clinical report on a patient with lyme diease

by Valentine Reinger 9 min read

Report of Findings of a Clinical Case on Lyme Disease

7 hours ago  · At 12 months, only 2.2% of Lyme disease patients reported new or increased symptoms, and in none of the patients were the symptoms disabling. These findings are similar to those of a study done in the US involving patients with and without Lyme disease from 1984 to 1991 . The frequency of new symptoms and increased difficulties with daily activities were … >> Go To The Portal


The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a "bull's eye rash", fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms.

Full Answer

What are the symptoms of Lyme disease?

The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a “bull’s eye rash”, fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms.

Is there a guide for interpreting Lyme disease serologic test results?

APHL Guidance and Interpretation of Lyme Disease Serologic Test Results This report describes the proper interpretation of serologic testing for B. burgdorferi and identifies best practices for reporting results to clinicians, public health agencies, and patients.

Can I participate in a Lyme disease research study?

If you suspect that you have Lyme disease, you may be eligible to participate in one of the research studies currently underway at the National Institutes of Health (NIH) in Bethesda, Maryland. The studies offer evaluation, therapy, and follow up to patients with Lyme disease in hopes of learning more about the infection.

Is “chronic Lyme disease” a valid diagnosis?

Chronic Lyme disease is not a valid diagnosis. In this case, some of the patient’s subjective complaints may be compatible with late Lyme disease, but it is unlikely that Lyme disease is the cause of her symptoms. She lacks objective clinical findings and a history of tick exposure.

What is the clinical presentation of Lyme disease?

Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.

What is the most common clinical manifestation in patients with Lyme disease?

The most common manifestation oflate Lyme disease is Lyme arthritis. Early manifestations (and usually also late manifestations) of Lyme disease can be treated successfully by application of suitable antibacterial agents.

What is the best clinical marker of Lyme disease?

Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis.

Is Lyme a clinical diagnosis?

Diagnosis of Lyme disease is made through a clinical decision making process that includes a medical history, physical exam, review of past diagnostic tests and consultations, and results from newly ordered tests.

What are the complications of Lyme disease?

ComplicationsChronic joint inflammation (Lyme arthritis), particularly of the knee.Neurological symptoms, such as facial palsy and neuropathy.Cognitive defects, such as impaired memory.Heart rhythm irregularities.

What are neurological symptoms of Lyme disease?

What are the symptoms? Neurological complications most often occur in early disseminated Lyme disease, with numbness, pain, weakness, facial palsy/droop (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache.

What labs are abnormal with Lyme disease?

A positive ELISA result is abnormal. This means antibodies were seen in your blood sample. But, this does not confirm a diagnosis of Lyme disease. A positive ELISA result must be followed up with a Western blot test.

What are the 3 stages of Lyme disease?

There are three stages of Lyme disease.Stage 1 is called early localized Lyme disease. The bacteria have not yet spread throughout the body.Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.Stage 3 is called late disseminated Lyme disease.

How do doctors check for Lyme disease?

ELISA (enzyme-linked immunosorbent assay) test. Once Borrelia burgdorferi gets into your blood, your body begins to make special proteins called antibodies to fight it off. The ELISA test checks for those antibodies. Although it's the most common way to check for Lyme disease, the ELISA test isn't perfect.

Can Lyme disease cause neurological problems?

Neurological complications most often occur in the second stage of Lyme disease, with numbness, pain, weakness, Bell's palsy (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache.

When do Lyme disease symptoms start?

Symptoms of Lyme disease usually start 3 to 30 days after the tick bite. One of the earliest signs of the disease is a bull's-eye rash. The rash occurs at the site of the tick bite, usually, but not always, as a central red spot surrounded by a clear spot with an area of redness at the edge.

What is normal range for Lyme disease?

Reference Range Borrelia burgdorferi antibody enzyme immunoassay (Lyme index value) : < 0.9 = negative. 0.91-1.09 = equivocal. >1.1 = positive.

Tools for the Clinic

Tickborne Diseases of the United States: A Reference Manual for Health Care Providers, Fifth Edition (2018).

