Symptom Statements From Scientific Literature
Symptom Statements From Scientific Literature
Part 5
- ... pre-neurologic symptoms (stage one) consisting of erythema chronicummigrans (ECM), fever, arthralgias, myalgias, malaise, and fatigue.
- ...[headaches] usually frontal or occipital, and itcharacteristically fluctuated in intensity over a period of weeks.
- ...signs often present inpurulent meningitis were absent.
- It should be stressed that meningitis may be the first manifestation of Lyme disease.
- ... mild encephalitic symptoms - lethargy, difficulty in concentrating, fatigue, emotional lability, irritability, and poor memory.
- Symptoms also varied from day to day but did not necessarily correlate with the severity of headache and stiff neck.
- Although a few patients madeoccasional mistakes in their mental status testing,none had a definite organic brainsyndrome, obtundation,or coma.
- Neither the CT scan nor the EEG was helpful insupporting the diagnosis of encephalitis.
- ... patients with encephalitic symptoms had abnormalelectroencephalograms, which showed mild generalized slowing or some sharp activity.
- LP consistently revealed a lymphocytic pleocytosis with normal opening pressure.
- Median CSF white count was 166 with a range of 5-700.
- Median protein was 79 with a range of 8-400.
- CSF glucose was usually normal.
- Intermittent diplopia without clinicaly evident extra ocular movement palsy.
- Intense pain or pressure within the distribution of dermatomes.
- Radiculoneuritis involved more than one extremity.
- Mononeuritis multiplex- different sites became affected days to weeks apart.
- Peripheral nerve lesions may occur at the root,plexus, or distal nerve.
- Denervation changes in the infraspinatus muscle.
- Neurological involvement may be confused with a number of other disorders.
- Most common misdiagnosis is viral meningitis which rarelyruns the protracted and relapsing course of Lyme meningitis.
- In Lyme radiculoneuritis,the Guillain-Barre syndrome has been considered.
- Three major types of lesions comprise the neurological manifestations of Lymedisease: meningitis, cranial neuropathy, and radiculoneuritis [1]. These three mayoccur alone or in combination.
- We believe that this constellation of symptoms is unique among neurological diseases. (Yale)
- Half of the patients also had facial palsies, which were unilateral in 12 and bilateral in seven.
- In addition, 12 patients had motor and/or sensory radiculoneuropathies; asymmetric weakness of extremities was the most common finding.
- Although incomplete presentations of neurologic involvement of Lyme disease may be confused with other entities, the typical constellation of neurologic symptoms represents a unique clinical picture.
- Other relapsing-remittingdiseases like multiple sclerosis sometimes appear in the differential diagnosis.
- Headache and mild neck stiffness, which fluctuated in intensity, and lymphocytic pleocytosis were the common findings.
- Other relapsing-remittingdiseases like multiple sclerosis sometimes appear in the differential diagnosis.
- Lyme disease- nerve involvement is rarely ascending or symmetrical.
- In Lyme radiculoneuritis,the Guillain-Barre syndrome has been considered.
- Lyme disease- nerve involvement is rarely ascending or symmetrical.
- Meningitis, frequently accompanied by cranial and/orperipheral radiculoneuritis
- With all three antibiotic agents, nearly half of patients had minor late symptoms.
- Seven of the 20 penicillin-treated patients (35%) were apparently cured.
- Of 20 arthritis patients treated with intravenous penicillin G, 11 (55%) were apparently cured.
- All 3 stages of Lyme disease can be treated with antibiotic therapy, but some patients with late disease may not respond.
- Infectious-toxic nature of the condition.
- Late stage Lyme borreliosis can occur in children without a history of tick bite or ECM
- The arthritis syndrome can mimic oligoarticular juvenile rheumatoid arthritis
- The diagnosis of Lyme borreliosis depends upon clinical recognition
- Lyme keratitis characterized by multiple focal, nebular opacities at varying levels of the stroma which may progress to edema, neovascularization, and scarring.
- 10
- Brain biopsy specimen showed microgliosis without an inflammatory infiltrate and spirochetes morphologically compatible with Borrelia burgdorferi.
- All six patients had elevated antibody titers to B burgdorferi in serum, but none had selective concentration of specific antibody in the cerebrospinal fluid.
- All six patients were treated with high-dose intravenous penicillin; four had complete recoveries and two did not.
