Delaware County Medicine & Health Spring 2017 - 28

FEATURE

swelling may resolve completely on its own, may recur
intermittently over time, or may be chronic and persistent.

Heart
Uncommonly, Lyme spirochete may infect the
heart, causing abnormal heart rhythm and muscular
inflammation. This usually occurs within weeks to
several months of the initial infection. Symptoms may
include lightheadedness, fainting, shortness of breath,
heart palpitations, or chest pain. An individual with
these symptoms should be evaluated by a doctor so that
the appropriate cause can be identified and treated.
While palpitations and the sensation that the heart is
pounding or racing can be benign and most often unrelated
to Lyme disease, these symptoms should be evaluated
by a clinician so that the proper diagnosis is made.
Radiculoneuritis may result from inflammation of
the roots of the spinal nerve. Symptoms may include
numbness or tingling on one or both sides of the body;
there may be increased sensitivity to pain in the affected
areas. Radicular pain may be described as stabbing,
burning, or shooting pains that radiate down along the
nerves into the limbs or across the trunk. There may be
loss of sensation, or inability to move an extremity.
When Lyme disease is unrecognized because the initial
symptoms are mild or absent, or the infection is treated
with too short a course, or a wrong antibiotic, it may enter
a late stage. In some individuals, the immune system is
so effective in killing the invading Lyme bacteria that the
infection is cleared up without any antibiotic treatment; in
this scenario, the symptoms resolve and the patient is well.
In others, the immune system may eliminate only some of
the Borrelia spirochetes, so the individual may feel reasonably
well for months or years while the residual bacteria remain
inactive, lodged in tissues without causing disease. However,
these bacteria have the potential to "wake up" and become
active, causing the patient to experience Lyme disease
symptoms. This is called Late Disseminated disease.
At the late disseminated phase, the joints and nervous
system tend to be most often affected. Common
symptoms may include joint pain and swelling,
fatigue, cognitive problems, sleep disturbance,
irritability, or hypersensitivity to sensory stimuli.

Joints
More than half of patients with untreated Lyme disease
develop arthritis (e.g., joint swelling), which can be
temporary or chronic, most commonly in the knees.
While the arthritis commonly emerges approximately
six months after initial infection, the range of onset
is wide (4 days to 2 years). Besides the knees, other
joints that may be involved include the ankle, shoulder,
elbow, wrist, or temporomandibular joint. The pain and

26 DELAWARE COUNTY MEDICINE & HEALTH

spring 2017

Patients with Lyme arthritis will often have
positive Lyme tests (IgM and IgG antibodies) for
many years, despite the antibiotic treatment.

Nervous System
Some patients whose Lyme disease has been left untreated
for months or years may develop cognitive problems
(memory deficits, processing speed, loss of language
fluency), or dementia-like presentation. Numbness, pain,
tingling or burning in extremities is another complaint.
Psychiatric symptoms may include depressive
symptoms, anxiety, irritability, suicidal thinking,
ADHD (particularly, children).

Post-Treatment Lyme Disease
Syndrome (PTLDS)
As many as 1 in 5 patients treated for Lyme disease
continue to have distressing or disabling symptoms
that can last months or even years after treatment.
Common symptoms include: Muscle and/or joint pains,
cognitive problems, severe fatigue, and sleep disturbance.
In the future articles in the series, I will discuss suspected
causes of this PTLDS and possible effective treatments.
-------------------------------------------------------------------------Dr. Makous completed a 2-year Post-Doctoral
Fellowship at the Columbia University Lyme and
Tick-Borne Diseases Research Center. She stayed
on as an Assistant Professor, continuing her clinical
work for an additional 2 years. She recently relocated
to Chester County, and continues to evaluate and
treat patients with suspected or ongoing symptoms of Lyme disease.
430 Exton Commons, Exton, PA 19341
484-876-1362



Table of Contents for the Digital Edition of Delaware County Medicine & Health Spring 2017

Delaware County Medicine & Health Spring 2017 - 1
Delaware County Medicine & Health Spring 2017 - 2
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