Cardiac manifestations of Lyme disease

Lyme disease is a vector-borne illness that can affect numerous organ systems during the early disseminated phase, including the heart. The clinical course of Lyme carditis is usually benign with most patients recovering completely. In rare instances, death from Lyme carditis has been reported. The cardinal manifestation of Lyme carditis is conduction system disease, which generally is self-limited. Heart block occurs usually at the level of the atrioventricular node but often is unresponsive to atropine sulfate. Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement can occur but generally is mild and self-limited. Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, EM, or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea. Serologic studies and endomyocardial biopsy can support the diagnosis in the correct clinical setting, and MR imaging, echocardiography, and gallium scanning have utility in selected circumstances. No treatment has been shown clearly to attenuate or prevent the development of Lyme carditis, but mild carditis generally is treated with oral antibiotics and severe carditis with intravenous antibiotics in an effort to eradicate the infection and prevent late complications of Lyme disease. There is conflicting evidence regarding the role that B. burgdorferi plays in the development and progression of chronic congestive heart failure. Because of the significant false-positive ELISA rate in this population and the unclear benefit of antibiotic therapy, confirmatory Western blot analysis is recommended. Routine therapy and screening of patients with idiopathic dilated cardiomyopathy is of limited utility and should be reserved for patients with clear history of antecedent Lyme disease or tick bite.     

Lyme disease: neurologic manifestations

Lyme disease is a multisystem infectious, inflammatory, and immune-related disorder that follows the bit of an Ixodes dammini tick infected with Borrelia burgdorferi. Subsequent manifestations are protean. This is particularly true concerning the nervous system. It is estimated that 15% of patients with Lyme disease have neurologic complications. It is very possible that nervous system manifestations of Lyme disease are even more common, and these can occur from weeks to many years following the primary infection and can be quite devastating. A high index of suspicion is necessary in diagnosing Lyme-related disorders, because the majority of patients will not recall a tick bite or characteristic rash, and because the subsequent neurologic manifestations are not unlike those seen with many other diseases. With this awareness and appropriate laboratory testing, a presumptive diagnosis can usually be made without significant difficulty. When the nervous system has been affected by Lyme disease, aggressive antibiotic treatment is usually necessary, often using IV preparations. Usually, there will be significant improvement following the use of antibiotics, but there are some patients who will continue to have persistent, probably irreversible, nervous system abnormalities. This is often the case in patients who have had symptoms for long periods of time or who have had multiple recurrences.     

Neurological manifestations of Lyme disease and treatments

Lyme disease is a multi-systemic infection due to B. burgdorferi, with neurological manifestations observed in its second and third stages. Except for the suggestive triad meningitis--radiculoneuritis--facial palsies, the diagnosis is often difficult because of the pleiomorphism of neurological manifestations. These can be localized or diffuse, with central involvement, meningitis or peripheral manifestations. Past history, cerebrospinal fluid (CSF) examination, immuno-assays for specific antibodies in serum and especially CSF are helpful in diagnosis. Betalactam antibiotics (penicillin G, amoxicillin, and third generation cephalosporins) are the most effective treatment with good results in the early and acute stages of neurological disease.     

Lyme disease. Recognizing its many manifestations

Lyme borreliosis is a relatively new disease, so much remains to be learned about it. In this article, typical manifestations at each stage are reviewed. However, as the authors emphasize, diagnosis is still a challenge because a given patient may have from a few to all of the features discussed, stages often overlap, and characteristics come and go and may mimic other illnesses.     

Polymorphism of clinical manifestations of Lyme disease]

The paper describes a clinical picture of a new transmissible disease which got widespread in the Middle zone of Russia. It is caused by a tick-borne organism pertaining to new pathogenic species of Borrelia. Early in its onset Lyme Borrelia (LB) infection presented with tick-borne erythema, followed by neurological and cardiac complications eventuating in locomotor disturbances. Altogether 118 patients at various stages of the disease were examined and treated. Wide-spectrum antibiotics proved an effective therapeutic modality in LB infection management.     

Cardiac involvement in Fabry's disease.]