- Lyme disease may affect the central nervous system causing organic brain disease or syndromes suggestive of demyelination.
- Lyme disease is a multisystem infectious, inflammatory, and immune-related disorder.
- Neurological symptoms can occur from weeks to many years following the primary infection and can be quite devastating.
- The majority of patients will not recall a tick bite or characteristic rash.
- When the nervous system has been affected by Lyme disease, aggressive antibiotic treatment is usually necessary, often using IV preparations.
- Usually, there will be significant improvement following the use of antibiotics, but there are some patients who will continue to have persistent, probably irreversible, nervous system abnormalities.
- Children aged five to 14 years had the highest incidence.
- 20
- Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans.
- Affected joints were the knee (89 percent), hip (9 percent), shoulder (9 percent), ankle (7 percent),and elbow (2 percent).
- The positivity rate for the first serum specimen for those with erythema migrans was only 30 percent by IFA and 24 percent by ELISA.
- In view of the low sensitivities of serologic testsduring early Lyme disease, it is particularly important for physicians to re-evaluateclinical data when antibodies are not detected.
- Seropositive children with aseptic meningitis and without initial signs of an infectious aetiology should be checked for a neuroborreliosis even when CSF negative in the first lumbar puncture.
- A 3-year-old boy with typical clinical features of Lyme disease, including erythema chronicum migrans and arthritis... the clinical picture evolved into juvenile chronic myelocytic leukemia.
- Lyme borreliosis is the main cause of peripheral facial palsy in childhood.
- All cases of facial palsy with a tick bite and/or an erythema migrans in the head-neck region showed ipsilateral neurological affection suggesting direct invasion via the affected nerve by Borrelia burgdorferi.
- Only about 50% of patients with longstanding (1 to 12 months) untreated EM were IgG seropositive.
- Lyme disease during pregnancy- the child was born with a ventricular septal defect.
- Of six affected children, two had hyperbilirubinaemia, one muscular hypotonia, one was underweight for gestational age, one was macrocephalic, and one had supra ventricular extrasystoles.
- Acute hemorrhagic leukoencephalitis with renal insufficiency that had been diagnosed at the terminal stage.
- Convulsions, hemiplegia and consciousness disorders... detection of IgM and IgG specific serum antibodies raised against Borrelia burgdorferi.
- Tick-borne annular erythema (TAE) are much like those of Laim disease.
- Lyme borreliosis affecting the central nervous system does exist.
- Early diagnosis of children with Lyme is difficult- the bite of the ixodid tick often goes unnoticed.
- Erythema chronicum migrans occurs in less than 50% of cases.
- Brief intermittent attacks of swelling and pain in one or more joints.
- In most cases, pain is not severe enough to debilitate the patient or prevent weight-bearing activity.
- An elevated sedimentation rate is the only consistently abnormal routine laboratory finding in Lyme disease.
- 40
- Lyme disease shares symptoms in common with septic arthritis and juvenile rheumatoid arthritis.
- Erythema chronicum migrans (63%), neurological involvement (47%) and arthritis (22%), frequently in combination.
- Lyme disease can also involve the brain parenchyma.
- First manifestation was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis.
- 17 patients presented with acute Lyme disease and received prompt treatment with oral antibiotics, but chronic Lyme disease subsequently developed.
- Clinically active disease- none had diagnostic levels of antibodies to B. burgdorferi.
- On Western blot analysis reactivity against B. burgdorferi from chronic Lyme patients was no greater than that in serum from normal controls.
- Presence of chronic Lyme disease cannot be excluded by absence of antibodies against B. burgdorferi.
- 58 (64%) developed neurological abnormalities and four (4%) patients developed monoarticular or oligoarticular arthritis.
- Lyme disease is now recognized as an infectious process capable of involving multiple organs including the cardiovascular system.
- 50
- Symptomatic heart block may be the sole presenting complaint of Lyme Disease in children.
- Oligoarthritis appearing in part of the leg where the cutaneous or neurological complications, or both, of Lyme disease developed before arthritis.
- Twenty nine patients had neurological disorders as the only manifestation of Lyme disease.
- Patients with neuropsychiatric manifestations, focal CNS lesions, or profound fatigue appearing in the third stage of Lymedisease, many months to years after the initial infection.
- Arthritis was the presenting feature in more than half of the children.
