The Generalist: Lyme Disease Part 1
Chris Drumm, MD; Heidi James, MD; and Vanessa Cardy, MD
In this 2-parter, Chris Drumm and Heidi tell us (almost!) everything we need to know about Lyme Disease.
- Lyme disease is a tick-borne spirochete infection.
- Borrelia burgdorferi is the most common species in North America.
- Lyme is endemic in northeastern North America, where it is spread by the Ixodes tick.
- There are 3 clinical stages:
- Early localized disease
- Rash - erythema migrans
- Bullseye lesion
- Seen in 80% of cases
- +/- constitutional symptoms
- Usually occurs within 1 month following a tick bite
- Early disseminated disease
- Multiple erythema migrans lesions
- +/- neurologic findings
- Classic triad of meningitis, cranial neuropathy, and sensory radiculoneuropathy
- Bilateral cranial nerve palsies
- +/- cardiac findings
- AV heart block
- Usually occurs weeks to months after tick bite
- Late disease
- Usually monoarthritis
- Can persist or come and go
- Rare neurologic problems
- History of tick bite
- Erythema migrans
- Serologic testing
- Western blot (if ELISA is positive)
- New testing is on the horizon
Saul N. - August 1, 2020 12:53 PM
Thank you for discussing this topic. You mention testing. If a patient presents with meningitis in a Lyme endemic area could you comment on what Lyme specific labs we should be ordering on CSF, and interpretation of CSF lab testing? On whom would you selectively perform a lumbar puncture AND test for Lyme disease if the patient presents with general symptoms of meningitis? Would you obtain CSF if a patient presents with undifferentiated encephalopathy in a Lyme endemic area? Thank you again!
Heidi J., MD - August 4, 2020 5:22 AM
Thanks for your question, Saul. Here's Chris Drumm's reply:
Lyme meningitis presents similarly to viral meningitis. It can be difficult to tell the difference. The presence of cranial neuropathy helps point towards Lyme as the cause. We order a serum Lyme test here for all patients with a CSF looking like viral meningitis. The CSF often has moderately elevated protein and modest pleocytosis. The CSF can be sent for antibodies for Borrelia however the sensitivity is not clear. CSF is sent for cell count, protein and glucose concentrations, gram stain and culture. But my hospital will almost always include a serum Lyme testing and correlate clinically. We do not routinely do CSF antibody testing at this time. We do often include HSV and west Nile though.
I hope you have a tick free summer.