| Disease/Syndrome |
Lyme disease |
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| Category |
Infection, Occupational |
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| Acute/Chronic |
Acute-Moderate |
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| Synonyms |
Lyme borreliosis; Tickborne meningopolyneuritis; Borrelia burgdorferi infection |
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| Biomedical References |
Search PubMed |
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| Comments |
FINDINGS: A red macule or papule (erythema migrans) is the initial finding in 80% of patients. It appears at the site of the tick bite. In the classic presentation, the macule or papule expands concentrically with central clearing (annular shape), reaching a diameter of at least 5 cm. Regional lymphadenopathy may accompany the skin lesion. Lyme disease does not develop in experimental animals unless the tick has been attached for 24 hours or longer. The rash appears 3 to 32 days after the tick bite. Weeks to months after onset of the rash, about 1% to 2% of infected patients develop cardiac manifestations. Syncope may result from third degree heart block. The heart block is reversible in most cases. Months to years after onset, some patients develop recurrent swelling in large joints. Lyme arthritis tends to resolve spontaneously. About 15% of patients with erythema migrans develop meningitis, cranial neuritis, or radiculitis within 3 months of being infected. CSF findings include lymphocytic pleocytosis. [CCDM, p. 315-20; ID, p. 1816-9] Most patients do not recall a tick bite because the nymph stage of the deer tick is so small. Other stage 2 findings include hematuria, urticaria, conjunctivitis, hepatitis, pharyngitis, cough, and splenomegaly. [PPID, p. 2802] EPIDEMIOLOGY: Animal reservoirs include ticks, wild rodents, deer, and small mammals. A vaccine became available in 1999, but it was withdrawn by the only manufacturer in 2002. [CCDM, p. 315-20] Ticks in the nymph stage are the most efficient transmitters of infection. About the size of a poppy seed, the nymphs are often unnoticed. Lyme disease develops in about 10% of people bitten by infected ticks. [Lexi-ID, p. 56] LABORATORY TESTING: "Initial testing should use an enzyme immunoassay (EIA) or immunofluorescent assay (IFA); specimens yielding positive or equivocal results should be tested further by using a standardized Western immunoblot assay. Specimens negative by a sensitive EIA or IFA do not need further testing." [MMWR. February 11, 2005 / 54(05);125] |
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| Latency/Incubation |
3 days to 1 month; average about 1 week; |
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| Diagnostic |
CClinical; Antibody tests; "Serological tests are poorly standardized and must be interpreted with caution." [CCDM, p. 316] ELISA tests for antibodies are first detected about 4-6 weeks after infection. [5MCC] See Comments. |
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| ICD-9 Code |
104.8 |
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| Effective Antimicrobics |
Yes |
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| Scope |
47 states in USA, Ontario & British Columbia; cases reported in Europe, former USSR, China & Japan |
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| Reference Link |
CDC - Lyme disease |
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| Image |
U of WA - Lyme Disease Monograph - Page 4-6 |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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| Job Tasks |
High risk job tasks associated with this disease:
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