scholarly journals Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Katherine E. Guardado ◽  
Shane Sergent
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
The United States ◽  
Lyme Arthritis ◽  
Tick Bite ◽  
Joint Effusion ◽  
Test Results ◽  
History Of ◽  
Vector Borne

Abstract Lyme disease is the most common vector-borne illness in the United States. However, Lyme arthritis is a diagnosis that is often missed, even in children, who are the population with the highest incidence of Lyme disease. Lyme arthritis, which presents in the later stage of Borrelia burgdorferi infection, needs to be recognized and managed promptly, especially in endemic areas or when exposure to ticks is known. We present a case of a 3-year-old female presenting to the emergency department with a history of limping for 2 weeks. The mother of the child recognized a tick bite. However, the child was not taken to seek care expeditiously, because she had not developed any rashes. Test results demonstrated that the patient was IgG positive and IgM negative for Lyme disease, with Western blot confirming the diagnosis of Lyme arthritis. Most patients presenting with Lyme arthritis do not recall having a tick bite, making it difficult to differentiate it from other pediatric conditions. When this diagnosis is missed, it can result in long-term morbidity, which is generally refractory to intravenous antibiotic therapy, oftentimes requiring synovectomy. Hence, this underscores the importance of the consideration of Lyme arthritis as a differential diagnosis in patients presenting with joint effusion.

The Limping Child: Could It Be Lyme Arthritis? Information and Planning for School Nurses

2019 ◽  
Vol 34 (5) ◽  
pp. 262-265
Author(s):  
Tanya Laudenslager ◽  
Sheila Q. Hartung
Keyword(s):  
Lyme Disease ◽  
Joint Pain ◽  
School Setting ◽  
The United States ◽  
School Nurses ◽  
Lyme Arthritis ◽  
Acute Injury ◽  
Vector Borne Disease ◽  
History Of ◽  
Vector Borne

Lyme disease is the most common vector-borne disease in the United States with Lyme arthritis becoming one of the most common symptoms of Lyme disease. It is imperative that school nurses become familiar with vector-borne disease and promptly consider Lyme arthritis to be contemplated as a differential diagnosis of a child presenting to the office with a limp and joint pain and swelling with no history of acute injury. The following article will discuss the overview, implications and management of Lyme arthritis in the school setting and includes a relevant IHP for school nurses to utilize in practice.

scholarly journals Immune Mediators of Murine Lyme Arthritis

2014 ◽  
Author(s):  
◽  
Anna Maria Cunningham
Keyword(s):  
Lyme Disease ◽  
Subsequent Development ◽  
The United States ◽  
Lyme Arthritis ◽  
Immune Mediators ◽  
Eicosanoid Production ◽  
Immunological Mechanisms ◽  
Serum Transfer ◽  
Dietary Fish ◽  
Vector Borne

Lyme disease is the most common vector-borne disease in both the United States and Europe; however, its pathogenesis is incompletely understood. The studies described in this thesis aid in the elucidation of mechanisms regulating murine Lyme arthritis and may suggest mechanisms by which human Lyme disease is mediated. (1) We found that the chemokine KC is responsible for neutrophil recruitment and subsequent development of Lyme arthritis and carditis. This was the first study to describe an immunological regulatory mechanism mediating disease susceptibility to murine Lyme disease, as resistant mice (B6) produce less KC than susceptible (C3H/HeJ) mice and do not develop disease. (2) We found that metabolites produced via the COX-2 pathway are important for functional resolution and that resolution is likely mediated via the PGE2/EP2 axis. (3) We found that although dietary fish oil substitution leads to a global shift in eicosanoid production (from AA/LA-derived eicosanoids to EPA/DHA-derived eicosanoids) and promotes antiinflammatory prostaglandin production, disease severity is not altered. (4) We found that eicosanoid production throughout the course of autoantibody-drive K/BxN serum-transfer arthritis differs significantly from that seen during Lyme arthritis and that patterns of eicosanoid expression reflect the severity and kinetics of each type of arthritis. These studies aid in understanding the immunological mechanisms regulating the occurrence and severity of murine Lyme arthritis.

