Lyme Disease

1994 ◽  
Vol 15 (5) ◽  
pp. 167-173
Author(s):  
Robert S. Baltimore ◽  
Eugene D. Shapiro
Keyword(s):  
Lyme Disease ◽  
Lyme Borreliosis ◽  
Clinical Manifestations ◽  
Systemic Infection ◽  
The United States ◽  
Lyme Arthritis ◽  
Medical Attention ◽  
The Us ◽  
Ixodes Ticks ◽  
The Common

Introduction and Definitions Lyme borreliosis (Lyme disease) is a systemic infection caused by a spirochete, Borrelia burgdoferi. It is the most common vector-borne disease in the United States. Lyme disease was first described in Lyme, Connecticut (hence its name), where a cluster of children who had unexplained arthritis first were brought to medical attention by one of their parents. Investigation of this "epidemic" of arthritis led to the description of Lyme arthritis and ultimately to the discovery of its bacterial etiology. The clinical manifestations of Lyme borreliosis are protean; this, coupled with the practical difficulties of confirming the diagnosis in many patients, has led to many misconceptions about Lyme disease. Indeed, there is much we do not know about the disease, which was only recognized in the US as a distinct entity slightly more than 15 years ago, and the cause of which was first identified only about 10 years ago. Epidemiology ECOLOGY AND TRANSMISSION Borrelia burgdorferi is transmitted by ticks of the Ixodid species. In the US, the common vectors are Ixodes dammini (the deer tick), reported to be the same species as I scapularis, in the Northeast and the Midwest and I pacificus (the western black-legged tick) on the Pacific Coast. Ixodes ticks are much smaller than the common wood tick; the nymphal Ixodes tick is about the size of a pencil point (1 to 2 mm).

scholarly journals Diagnosis of Lyme Borreliosis

2005 ◽  
Vol 18 (3) ◽  
pp. 484-509 ◽  
Author(s):  
Maria E. Aguero-Rosenfeld ◽  
Guiqing Wang ◽  
Ira Schwartz ◽  
Gary P. Wormser
Keyword(s):  
Synovial Fluid ◽  
Clinical Diagnosis ◽  
Lyme Borreliosis ◽  
Detection Threshold ◽  
Clinical Manifestations ◽  
The United States ◽  
Lyme Arthritis ◽  
Confirmatory Test ◽  
Culture Methods ◽  
Immunodominant Antigens

SUMMARY A large amount of knowledge has been acquired since the original descriptions of Lyme borreliosis (LB) and of its causative agent, Borrelia burgdorferi sensu stricto. The complexity of the organism and the variations in the clinical manifestations of LB caused by the different B. burgdorferi sensu lato species were not then anticipated. Considerable improvement has been achieved in detection of B. burgdorferi sensu lato by culture, particularly of blood specimens during early stages of disease. Culturing plasma and increasing the volume of material cultured have accomplished this. Further improvements might be obtained if molecular methods are used for detection of growth in culture and if culture methods are automated. Unfortunately, culture is insensitive in extracutaneous manifestations of LB. PCR and culture have high sensitivity on skin samples of patients with EM whose diagnosis is based mostly on clinical recognition of the lesion. PCR on material obtained from extracutaneous sites is in general of low sensitivity, with the exception of synovial fluid. PCR on synovial fluid has shown a sensitivity of up to >90% (when using four different primer sets) in patients with untreated or partially treated Lyme arthritis, making it a helpful confirmatory test in these patients. Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato. Tests used to detect antibodies to B. burgdorferi sensu lato have evolved from the initial formats as more knowledge on the immunodominant antigens has been collected. The recommendation for two-tier testing was an attempt to standardize testing and improve specificity in the United States. First-tier assays using whole-cell sonicates of B. burgdorferi sensu lato need to be standardized in terms of antigen composition and detection threshold of specific immunoglobulin classes. The search for improved serologic tests has stimulated the development of recombinant protein antigens and the synthesis of specific peptides from immunodominant antigens. The use of these materials alone or in combination as the source of antigen in a single-tier immunoassay may someday replace the currently recommended two-tier testing strategy. Evaluation of these assays is currently being done, and there is evidence that certain of these antigens may be broadly cross-reactive with the B. burgdorferi sensu lato species causing LB in Europe.

