CCMS Medicine Spring 2017 - 26

skin, the joints, the nervous system, or the
Multiple rashes may be seen:

Joints and Muscles- Patients with Lyme
disease often experience joint and muscle
pain in early disease. When the Lyme
bacterium spreads beyond the skin to
the joints, swelling and pain may occur,
typically in the large joints and often
migrating from one joint to another.
Nervous system- When the B. burgdorferi
spirochete targets the nervous system,
conditions including meningitis,
encephalitis, inflammation of the nerves
(most typically, facial nerve, causing Bell's
palsy, or inability to smile or close the eye),
called cranial neuritis, and radiculoneuritis
may develop.
Meningitis, an inflammation of the
membranes covering the brain and spinal
cord, presents with headaches of varying
intensity, fever, sensitivity to light, nausea,
vomiting, and neck stiffness.

This patient with presented with a right
facial palsy and was subsequently diagnosed
with Lyme disease. Courtesy of CDC.
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

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
swelling may resolve completely on its own,
may recur intermittently over time, or may
be chronic and persistent.
Patients with Lyme arthritis will often
have positive Lyme tests (IgM and IgG
antibodies) for many years, despite the
antibiotic treatment.

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.

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,

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

26 C H E S T E R C O U N T Y M e d i c i n e | S P R I N G 2 0 1 7

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

Table of Contents for the Digital Edition of CCMS Medicine Spring 2017

CCMS Medicine Spring 2017 - 1
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