis is a common cause of anterior, intermediate, and posterior uveitis, which is covered in more detail later in this chapter. Other diseases causing uveitis are described in other chapters of this book and include Behcet's disease, relapsing polychondritis, syphilis, Lyme disease, cat-scratch disease, tuberculosis, fungal infection, and infection with the human immunodeficiency virus, cytomegalovirus, and herpes viruses.
An infection causing a rash similar to that produced by lyme disease affecting residents in southeastern and south central United States. Southern tick-associated rash illness (STARI) is associated with the bite of the lone star tick (Amblyomma americanum). These ticks are found through the southeast and south central states. Even though spirochetes have been seen in A. americanum ticks, attempts to culture them in the laboratory have consistently failed. However, a spirochete has been detected in A. americanum by DNA analysis and was given the name Borrelia lonestari.
Children who suddenly develop a painful, swollen knee should not be considered as having pauciarticular JA, as the pain and swelling could be caused by infection (including Lyme disease), reactive arthritis, foreign body synovitis, or injury. On rare occasions a child who has acute pain in conjunction with an infection will be discovered to also have pauciarticular arthritis. The chronic disease frequently can be recognized because of bony overgrowth, which occurs over a long period as the body manufactures extra bone to limit joint movement. Children who develop sudden pain in the hip also should not be considered as having pauciarticular JA. Although polyarticular-onset arthritis and systemic-onset arthritis may ultimately involve the hip, it is never the first joint involved, and the hip is never involved in pauciarticular arthritis. I have seen cases of toxic synovitis, Lyme disease, osteoid osteoma, fractures, and tumors misdiagnosed as juvenile arthritis starting in the hip....
Babesiosis (babesiasis) A rare, sometimes fatal disease caused by a tick-borne virus similar to both lyme disease and human granulocytic ehrlichiosis (HGE). Also known as Nantucket fever, it is most often seen in the elderly and those with impaired immune systems. Severe cases have been diagnosed in those who have had their spleen removed.
Sometimes, people strongly suspect (or are sure) that they have fibromyalgia. Instead, however, they may have arthritis, Lyme disease, lupus, thyroid Extreme tiredness is one of the possible symptoms of many medical problems, including hypothyroidism, anemia, chronic fatigue syndrome, Lyme disease, arthritis, and oh, yes fibromyalgia, too. No wonder sorting it all out can be so hard sometimes To find out more about illnesses often confused with FMS, and how doctors sort them out, read Chapter 6.
The most common infectious agents that cause these forms of arthritis are bacteria (shigella, salmonella, neisseria, and chlamydia) and viruses (especially parvovirus B19). The arthritis associated with Lyme disease is also a form of infection-associated arthritis. Mild and brief arthritis following a variety of infections is very common. Once the episode has passed, most children recover completely. A typical episode of infection-associated arthritis resolves in three to six weeks. However, some children develop arthritis that lasts for a longer period. If the arthritis persists for a year or more, then it is considered arthritis that was initiated by an infection, but it is no longer considered reactive or infection-associated arthritis.
Oligoclonal bands are another finding that suggests irritation of the central nervous system. They are sometimes found in lupus and sometimes in multiple sclerosis, but there may be other causes. If the doctors are worried about infections such as Lyme in the central nervous system, they will measure the concentration of antibodies to Lyme in the CSF and compare it with the concentration in the blood. Higher levels of antibodies in the CSF than in the blood suggest Lyme infection of the central nervous system.
In fact, research does suggest that a minority of people who develop viral diseases, which can include Lyme disease, Epstein-Barr (HHV-4), Herpes Lymphotropic Virus (HHV-6), Coxsackie B, Parvovirus, Hepatitis C, and HIV, may later go on to develop FM or CFIDS. Many people on the East Coast of the United States have been diagnosed with post-Lyme disease syndrome based on a positive blood test for Epstein-Barr. While the suffering of these patients is real, the diagnosis is now in question. Ongoing NIH-funded research suggests that many patients who have been treated at Lyme disease clinics may actually have FM, especially since multiple rounds of antibiotics and antiviral medication have failed to improve symptoms or physical functioning in these individuals. Regardless, the mechanism of how viruses may trigger FM in genetically higher-risk individuals merits further investigation.
In addition to staining teeth in young children, doxycycline causes a number of children to complain of stomach upset and photosensitivity (they burn easily in the sun). These complaints limit its use as well. It is also used in the treatment of acne in teenagers and in the treatment of Lyme disease. Some caution using doxycycline for acne is necessary, because it has been associated with rare cases of drug-induced SLE.
In Traditional Chinese Medicine, teasel root tonifies the liver and kidneys and works on painful lower backs and knees, weak legs, cartilage and joints. It is also held to promote circulation and reduce inflammation. American herbalists William LeSassier and Matthew Wood have built on these uses and found in practice that the teasel (introduced from Europe) is, in Wood's words, invaluable for joint injury and chronic inflammation of the muscles. It is indicated for fibromyalgia, chronic arthritis, and Lyme disease. The acute infection of Lyme disease, as explained in an excellent monograph by herbalist Stephen Harrod Buhner (which any Lyme sufferer should buy), involves these same issues of joint pain, blood circulation, and tonifying of cartilage. Buhner finds results of using teasel root tincture for Lyme in the US are promising, though inconsistent in different regions. Teasel flower essence has been found not only to bring relief in Lyme disease but also fibromyalgia, chronic...
Although infections of the various structures of the ear might well be expected to affect hearing and thus trigger tinnitus, infections of locations remote to the ear can do the same. Meningitides can cause tinnitus, as can Bell's palsy. Syphilis (Chapter 15) can affect the labyrinth as well as the rest of the nervous system. Finally, it is curious that Lyme disease can have a hearing manifestation. As described above under endocrine disorders with Addison's disease, hyperacusis is associated with tinnitus and with Lyme disease. Fallon (11) reports that 48 of their cohort of Lyme disease had hyperacusis.
Infectious causes for vertigo include suppurative or toxic labyrinthitis secondary to otitis media, viral labyrinthitis or neuritis (frequently from the herpes virus family), otosyphilis, Lyme disease, and bacterial and viral meningitis. In such cases, accompanying signs of middle ear or meningeal involvement will be seen, which helps facilitate the diagnosis.
There are too many possibilities to name them all here, but several are worth discussing, including Lyme disease, Raynaud's phenomenon, various medical conditions that cause back pain, and infectious mononucleosis. Being ticked off by Lyme disease Lyme disease is an infection caused by an organism with a tongue twister name Borrelia burgdorferi. It's spread by tiny, dot-like ticks that typically feed off animals but aren't opposed to a human treat. If they latch onto you, you could get the disease. Lyme disease was originally believed confined to the northeastern United States and was first identified in Lyme, Connecticut. However, subsequent clusters of Lyme disease were identified in most states, as well as in France, Germany, and Switzerland, and other countries worldwide. Lyme disease can be cured if treated early on, but if the disease goes undiag-nosed for months or longer, then it usually becomes a chronic illness. forest in order to be afflicted by Lyme disease. You can become...
There are a variety of infections that may damage the spine. Fortunately, none of them is common in childhood. Staphylococcal bacteria are common causes of infections that may affect the bones of the spine. Tuberculosis can also affect the bones of the spine (in which case it is sometimes called Potts' disease). Bacterial infections of the spine are usually very painful. They are easily diagnosed by either X-rays or bone scans (Chapter 22). Despite many claims to the contrary, back pain in children is not a result of Lyme disease.