Progressive Catholicism in the United States

2018 ◽  
Author(s):  
Matthew A. Shadle
Keyword(s):  
Common Good ◽  
The United States ◽  
Economic Life ◽  
Ethical Framework ◽  
Social Teaching ◽  
American Catholicism ◽  
The Common Good ◽  
The Us ◽  
The Common ◽  
American Society

American Catholicism has long adapted to US liberal institutions. Progressive Catholicism has taken the liberal values of democratic participation and human rights and made them central to its interpretation of Catholic social teaching. This chapter explores in detail the thought of David Hollenbach, S.J., a leading representative of progressive Catholicism. Hollenbach has proposed an ethical framework for an economy aimed at the common good, ensuring that the basic needs of all are met and that all are able to participate in economic life. The chapter also looks at the US Catholic bishops’ 1986 pastoral letter Economic Justice for All, which emphasizes similar themes while also promoting collaboration between the different sectors of American society for the sake of the common good.

Lyme borreliosis

2013 ◽  
pp. 772-777
Author(s):  
Andreas Krause ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Lyme Arthritis ◽  
Symptomatic Therapy ◽  
Positive Serology ◽  
Antibiotic Resistant ◽  
Acrodermatitis Chronica Atrophicans ◽  
Rapid Healing ◽  
The Central Nervous System

Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.

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

Lyme borreliosis

2013 ◽  
Author(s):  
Andreas Krause ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Lyme Arthritis ◽  
Symptomatic Therapy ◽  
Positive Serology ◽  
Antibiotic Resistant ◽  
Acrodermatitis Chronica Atrophicans ◽  
Rapid Healing ◽  
The Central Nervous System

Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.

scholarly journals Seasonality of Acute Lyme Disease in Children

2021 ◽  
Vol 6 (4) ◽  
pp. 196
Author(s):  
Kathryn M. Sundheim ◽  
Michael N. Levas ◽  
Fran Balamuth ◽  
Amy D. Thompson ◽  
Desiree N. Neville ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Regression Models ◽  
Disease Incidence ◽  
Erythema Migrans ◽  
The United States ◽  
Lyme Arthritis ◽  
Cranial Neuropathy ◽  
Acute Arthritis ◽  
Presenting Symptoms ◽  
Fourier Regression

Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.

scholarly journals Germany, the United States, and Future Core Conflict

1995 ◽  
pp. 445-482
Author(s):  
Brigitte Schulz
Keyword(s):  
United States ◽  
Cold War ◽  
World Order ◽  
The United States ◽  
Post Cold War ◽  
New Era ◽  
The Us ◽  
The Common ◽  
Will Power ◽  
The Cold War

With the end of the Cold War, much attention has been paid to the nature of the emerging new world order. By what criteria will power and influence be measured in this new era? Who will be the winners and losers? What types of allegiances will develop? Or is Francis Fukuyama's argument correct that, with the collapse of communism, we have reached the "...endpoint of man's ideological evolution" and thus "the end of history". Unlike Marx, who saw socialism at the end of humanity's arduous journey, Fukuyama tells us that the search is off because we have already arrived at our evolutionary destination: liberal capitalism...Other analysts envision less optimistic scenarios...One of the most popular scenarios over the past few years has been to anticipate growing tensions between the three main core powers: the US, Germany, and Japan... The first task of this paper, then, is to look at Germany within the context of the radically altered post-Cold War period... We argue that Germany, based on a multitude of factors which will be outlined below, is not now, nor will it ever become in the foreseeable future, a global hegemon... Indeed, as will be asserted in the second part of this paper, Germany will enter into a close alliance with the United States to form a reinvigorated trans-Atlantic marriage in which the common bonds of "culture and civilization" will replace a virulent anti-communism as the common vow.

scholarly journals 1200. Healthcare Claims-Based Lyme Disease Case-Finding Algorithms in the United States: A Systematic Literature Review

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S691-S692
Author(s):  
Young Hee Nam ◽  
Sarah J Willis ◽  
Aaron Mendelsohn ◽  
Susan Forrow ◽  
Jeffrey Brown ◽  
...  
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Claims Data ◽  
The United States ◽  
Case Finding ◽  
Diagnosis Codes ◽  
Disease Case ◽  
The Us