- Half of the children had initially consulted an orthopaedic surgeon, none of whom made the correct diagnosis.
- Sweden- Skin lesions were of longer duration (median 5-6 weeks), but less often multiple (8%) than in the USA.
- 72 patients with erythema migrans disease (EMD) had 1 to 10 constitutional symptoms besides the erythema migrans.
- Patients with ACA developed signs and symptoms consistent with neurologic, cardiac and joint involvement, and 2 had a history of erythema migrans disease (EMD).
- 60
- Borreliae were found in brain and liver of a newborn.
- Early erythema migrans disease (EMD) appears to be quite similar to early Lyme disease.
- Spirochetes were localized in dermal papilles and subepidermal zones of skin sections of ECMA, in lymph vessels and collagen fibres.
- In synovia of patients with arthritis spirochetes were found beneath the synovial lining cells and perivascularly.
- In the lymphnode of patient with arthritis and lymphadenitis spirochetes were localized in and round the blood vessels and in the lymph vessels.
- (52%) children had no history of erythema chronicum migrans or other rash.
- Temperatures as high as 41 degrees C (105.8 F) for up to 2 months before the onset of arthritis.
- Ten (40%) children, seven had no rash, were hospitalized for presumed septic arthritis.
- Four had diagnoses of pauciarticular juvenile rheumatoid arthritis for as long as 3 years.
- Seven patients had less acute, recurrent episodes of synovitis.
- 70
- Two children had seventh nerve palsies 2 months before onset of arthritis.
- Lyme arthritis may be confused with acute bacterial septic arthritis or recurrent "pauciarticular juvenile rheumatoid arthritis".
- Individuals with ECM rash who are treatedimmediately develop Lyme diseaseantibody only 40 per cent to 50 per cent of the time.
- In many instances the diagnosis is a clinical rather than a serologic one.
- Clinical expressions of the disease vary widely.
- Some patients have very mild disease and others develop severe and prolonged illness.
- Different subtypes of this organism may infect man.
- Most commonly affecting the brain or meninges, other skin sites, lymph nodes, or joints.
- Of 40 blood cultures, only one, from a patient with disseminated infection, yielded spirochetes.
- Due to low yield of cultures and delay in antibody response, recognition of clinical picture remains very important in diagnosing early Lyme disease.
- 80
- Spirochetes were seen in and around blood vessels.
- Lyme spirochete may survive for years in affected synovium and may be directly responsible for the microvascular injury.
- Nonspecific villous hypertrophy, synovial cell hyperplasia, prominent microvasculature, lymphoplasmacellular infiltration, and sometimes lymphoid follicles.
- Larger surgically obtained specimens also showed striking deposition of fibrin in synovial stroma and a form of endarteritis obliterans.
- Joint involvement is typically intermittent and oligoarticular.
- Lyme may become chronic, with erosion of cartilage and bone.
- Lyme synovia often showed greater proliferative changes in arterioles.
- Spirochetes were seen near these vessels (arterioles).
- Joint involvement was intermittent, but became chronic (>6 months) in the knees.
- Vascular microangiopathy, which resembled lupus"onion-skinning"inspleens,was seen.
- 90
- Spirochetes were seen within edematous vascular beds and in vessel walls.
- This finding implies that that the Lyme spirochete may survive for years in affected synovium.
- Chronic, with erosion of cartilage and bone.
- The importance of a sufficient antibiotic therapy to prevent late manifestations is stressed.
- Although there are many similarities between erythema chronicum migrans Afzelius and Lyme disease, the results of the present study also point to differences.
- Decreased suppression may permit damage to tissues because of autoimmune phenomena or a heightened response to the Lyme spirochete.
- (75%) had single EM lesions, 13 patients (25%) had multiple lesions.
- Meningitis, cranial neuropathy, and radiculoneuritis, alone or in combination, lasting for months.
- Unilateral iritis followed by panophthalmitis- spirochetes found in specimens of vitreous debris obtained at surgery
CONTINUED HERE- PART 2
PART 3 IS HERE
PART 4 IS HERE
https://sites.google.com/view/symptoms-of-lyme/childrens-symptoms/symptom-descriptions-children
PART 5 IS HERE
https://sites.google.com/view/symptoms-of-lyme/childrens-symptoms/childrens-symptom-statements
Last Updated- April 2019
Lucy Barnes