Delaware County Medicine & Health Spring 2017 - 27

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.

In addition to taking care in preventing tick exposure, it
is important to recognize Tick-Borne infections as soon
as possible, when they are most easily treatable. Exposure
to tick bites is not always suspected or known, since the
offending tick may be missed, or found after the transmission
of the infection has occurred. Some of the Tick-Borne
infections can be transmitted within a short time of the
tick attachment, while Lyme disease transmission typically
occurs after at least 24-36 hours of tick attachment. In
some cases, if the tick had an incomplete prior blood
meal, it may allow the spirochetes to migrate to the tick's
salivary glands, resulting in a more rapid transmission.
Ticks can attach to any part of the body and can be
easily missed, hiding under the hair, behind the ears,
under the arms, the groin, or behind the knees. In the
previous edition of Chester County Medicine Magazine, I
described some diagnostic challenges in interpreting
Lyme test results and establishing a diagnosis. This article
will describe the stages of Lyme disease (also known as
Borreliosis) and address some of 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 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
skin, the joints, the nervous system, or the heart.

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.

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