Continuing Education

This report describes the proper interpretation of serologic testing for B. burgdorferi and identifies best practices for reporting results to clinicians, public health agencies, and patients.

Videos

PCR for Diagnosis of Lyme Disease: Is It Useful? An update on testing for Lyme disease is provided in this commentary from the CDC.

Understanding pre-test probability

The illustration depicts the likelihood of false positive and false negative test results based on the prior probability of a disease occurring in a given population. Clinicians should consider the likelihood of disease before performing laboratory testing. The likelihood that a patient has a disease depends on many factors:

Additional Reading

Halperin JJ, Baker P, Wormser GP. Common misconceptions about Lyme disease. external icon Am J Med 2013;126 (3):264.

Ongoing Research

ClinicalTrials.gov external icon Studies of Lyme disease / “ Borrelia Infections”.

What is the treatment for erythema migrans?

Individuals with diagnosed erythema migrans should be treated with doxycycline, amoxicillin, or cefuroxime axetil.

What antibiotics are used for lyme disease?

Individuals with acute neurological manifestations of Lyme disease should be treated with intravenous ceftriaxone, cefotaxime, penicillin G, or oral doxycycline. Decisions about the choice of antibiotic, including the route of administration, should be based on an individual’s clinical history and preferences.

Who endorses the 2020 guidelines for lyme disease?

(Endorsed, July 2020) The “2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease” was developed by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) and endorsed by the American Academy of Family Physicians prior to publication.

What is the clinical diagnosis of lyme disease?

The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a "bull's eye rash", fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms.

Why is it important to know where Borrelia is endemic?

Knowing the regions where <i>Borrelia</i> infection is endemic in North America is important for recognizing patients at risk and informing the need for treatment. Clinicians need to be aware of the signs and symptoms of Lyme disease.

Is lyme disease a subacute disease?

Late Lyme disease in North America typically manifests with oligoarticular arthritis but can present with a subacute encephalopathy. Antibiotic treatment is effective against Lyme disease and works best when given early in the infection. Prophylaxis with doxycyline may be indicated in certain circumstances.

What ticks are associated with lyme disease?

The western blacklegged tick, Ixodes pacificus, has been shown to transmit Borrelia burgdorferi, the agent of Lyme disease. The western blacklegged tick, Ixodes pacificus, has been shown to transmit Borrelia burgdorferi, the agent of Lyme disease. Do you have Lyme disease? Warm weather brings outdoor fun and also the risk of tick bites, ...

Why is my lyme disease rash red?

Warm weather brings outdoor fun and also the risk of tick bites, which can cause Lyme disease. The Lyme disease rash is usually round or oval and gradually expands. It may be all red or have a bull’s-eye appearance. If untreated, the infection may spread to other parts of the body and cause other problems, including paralysis of the face ...

How to contact Lyme Disease?

For more information about the studies you may click on the links, call 1-800-411-1222, or email lymedxstudies@niaid.nih.gov. If you suspect that you have Lyme disease or have been recently diagnosed, you may be eligible to participate in this research study. Participation in the study offers an evaluation, therapy, ...

Can Borrelia burgdorferi be detected?

This NIH study is seeking volunteers to determine whether Borrelia burgdorferi can be detected in people who have Lyme disease or who have a history of Lyme disease and have received antibiotic therapy. Borrelia burgdorferi is the bacteria that causes Lyme disease. Most cases of Lyme disease are cured by antibiotics, ...

Can lyme disease be cured?

Most cases of Lyme disease are cured by antibiotics, but some people continue to experience symptoms despite the absence of detectable Lyme bacteria. This study uses a process known as xenodiagnoses, where clean laboratory-bred ticks are used to find Lyme disease bacteria in patients.

Can you participate in a Lyme disease study?

If you suspect that you have Lyme disease or have been recently diagnosed, you may be eligible to participate in this research study . Participation in the study offers an evaluation, therapy, and follow-up to patients with Lyme disease in hopes of learning more about the infection.

Where are the NIH clinical studies located?