Lyme Arthritis as the Incorrect Diagnosis in Pediatric and Adolescent Fibromyalgia

PEDIATRICS ◽  
1992 ◽  
Vol 90 (4) ◽  
pp. 523-528
Author(s):  
Leonard H. Sigal ◽  
Sondra J. Patella
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
Antibiotic Therapy ◽  
Lyme Arthritis ◽  
Musculoskeletal Complaints ◽  
Common Disorder ◽  
Chronic Lyme Disease ◽  
Incorrect Diagnosis ◽  
Chronic Complaints

In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease. The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains. Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility. The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia. Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease. Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis."

scholarly journals Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Takaaki Kobayashi ◽  
Yvonne Higgins ◽  
Roger Samuels ◽  
Aurasch Moaven ◽  
Abanti Sanyal ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Infectious Diseases ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Community Settings ◽  
Academic Center ◽  
History Of ◽  
Observational Cohort ◽  
Vector Borne ◽  
Retrospective Observational Cohort Study

Abstract Background Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized. Methods A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared. Results Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08–2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87–13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02–1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03–1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14–8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations. Conclusions Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.

Lyme Disease: Acute Focal Meningoencephalitis in a Child

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 931-934
Author(s):  
HENRY M. FEDER ◽  
EDWIN L. ZALNERAITIS ◽  
LOUIS REIK
Keyword(s):  
Nervous System ◽  
Case Report ◽  
Lyme Disease ◽  
Signs And Symptoms ◽  
Brain Parenchyma ◽  
Tick Bite ◽  
System Involvement ◽  
History Of ◽  
Csf Pleocytosis ◽  
The Brain

Nervous system involvement in Lyme disease was originally described as meningitis, cranial neuritis, and radiculoneuritis,1-3 but Lyme disease can also involve the brain parenchyma. We describe a child whose first manifestation of Lyme disease was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis. CASE REPORT A 7-year-old boy was hospitalized Aug 27, 1985, because of hemiparesis. Six weeks prior to admission he had vacationed at Old Lyme, CT. There was no history of rash or tick bite. He had been well until eight hours prior to admission when fever and headache developed.

scholarly journals Postoperative Lyme Arthritis in the Orthopaedic Patient

2019 ◽  
Vol 11 (4) ◽  
pp. 350-354
Author(s):  
Matthew C. Hess ◽  
Zachary Devilbiss ◽  
Garry Wai Keung Ho ◽  
Raymond Thal
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Postoperative Complication ◽  
Joint Pain ◽  
English Language ◽  
The United States ◽  
Lyme Arthritis ◽  
Level Of Evidence ◽  
Pubmed Database ◽  
Level 3

Context:Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication.Evidence Acquisition:The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles.Study Design:Clinical review.Level of Evidence:Level 3.Results:A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature.Conclusion:These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis.Strength of Recommendation Taxonomy (SORT):C

scholarly journals Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks

2020 ◽  
Author(s):  
Henry M Feder ◽  
Sam Telford ◽  
Heidi K Goethert ◽  
Gary P Wormser
Keyword(s):  
United States ◽  
Lyme Disease ◽  
The United States ◽  
Tick Bite ◽  
Molecular Testing ◽  
Tick Bites ◽  
Epidemiologic Evidence ◽  
Powassan Virus ◽  
Tick Attachment ◽  
Virus Subtype

Abstract Background Powassan virus (POWV) is a tick-transmitted pathogen that may cause severe encephalitis; experimentally, it can be transmitted within just 15 minutes following a tick bite. The deer tick virus subtype of POWV (DTV) is transmitted by the deer tick and is the likely cause of the increase in the number of POWV cases reported in the United States. However, DTV has only been definitively documented in 6 patients by molecular analysis of the virus. Methods Two patients from Connecticut with encephalitis, who had a recent deer tick bite, were evaluated by the relevant serologic tests to determine if they had been infected with POWV. Evaluation also included molecular testing of an adult deer tick that had been removed from one of the patients. Results We documented neuroinvasive POWV infection in 2 children from Connecticut. Based on the results of testing the tick removed from case 2, this patient was infected by DTV, representing the 7th reported case and the first documented case of DTV infection in a child. Of note, the duration of the tick bites in both cases was very short. Conclusions We provide the first clinical and epidemiologic evidence that POWV/DTV can be rapidly transmitted to a human host, that is, within hours of tick attachment, which is distinctive when compared to other deer tick-transmitted infections such as Lyme disease.