Abstract Background Lyme disease (LD) is the fifth most common notifiable disease in the US with 30,000-40,000 LD cases reported annually via public health surveillance. Recent healthcare claims-based studies utilizing case-finding algorithms estimate national LD cases are >10-fold higher than reported by surveillance. The reliability of claims-based data depends on the accuracy of the case-finding algorithms using the information available in the claims primarily generated for the administrative purposes. To assess the true burden of LD, it is imperative to use validated well-performing LD case-finding algorithms (“LD algorithms”). We conducted a systematic literature review to identify LD algorithms based upon healthcare claims data in the US and their respective performance. Methods We searched PubMed and Embase for articles published in English from January 1, 2000 through the most recent date as of February 20, 2021. We selected articles including all of the following search terms: (1) “Lyme disease”; (2) “claim*” or “administrative* data”; and (3) “United States” or “the US*”. We then reviewed the titles, abstracts, and full texts to identify articles describing LD algorithms developed for claims data. Figure 1 shows the flow diagram following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results We found 15 articles meeting the inclusion criteria. Of these, 7 study algorithms used only LD diagnosis codes (ICD-9, 088.81; ICD-10, A69.2 or A69.2x), 4 studies additionally used antibiotic dispensing records, and 4 studies additionally used serologic test order codes (CPT 86617, 86618). Three studies used different algorithms for inpatient and outpatient settings. Only one study (in Tennessee, a low-incidence state for LD) provided validation results for their algorithm, which only used a LD diagnosis code (ICD-9, 088.81), with reported sensitivity=50% and positive predictive value=5%. Conclusion Validation data on the LD algorithms developed for healthcare claims data are limited, and suggest algorithms using only LD diagnosis codes may not perform well. Further validation of high-performance claims-based LD algorithms is critical to inform the true burden of LD overall and within subgroups. Disclosures Bradford D. Gessner, MD, MPH, Pfizer Inc. (Employee) James Stark, PhD, Pfizer Inc. (Employee) Sarah Pugh, PhD, Pfizer Inc. (Employee)

scholarly journals Lyme Borreliosis as Cause of Myocarditis: A Case Report and a Review of the Literature

2021 ◽  
Vol 07 (12) ◽  
Author(s):  
Yousra Serroukh ◽  
Keyword(s):  
Case Report ◽  
Lyme Disease ◽  
Lyme Borreliosis ◽  
Clinical Manifestations ◽  
Left Ventricular ◽  
Review Of The Literature ◽  
Conduction Disorders ◽  
Lyme Carditis ◽  
The Subject ◽  
Cardiac Manifestation

lyme borreliosis (LB) is the most common tick-born disease in the Northern Hemisphere. During early disseminated Lyme disease, cardiac manifestation can occur. including acute conduction disorders, atrioventricular block, acute myopericarditis or left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis. We report a case of a patient with isolated Lyme myocarditis manifested by acute heart failure with atrial fibrillation and review of the literature on the subject. The interested of this case report is to show the need to acquire the reflex to think about a lyme carditis when patients in endemic areas come to attention with cardiovasculair symtoms, even in the absence of others concurerenr clinical manifestations of early lyme disease.

Lyme borreliosis

2011 ◽  
Author(s):  
Sue O’Connell
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
The United States ◽  
Borrelia Burgdorferi Sensu Lato ◽  
Protection Measures ◽  
Stage Disease ◽  
Control And Prevention ◽  
Ixodes Ticks ◽  
Musculoskeletal Systems ◽  
Specific Symptoms

Lyme borreliosis is the most common vector-borne bacterial infection in the temperate northern hemisphere. In the United States of America over 35,000 confirmed or probable cases were reported by state health departments to the Centers for Disease Control and Prevention (CDC) in 2008. It is likely that well over 100,000 cases occur in Europe each year. Lyme borreliosis is caused by several genospecies of Borrelia burgdorferi sensu lato, which are transmitted by ticks of the Ixodes ricinus complex. The infection occurs most commonly in forested, woodland and heathland habitats that support the lifecycles of Ixodes ticks and the small mammals and birds that are reservoir-competent hosts for B burgorferi. The most common presenting feature of Lyme borreliosis is erythema migrans, a slowly spreading rash. The spirochaetes can disseminate through the bloodstream and lymphatics to other organs and tissues and cause later manifestations, most commonly affecting the nervous and musculoskeletal systems. The infection responds to appropriate antibiotic treatment at any stage of disease, with excellent outcomes in most cases, but patients with severe tissue damage from previously untreated late stage disease may recover incompletely. A small proportion of patients can have persistent non-specific symptoms following treatment, without evidence of continuing active infection. This has been termed “post-Lyme syndrome” and appears to be similar to other post-infection syndromes. Prevention relies mainly on personal protection measures against tick bites.

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