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Lyme disease - chronic persistent

Definition

Chronic persistent Lyme disease is a late stage of an inflammatory disease caused by Borrelia burgdorferi bacteria. It is also called Stage 3, or tertiary, Lyme disease.

See also:

Alternative Names

Tertiary Lyme disease; Stage 3 Lyme disease; Late persistent Lyme disease; Lyme arthritis

Causes, incidence, and risk factors

Lyme disease is transmitted by the bite of a deer tick.

Some people may not be treated for Lyme disease because they do not have any symptoms or their symptoms are mild. Chronic persistent Lyme disease may develop months or even years after the Lyme disease infection.

Even people who were treated may develop chronic persistent Lyme disease.

Symptoms

Chronic persistent Lyme disease can affect the skin, brain, and nervous system, and muscles, bones, and cartilage.

Symptoms include:

Other symptoms that may occur with this disease:

Signs and tests

A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most common one used is the ELISA for Lyme disease test. A Western blot test is done to confirm ELISA results.

A spinal tap will be abnormal if you have central nervous system symptoms from the disease.

Treatment

Antibiotics are given to fight the infection. Medications sometimes need to be given through a vein (intravenously).

Chronic persistent Lyme disease is treated for up to 28 days with antibiotics. If arthritis symptoms do not go away, a second 2 - 4 week course of antibiotics may sometimes be used. Antibiotics given by mouth (doxycycline, amoxicillin, or cefuroxime) are used most of the time.

People with severe Lyme disease that affects the nervous system may receive 2 - 4 weeks of the antibiotic ceftriaxone through a vein (by IV).

Treating patients for longer periods of time is generally not thought to be helpful, even if symptoms do not go away.

Expectations (prognosis)

Arthritis symptoms may not get better with treatment. Other symptoms should improve with treatment.

Rarely, a person will continue to have symptoms that can sometimes interfere with daily life or activities. Some people call this post-Lyme disease syndrome. There is no effective treatment for people with these symptoms.

Complications

  • Arthritis symptoms may continue
  • Heart problems (slow heart rate, and effects on the electrical system of the heart)

Calling your health care provider

Call your health care provider if you develop symptoms, especially if you have had Lyme disease before, or live or travel in high-risk areas.

Prevention

Early diagnosis and appropriate antibiotic treatment for primary Lyme disease is the most effective way to prevent tertiary Lyme disease.

Here are some tips for preventing primary Lyme disease:

When walking or hiking in wooded or grassy areas:

  • Spray all exposed skin and your clothing with insect repellent (spray outdoors only, do not use on face, use just enough to cover all other exposed skin, don't spray under clothing, don't apply over wounds or irritated skin, wash skin after going inside)
  • Wear light-colored clothing to make it easier to spot ticks
  • Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks
  • Wear high boots, preferably rubber

Check yourself and your pets frequently during and after your walk or hike.

Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp.

If possible, ask someone to help you examine your body for ticks. Adults should carefully examine children.

References

Bratton RL, Whiteside JW, Hoyan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83:566-571.

Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 242.


Review Date: 2/23/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; andJatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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