scholarly journals An Introduction to Nicos Hadjinicolaou's “Art Centers and Peripheral Art” (1982)

ARTMargins ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 112-118
Author(s):  
Terry Smith
Keyword(s):  
The United States ◽  
Political Art ◽  
Book Art ◽  
Hard Edge ◽  
War Of Independence ◽  
History Of ◽  
The 1960S ◽  
The Impact ◽  
First Time

Change in the history of art has many causes, but one often overlooked by art historical institutions is the complex, unequal set of relationships that subsist between art centers and peripheries. These take many forms, from powerful penetration of peripheral art by the subjects, styles and modes of the relevant center, through accommodation to this penetration to various degrees and kinds of resistance to it. Mapping these relationships should be a major task for art historians, especially those committed to tracing the reception of works of art and the dissemination of ideas about art. This lecture, delivered by Nicos Hadjinicolaou in 1982, outlines a “political art geography” approach to these challenges, and demonstrates it by exploring four settings: the commissioning of paintings commemorating key battles during the Greek War of Independence; the changes in Diego Rivera's style on his return to Mexico from Paris in the 1920s; the impact on certain Mexican artists in the 1960s of “hard edge” painting from the United States; and the differences between Socialist Realism in Moscow and in the Soviet Republics of Asia during the mid-twentieth century. The lecture is here translated into English for the first time and is introduced by Terry Smith, who relates it to its author's long-term art historical quest, as previously pursued in his book Art History and Class Struggle (1973).

Social Security

2012 ◽  
Author(s):  
Larry DeWitt ◽  
Edward D. Berkowitz
Keyword(s):  
United States ◽  
Social Security ◽  
Older People ◽  
Age Groups ◽  
The United States ◽  
Critical Question ◽  
Term Survival ◽  
History Of ◽  
Government Benefits

This chapter considers the history of Social Security, arguing that the 1950 amendments represented the fundamental adjustment that allowed the program’s long-term survival. It analyzes current issues in Social Security related to gender, race, and the program’s long-term solvency. It concludes that Social Security has legitimized the receipt of government benefits among many Americans and changed the nature of old age in the United States by providing older people with a guaranteed means of support. A large and costly program, Social Security has evolved into the United States’ major antipoverty program. Nonetheless it faces the criticism of those who argue that it favors older people over other age groups and that it represents an inefficient form of government coercion. Whether the program will be sustained in the future or modified in a significant way remains a critical question.

Leiomyosarcoma of the Foot

2007 ◽  
Vol 97 (6) ◽  
pp. 475-479 ◽  
Author(s):  
Erin Engel ◽  
Michael Butler ◽  
Joseph Anain
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Malignant Tumor ◽  
Clinical Presentation ◽  
Spindle Cell ◽  
Pyogenic Granuloma ◽  
The United States ◽  
Spindle Cell Sarcoma ◽  
Cell Sarcoma ◽  
History Of

Leiomyosarcoma is a very rare malignant tumor, with only 28 new cases diagnosed in the United States each year. The prognosis varies, with average 5-year survival of 65%. Although most leiomyosarcomas occur in the lower extremity, there is a paucity in the literature on these sarcomas in the foot. Only 15 cases of leiomyosarcoma in the foot have been reported in the literature since the mid-1930s. We describe a 31-year-old man with a history of an ingrown toenail and nonhealing pyogenic granuloma. His clinical presentation suggested atypical tissue. Biopsy findings confirmed the diagnosis of spindle cell sarcoma, specifically, leiomyosarcoma. The patient was treated with amputation of the affected hallux and adjuvant therapy. The similar presentations of a pyogenic granuloma and a malignant tumor necessitate a thorough differential diagnosis with even common foot ailments. (J Am Podiatr Med Assoc 97(6): 475–479, 2007)

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