1/9. lyme disease in childhood: report of one case.We report a pediatric patient of lyme disease in taiwan, confirmed by laboratory tests. An 8-year-old overseas Chinese girl from new jersey, USA, visited our dermatological clinic with joint pain and multiple expanding annular erythema rashes (measured up to 17x10 cm) for three days. lyme disease was diagnosed by the presence of the antibody against borrelia burgdorferi. The skin lesions and arthralgia were resolved after amoxicillin treatment, and she got well in the following one year. This presented work tries to remind physicians to be aware of lyme disease in taiwan, particularly for children or young people with recurrent expanding annular skin rashes and chronic arthralgia of undetermined causes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Acute onset of facial nerve palsy associated with lyme disease in a 6 year-old child.Pediatric facial nerve palsy (FNP) can result from a variety of etiologies including lyme disease, varicella, primary gingivostomatitis, herpes zoster oticus (Ramsay Hunt syndrome), coxsackievirus, trauma, otitis media, hiv, diseases causing tumors or demyelinations, compressions, and possibly Epstein Barr virus. lyme disease has been implicated as the cause of over 50% of the FNPs in children. The paralysis of the facial nerve disturbs motor function to the muscles of facial expression and results in a flaccid appearance of the face (unilateral or bilateral). This case report derails undiagnosed lyme disease presenting as a facial palsy in a 6 year, 5 month-old white female. The palsy was recognized and consultation with the child's physician prompted definitive diagnosis and treatment. A review of the literature and the implications of facial nerve palsy are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Emergency department presentations of transverse myelitis: two case reports.Transverse myelitis, a diagnosis that may be made in the emergency department (ED) by emergency physicians, can be difficult to diagnose because of its variable signs and symptoms and its poorly understood pathogenesis. In this article, we recount 2 cases of transverse myelitis to demonstrate its presentation, diagnosis, and management in the ED.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. life-threatening complications of empiric ceftriaxone therapy for 'seronegative lyme disease'.lyme disease, now the most common tick-borne illness in the united states, has recently received much media attention, due in part to its potentially serious sequelae in untreated patients. Because a rare patient with late illness may lack antibodies to the etiologic agent, borrelia burgdorferi, physicians may be tempted to give empiric antibiotics for illnesses that may not be lyme disease. We have described a patient who, despite negative laboratory evidence for late lyme disease, was treated for 3 weeks with intravenous ceftriaxone and sustained serious complications, including granulocytopenia, fever, hepatitis, and clostridium difficile-associated diarrhea. We caution physicians to weight carefully the risks of empiric treatment for ill-defined medical problems, and to recognize the hazards of even "safe" medications.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/9. Non-lyme disease.Four syndromes of non-lyme disease are described on the basis of the history and serologic test result. Recognition of non-lyme disease enables the physician to avoid unnecessary treatment and to keep considering the possibility of alternative diagnoses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Neuro-ocular Lyme borreliosis.Any patient who has a Bell's palsy (unilateral or bilateral), aseptic meningitis, chronic fatigue syndrome, atypical radiculoneuropathy, presenile dementia, atypical myopathy, or symptoms of atypical rheumatoid arthritis should be asked specifically about the following: visits to highly endemic areas, any known tick bites, any skin lesion suggestive of erythema migrans, any history of palpitations or of prior Bell's palsy, aching in joints (especially the knees), paresthesias, chronic fatigue and depression, forgetfulness, and eye problems. Any patient showing a chronic iritis with posterior synechiae, vitritis in one or both eyes, an atypical pars planitis-like syndrome, big blind spot syndrome, and swollen or hyperemic optic discs should be asked the same questions. The physician should send one red-top tube of blood containing 2 to 3 ml serum to microbiology Reference Laboratory, 10703 Progress Way, Cypress, CA 90630-4714, requesting a Lyme/treponemal panel. For $90 the patient will receive an RPR test with titer, serum FTA-ABS test, serum Lyme IFA IgG and IgM, and a serum Lyme ELISA test. If these tests are within normal limits and the physician is still suspicious, a Western blot can be ordered on serum. A green top tube with fresh white blood cells sent out by overnight express on a Monday or Tuesday will produce a Lyme PCR and a lymphocyte stimulation test. Finally, R.K. Porschen, director of MRL Laboratory, will provide information on the urine antigen test on an investigational basis. A careful history with emphasis on the specific questions noted above, a complete neuro-ophthalmological and physical examination ruling out other causative problems, and the laboratory studies here discussed will usually provide sufficient data to choose therapy. Much further active research into Lyme borreliosis is an important priority in medicine.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/9. lyme disease misdiagnosed as a temporomandibular joint disorder.craniomandibular disorders cause many pleomorphic and seemingly unrelated clinical manifestations that mimic other more serious medical problems and thus can present physicians and dentists with a challenge that invites misdiagnosis and improper treatment planning. Conversely, misdiagnosis and ineffective treatment planning are facilitated when serious medical problems manifest a range of signs and symptoms that are clinically similar to temporomandibular joint muscle dysfunction. At times, the patient's response to therapy may be the best method of corroborating a diagnosis, as illustrated in this report of a patient with lyme disease that was misdiagnosed as a temporomandibular joint disorder. lyme disease has already reached epidemic proportions in several parts of the united states and its geographic distribution is spreading. Because lyme disease is a life-threatening illness whose clinical manifestations can mimic temporomandibular joint/myofascial pain-dysfunction, it is the responsibility of every dentist who treats craniomandibular disorders to become familiar with the clinical presentations of lyme disease and more proficient in its differential diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. lyme disease acquired in europe and presenting in CONUS.lyme disease is recognized in many parts of the world, including large areas of north america, europe, asia and australia. diagnosis and treatment of the disease is essential to avoid the debilitating and potentially life-threatening long-term effects of the infection; however, many physicians may not be aware of the international scope of the disease. This is particularly important for military physicians whose patients may visit or live in endemic areas and whose activities may bring them in contact with the organism. We report here the case of a soldier with near-fatal Lyme carditis acquired in europe and presenting in massachusetts.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/9. Early lyme disease: a flu-like illness without erythema migrans.The existence of a form of early lyme disease characterized by a flu-like illness without erythema migrans is controversial. To confirm the existence and define the clinical characteristics of the flu-like illness without erythema migrans of localized lyme disease, the authors studied patients from a lyme disease endemic area of connecticut who visited their primary care physicians with an undefined flu-like illness. patients kept a diary of their symptoms. Acute and convalescent sera were obtained. The diagnosis of lyme disease was based on the appearance of IgM or IgG antibodies to borrelia burgdorferi as demonstrated by both enzyme-linked immunosorbent assay and immunoblot assay. Twenty-four untreated patients were studied. In five patients acute serologic evidence of lyme disease developed. The flu-like illness in these five patients was characterized by fever and fatigue and resolved spontaneously in 5 to 21 days. Symptoms recurred in three of these five patients. The existence of a flu-like illness without erythema migrans of early lyme disease has been clearly established. Prospective, controlled studies are needed to better define its incidence, characteristics, and prognosis so that appropriate diagnostic and therapeutic strategies can be developed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |