1/5. Living with lyme disease.The occurrence of lyme disease is rising steadily in the united states. The majority of health care providers are unfamiliar with this complex syndrome. nurses lack accurate clinical information to provide comprehensive nursing care to these patients. The progression of lyme disease is addressed through three stages. Untreated or poorly managed, lyme disease may become a chronic, debilitating illness. The author's personal story is interwoven and serves to highlight the pathophysiology of the disease and the emotional and physical costs to the patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Gonarthritis in the course of lyme disease in a one-and-a-half-year-old child.A case of a one-and-a-half-year-old girl is reported in whom gonarthritis in the course of lyme disease was diagnosed. The girl was brought up in an urban environment. She never was in a forest and had no contact with animals (except for a healthy pet-dog, which was under veterinary supervision). She did not attend a nursery, and went for walks only within urban area under the careful guidance of her parents. In spite of the negative family history the level of antibodies against borrelia burgdorferi was estimated. A very high level of IgG antibodies and a low level of IgM borrelia burgdorferi antibodies, accompanied by physical symptoms allowed to diagnose the second stage of lyme disease. We considered the described case as worth presentation due to the child's very early age. Moreover, the infection was caused supposedly due to the contact with a dog (which may be unusual carrier of ticks), and not--as in most cases--in a forest.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Transverse myelitis secondary to coexistent lyme disease and babesiosis.OBJECTIVE: To describe transverse myelitis secondary to coexistent lyme disease and babesiosis. METHOD: Case report. BACKGROUND: A 74-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier. FINDINGS: T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T12. Western blot and enzyme-linked immunosorbent assay identified infection with borrelia burgdorferi, the spirochete responsible for lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T4 paraplegia by 2 months. CONCLUSION: The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to lyme disease and babesiosis. The severity and permanence of this patient's deficits were greater than those reported in the majority of previous cases of transverse myelitis due to lyme disease alone, suggesting a possible role for coinfection with babesiosis.- - - - - - - - - - ranking = 7.4426083664968keywords = physical examination, physical (Clic here for more details about this article) |
4/5. 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 = 7.4426083664968keywords = physical examination, physical (Clic here for more details about this article) |
5/5. lyme disease. A cause of bilateral facial paralysis.Recently we had the opportunity of treating a boy from the northeastern region of the united states in whom bilateral facial palsies developed. After obtaining a detailed history and performing a thorough physical examination, the findings suggested lyme disease. We herein discuss our evaluation and treatment of this child as well as review the otolaryngologic manifestations of this rare disease.- - - - - - - - - - ranking = 7.4426083664968keywords = physical examination, physical (Clic here for more details about this article) |