Sunday, July 5, 2020

Diagnosing Lyme disease in the absence of classic symptoms

New studies show unusual presentations of Lyme disease in people. At least three articles are presented with a 37-year-old man having fatal Lyme carditis, a 56-year old woman with abnormal skin lesions and heart complications, and a 4-year-old boy with neurological symptoms. These are now presenting as challenges as it is becoming increasingly difficult for physicians to diagnose the disease. The particular case of the 37-year-old man illustrates the real challenge behind diagnosing the disease in the absence of classic symptoms.

The man was initially presented for fever, nasal congestion, sore throat, and joint pains. He had reportedly known to have lesions on his chest, which he thought he picked up during picking raspberries, which later faded over a week. He also recalled having tick exposure but did not remember from removing an engorged one. Weeks later, he was rushed with palpitations of heart, difficulty in breathing, and chest discomfort as symptoms. The ECG results showed a complete heart block, so physicians narrowed down their diagnosis to Lyme carditis.

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While treated for Lyme carditis, his conditions worsened, and physicians were unable to treat his conditions. Unfortunately, he died, but serology and autopsy confirmed the Lyme carditis is the cause of his death. Usually, the serologic analysis will take time, so doctors immediately proceed with antibiotics after the ECG performed. Although uncommon, serious heart-related abnormalities do occur in small groups in Lyme disease. The common features like the bulls-eye rash are said to be a common feature; this is not occurring in all patients. This is presenting a challenge for physicians to treat and combat the disease.

The disease

Lyme disease is a disease caused by a spirochete Borrelia burgdorferi, and ticks of genus Ixodes act as a vector for the disease. While initially thought to exist in the Northeastern part of the US, this disease has spread far across the country, even entering into Canada. Rising temperatures, exposure to tick population, and change in animal hosts are becoming the possible cause of changes in Lyme disease. Lyme carditis is occurring in 3-4 percent of patients while literature is estimating the manifestation can go up to 10 percent. With sudden cardiac arrest also occurring in patients and varying epidemiology, the future of combating the disease is expected to change in the coming days.

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Source: News-Medical, CMAJ

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