Basic Facts About the Studies. The studies are located in the Clinical Center on the NIH campus in Bethesda, Maryland. Some travel costs may be covered. There is no cost for study-related medical care or medicines. People can be referred to a clinical trial by their personal physicians, or they can refer themselves.

Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not?

There is considerable uncertainty regarding treatment of Lyme disease patients who do not respond fully to initial short-term antibiotic therapy. Choosing the best treatment approach and duration remains challenging because treatment response among these patients varies: some patients improve with treatment while others do not.

Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey

Lyme disease is a rapidly growing illness that remains poorly understood within the medical community. Critical questions about when and why patients respond to treatment or stay ill, what kinds of treatments are effective, and even how to properly diagnose the disease remain largely unanswered.

Chinese Medical Theory

  • Despite Borrelia burgdorferi’s recent classification from Lyme and Old Lyme, Connecticut 1975, as the bacterium causing the disease, ticks, and Lyme disease has been around for thousands of years (Lyme Disease Facts and Statistics, 2020). The concept of a pathogen that can penetrate t…
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Treatment Plans

  • The clinical case study presented here is a patient who suffered with LD years ago, and still struggles with recurring symptoms to this day despite treatment with rounds of antibiotics years ago. Patient S.M. is a 44-year-old female who is currently suffering from fatigue, anxiety, and whole body musculoskeletal pain She is 5’2”, 104 pounds, and after her initial Lyme diagnosis in …
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Treatment #1: Acupuncture Points and Rationale (Bilateral)

  • GB 34 – soothe the LV qi and tonify tendon and sinews SP 21 – Great Luo – whole body pain PC 6 – Luo – harmonizes the qi and blood in whole body Ren 17 – Mu of PC – descends qi in chest – helps lessen anxiety LV 3/LI 4 – 4 Gates – regulates the LV and spreads qi to stop whole body pain SP 6 – Luo – tonify 3 yin meridians ST 36 with needlehead moxa – tonify qi in body for fatig…
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Treatment #2: Acupuncture Points and Rationale(All bilateral)

  • LI 11 – draining technique – clear heat LI 4 – draining technique – Master command point for pain UB 43 and UB 13 – garlic moxibustion – Back Shu of LU – tonify back UB 23 and DU 4 – tonify KD and alleviate back pain PC 8 – clear heat to help with anxiety DU 16 – calm spirit and to eliminate sweating, headache and heaviness in body SJ 5 and PC 6 – strongly move qi to allevia…
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Alternative Approaches to Treating Lyme Disease

  • There are alternative and new approaches that are available in treating LD. According to Lymedisease.org (2020), Professor Tim Haystead and a team of researchers from Duke University are currently working on identifying B.burgdorferi infection using a “small molecule imaging probe” similar to imaging techniques. They are working on developing targeted therapy compara…
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Biomedical Considerations

  • There are a few newly identified biomedical markers to measure progress for LD, according to Professor Mark Soloski of Johns Hopkins University, who presented research being done at the JHU Lyme Disease Research Center (Lymedisease.org, 2020). The research center has been conducting a years-long “Study of Lyme disease Immunology and Clinical Events (SLICE)” on a s…
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Community Resources

  • There are many useful community resources at www.lymedisease.org(2020). The website focuses on providing free resources for both members and non-members. For an additional cost, the website grants members access to a multitude of research and informative articles. It features resources regarding LD prevention, a patient resource guide to tick testing, symptoms o…
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Prognosis

  • According to Flaws and Sionneau (2011), most patients respond to appropriate therapy with prompt resolution of symptoms within 4 weeks—if treated and diagnosed within the short and proper timeframe. Prolonged courses of antibiotic therapy for nonspecific symptoms that persist after completion of appropriate assessment and treatment of LD are not recommended (Palmiei…
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Summary of Key Learnings

  • Lyme disease is a single infection that can turn into a lifetime of debilitating pain. Over the years we have discovered that this one-time event can have longstanding effects on the body in the form of arthritis and joint pain, degeneration of the muscles, spine, and brain, and even heart conditions. Over the course of my research for this project, I found that there are options and ma…
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