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Harrison's Principles of Internal Medicine, 18e
| Part 8. Infectious Diseases > Section 9. Spirochetal Diseases > |
Chapter 173. Lyme Borreliosis
Sections: Lyme Borreliosis: Introduction, Further Readings.
Topics Discussed: lyme disease.
Excerpt:"Lyme borreliosis is caused by a spirochete, Borrelia burgdorferisensu lato, that is transmitted by ticks of the Ixodes ricinus complex. The infection usually begins with a characteristic expanding skin lesion, erythema migrans (EM; stage 1, localized infection). After several days or weeks, the spirochete may spread to many different sites (stage 2, disseminated infection). Possible manifestations of disseminated infection include secondary annular skin lesions, meningitis, cranial neuritis, radiculoneuritis, peripheral neuritis, carditis, atrioventricular nodal block, or migratory musculoskeletal pain. Months or years later (usually after periods of latent infection), intermittent or persistent arthritis, chronic encephalopathy or polyneuropathy, or acrodermatitis may develop (stage 3, persistent infection). Most patients experience early symptoms of the illness during the summer, but the infection may not become symptomatic until it progresses to stage 2 or 3.Because of the small size of nymphal ixodid ticks, most patients do not remember the preceding tick bite. After an incubation period of 3–32 days, EM, which occurs at the site of the tick bite, usually begins as a red macule or papule that expands slowly to form a large annular lesion..."
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