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  Clinical manifestations of Lyme disease

Clinical manifestations of Lyme disease:

Lyme disease takes place in phases with remissions and exacerbation and distinct clinical manifestations at various phases.

STAGE 1:

Erythema Migrans (Em):

After an incubation period of 3 to 32 days, EM takes place at the site of the tick bite. It starts as a red macule or papule which expands to form a large annular lesion. Generally it has a bright red outer border and partial central clearing. As the Ixodid ticks are little, many patients do not keep in mind the preceding bite. Lesions can be situated anywhere. Usually they are generally seen in the groin, thigh, and axilla. Lesion is warm however not frequently painful. Spirochetes might be present in the local site or they spread hematogenously via out the body. EM patients might develop secondary annular skin lesions. Dermal symptoms might accompany others like severe headache, fever chills, mild neck stiffness, migratory musculo skeletal pain arthralgia malaise and fatigue. Less general manifestations seen are generalized lymphadenopathy, spleenomegaly hepatitis, sore throat non-productive cough conjunctivitis, and testicular swelling. Fatigue and lethargy last for numerous months. Others might disappear within numerous weeks.

STAGE 2:

Neurological Symptoms:

Symptoms suggestive of meningeal irritation might take place in early Lyme disease whenever EM is present. After numerous weeks to months around 15 percent of the patients build up frank neurological abnormalities. These comprise meningitis, cranial neuritis, subtle encephalitic signs, bilateral facial palsy, chorea or myelitis alone or in different combinations. CSF shows lymphocytic pleocytosis (i.e., l00 cells/ìl), elevated proteins, normal or slightly low glucose. Such symptoms might resolve in months. Chronic symptoms might take place later.

Cardiac Involvement:

Within numerous weeks after the onset of illness, around 8 percent of patients build up cardiac symptoms. Most general abnormality was atrioventncular block. Rare cardiac symptoms are cardiomegaly, pancarditis. Cardiac symptoms might last for few weeks however might recur. Musculoskeletal symptoms might also be observed commonly during this stage. Migratory pain in joints, bursae, tendons, muscle or bone is the symptoms present.


STAGE 3:

Arthritis:

Within weeks to 2 years subsequent to the onset of infection 80 percent of untreated patients build up joint symptoms. They comprise subjective joint pains, intermittent attack of arthritis to chronic erosive synovitis. The typical pattern is oligoarticular arthritis in big joints like knee joints. Symptoms last for weeks to months. Small joints and periarticular sites might also be included. Recurrence might last for many years. Chronic arthritis might lead to erosion of cartilage and bone.

 

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