CCMS Medicine Spring 2017 - 25

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This article will describe the stages of Lyme
disease (also known as Borreliosis) and
address some of the confounding issues.
If discovered early, Lyme disease is
often a short-lived illness that responds to
antibiotic treatment. However, in some
individuals - especially if the diagnosis
is delayed for months or years - the
response to antibiotic treatment is not
complete and symptoms linger or reoccur,
resulting in chronic or prolonged illness.
Early Lyme disease (3-30 days following
tick bite): many but not all patients will
develop an enlarging rash, which may
be red or purple (Erythema Migrans),
sometimes, with a darker center, enlarging
to more than 2 inches in diameter in the
span of 1-2 days. It may or may not be
accompanied by fevers, chills, muscle and
joint aches, fatigue, headache, increased
need for sleep, and occasionally, swollen
glands. These symptoms should raise
suspicion of Lyme disease in patients who
do not have the typical rash, but may be
dismissed as a viral illness by a physician or
the patient.
Notably, gastrointestinal (diarrhea,
vomiting) or upper respiratory symptoms

(cough, nasal congestion, or sore throat) are
not characteristic of Lyme disease.

Courtesy of the CDC. The middle picture
shows a crusty rash with a purple center,

Welcome

without the typical "bull's eye" appearance.
In a 2003 article in the New England
Journal of Medicine Dr. Steere reported a
high prevalence of early symptoms without
a rash: "Particularly when erythema migrans
is not present early in the illness, patients may
not go to a physician or Lyme disease may
not be recognized until the more debilitating,
harder-to-treat late manifestations of the
infection become apparent. The challenge for
patients and physicians is early recognition
and treatment of the infection, particularly
when patients present during the summer
with non-specific systemic symptoms."
It would be a mistake to obtain, or to
wait for the Lyme disease tests results at this
stage before treating the patient: Lyme tests
may not become positive for a number of
weeks. When Lyme disease is suspected,
treatment should not be delayed. In
addition, currently available tests have
limited sensitivity and specificity in early
Lyme disease.
The spread of Lyme spirochete from the
initial site where the tick bite occurred may
take several days to weeks. The bacteria
may be carried by the blood and lymphatic
vessels, and settle in the tissues, like the
Continued on page 26

Brandon A. Bosque, DPM
Board-eligible Podiatrist

* Preventative and collaborative patient care
* Customized treatment plans for a variety of foot and ankle conditions caused by
diabetes, trauma, and vascular/other diseases, using surgical options as last resort
* Pedorthist on site
* Most major insurance plans accepted
* Fluent in English and Spanish

Now accepting appointments (walk-ins welcome*)
Monday - Friday, 8:30 a.m. - 5:00 p.m.
Brandywine Professional Building
213 Reeceville Road, Suite 13
Coatesville, PA 19320
610-383-5220
*Recommend confirming availability
Independent Member of the Medical Staff at Brandywine Hospital
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Table of Contents for the Digital Edition of CCMS Medicine Spring 2017
