Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Lyme Disease: A Growing Threat to Urban Populations
Lyme Disease: A Growing Threat to Urban Populations
Pages 1-14
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Prospective studies of these patients showed that the illness could affect multiple systems over a period of years, including the skin, nervous system, heart, or joints (4~. Erythema migrans also linked Lyme disease in the United States with certain syndromes described previously in Europe.
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burgdorferi varies among geographic locations. In the northeastern and midwestern United States, the preferred host for both the larval and nymphal stages of I
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The endemic cycle of B burgdorferi is different in the western United States.
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EPIDEMIOLOGY OF LYME DISEASE Lyme disease is now the most common vector-borne infection in the United States (35~. The infection is usually acquired when nymphal ticks feed between May and July, but adult ticks occasionally transmit the 10,0~10 8,000 U
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, and Australia (39~. During the last several decades, Lyme disease has spread and has caused focal epidemics, particularly in the northeastern United States.
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, the spirochete often disseminates to multiple sites, manifested most commonly by secondary annular skin lesions (18) , meningitis, facial palsy, radiculoneuritis (46)
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Compared with Lyme disease, chronic fatigue syndrome or fibromyalgia tends to produce more generalized and disabling symptoms. They include marked fatigue, severe headache, diffuse musculoskeletal pain, multiple symmetric tender points in characteristic locations, pain and stiffness in many joints, diffuse dysesthesias, difficulty with concentration, or sleep disturbance.
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~~~r-~ -- 1 ~ DIAGNOSTIC TESTS Part of the reason for misdiagnosis is due to problems associated with diagnostic tests. In most instances, culture has yielded positive results only from biopsy samples of erythema migrans skin lesions (59, 60~.
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, but the value of PCR as a reliable diagnostic test is still being researched. TREATMENT The various manifestations of Lyme disease can usually be treated successfully with oral antibiotic therapy, except for objective neurologic abnormalities, which seem to require intravenous therapy (15, 66~.
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Should patients with tick bites receive prophylactic antibiotic therapy? In one recent study, the risk of acquiring Lyme disease from a recognized tick bite was only 1.2%, perhaps because 24~8 hours of tick attachment is often required for transmission of the spirochete (78~.
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A recent phenomenon is that a number of poorly understood conditions, such as chronic fatigue syndrome or fibromyalgia, are misdiagnosed as "chronic Lyme disease." Part of the reason for misdiagnosis is due to problems associated with diagnostic tests. The various manifestations of Lyme disease can usually be treated successfully with oral doxycycline or amoxicillin, except for objective neurologic manifestations, which seem to require intravenous therapy.
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(1993) in Ecology and Environmental Management of Lyme Disease, ed.
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35. Centers for Disease Control (1993)
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(1993) Arthritis Rheum.
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