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Lyme disease - early disseminated
Definition
Early disseminated or secondary Lyme disease is an inflammatory disease caused by the bacterium Borrelia burgdorferi.
See also:
Alternative Names
Lyme disease - secondary or stage 2; Stage 2 Lyme disease, Bannwarth syndrome
Causes
Lyme disease is transmitted through the bite of an infected tick. Secondary Lyme disease develops within days to months after the tick bite, when the infection spreads via the lymph system or bloodstream.
Symptoms
Some patients will remember having a tick bite or symptoms of stage 1 Lyme disease. Some patients with early disseminated or secondary Lyme disease may not have any history of symptoms, tick bites, or skin rashes.
Lyme disease can affect the central nervous system and cardiac system. Symptoms can come and go and may disappear after days, weeks, or months.
Symptoms include:
- Blurred vision
- Fainting
- Fatigue
- General discomfort, uneasiness, or ill feeling (malaise)
- Headache
- Heart palpitations
- Lightheadedness
- Joint inflammation in the knees and other large joints
- Lethargy
- Muscle pains
- Stiff neck
Other symptoms that can occur with this disease:
- Abnormal sensitivity to light
- Confusion
- Decreased consciousness
- Drooping eyelids
- Dysfunctional movement
- Facial paralysis (also called Bell's palsy)
- Hallucinations
- Loss of muscle function and feeling
- Nausea and vomiting
- Numbness and tingling
- Speech impairment
Exams and Tests
A physical examination may show signs of neurological problems or heart involvement.
Tests that may be done include:
- Chest x-ray
- ECG
- ELISA test to screen for substances specific to the infection
- Examination of cerebrospinal (CSF) fluid
- Western blot to confirm the presence of antibodies to Borrelia burgdorferi
Treatment
The objective of treatment is to get rid of the infection with antibiotics. The medicines are given for up to 28 days. A second round of antibiotics may be needed. The most commonly used antibiotics are doxycycline, amoxicillin, cefuroxime and ceftriaxone.
Antibiotics given through a vein (intravenous) are needed for patients who develop serious nervous system-related complications or arthritis that does not get better with medicines taken by mouth.
Outlook (Prognosis)
Symptoms of arthritis may not respond to treatment. Other symptoms should improve with treatment.
Rarely, a person will continue to have symptoms that can sometimes interfere with daily activities. Some people call this post-Lyme disease syndrome. Unfortunately, there is no effective treatment for this syndrome.
Possible Complications
- Late persistent infection
- Tertiary Lyme disease (Stage 2 Lyme disease)
When to Contact a Medical Professional
Call your health care provider if you develop symptoms of this disorder.
Prevention
Getting diagnosed early and treating Lyme disease with antibiotics are the most effective ways to prevent secondary Lyme disease.
When walking or hiking in wooded or grassy areas:
- Spray all exposed skin and your clothing with insect repellant (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.
References
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089-1134.
Feder HM Jr, Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP; Ad Hoc International Lyme Disease Group. A critical appraisal of "chronic Lyme disease." N Engl J Med. 2007 Oct 4;357(14):1422-30.
Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007 Jul 3;69(1):91-102. Epub 2007 May 23.
Reviewed By: Jatin M. Vyas, PHD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