Fabry's disease is a rare X-linked lysosomal storage disorder leading to an accumulation of globotriaosylceramides in the lysosomes of all tissues. The disease is characterized by a progressive involvement of important vital organs like the kidneys, the cerebrovascular system and the heart. Within the scope of this article an overview of Fabry's cardiomyopathy, the necessary cardiac diagnostic tests and, in addition, the new concept of enzyme replacement therapy is given.     

Posttransplantation lymphoproliferative disease in children: otolaryngologic manifestations and management

BACKGROUND: Posttransplantation lymphoproliferative disease (PTLD) is associated with Epstein-Barr virus (EBV) infection after solid organ and bone marrow transplantation. METHODS: We did a retrospective analysis of cases with a diagnosis of PTLD at Children's Hospital of Wisconsin. RESULTS: Ten patients were identified. Seven of 10 cases (70%) were associated with bone marrow transplantation and 3 with solid organ transplantation. Three patients (30%) died of PTLD. The average time to development of PTLD after transplantation was 120 days. CONCLUSIONS: Otolaryngologic symptoms and findings are often the first manifestations of PTLD. Associated findings in this series included tonsillar necrosis, tonsillitis, airway obstruction, lymphadenitis, sinusitis, and otitis media. Diagnosis generally requires pathologic evaluation of tonsillar or adenoid tissue. Surgical intervention may also be important for relief of airway obstruction when present. Prompt recognition, diagnosis, and intervention with reduction in immunosuppression and antiviral therapy are essential to reduce the mortality of PTLD.     

Gastrointestinal manifestations of graft-versus-host disease: diagnosis and management

The number of bone marrow transplantations performed to treat diseases such as leukemia, lymphoma, and aplastic anemia has been increasing during the past 2 decades. Improvements in histocompatibility testing, transfusion support, conditioning regimens, and antibiotics have dramatically improved survival after transplantation. As more patients survive the acute phase of bone marrow transplantation and leave major medical centers for their homes, healthcare providers across the country are caring for these patients and their transplantation-associated complications. Graft-versus-host disease (GVHD) of the skin, liver, and gastrointestinal tract are complications that patients may experience months after transplantation. As clinicians, advanced practice nurses encounter these patients in clinics, hospitals, and intensive care units, whether it be for specific GVHD-associated problems or other health conditions. This article reviews the current standards of care for the prevention, diagnosis, and treatment of GVHD of the gastrointestinal tract.     

Esophageal involvement in pemphigoid: Clinical and roentgen manifestations

Esophageal involvement in pemphigoid is rare. Review of 32 cases of pemphigoid seen at West Virginia University Hospital between January 1970 and December 1980 revealed 3 patients with esophageal involvement. These cases and review of reported cases of bullous and mucous membrane pemphigoid showed distinct radiographic features of esophageal involvement. These were diffuse inflammatory changes, adhesions, transverse and circumferential webs, and various sizes of strictures. Symptoms of dysphagia may precede radiographic findings by several months or years.     

The clinical manifestations and diagnosis of Lyme borreliosis

Lyme borreliosis (LB), an infectious disease occurring in the western and eastern hemispheres, is described. The disease that had been observed retrospectively for several decades was verified in the 1980 s. The causative agent of the disease is a new species of Borrelia transmitted with ticks. LB is characterized by staged development and impairment of some systems of the body. Erythema annulare occurring after the sucking of the ticks is a typical skin manifestation of LB. In the USSR, 90 patients with tick-borne erythema underwent examinations. 64 percent of the patients demonstrated nervous system injuries (serous meningitides, neuritis of craniocerebral nerves, and lesions of the peripheral nervous system). Serologic tests performed in part of the patients with LB in the USSR and USA identified similar responses to the causative agent of the disease.     

Lyme disease

A 29-year-old male tennis player was examined for neck pain, limited mobility, and right elbow pain. The patient was treated for cervical facet syndrome by chiropractic manipulative therapy (CMT) for a period of 6 weeks. After this time the patient had a relapse of cervical pain, spinal myofascitis, dermatitis and migratory arthropathy. Several specialists were consulted throughout the case including a rheumatologist, and a tentative diagnosis of psoriatic arthritis and fibromyalgia was made. A follow-up blood evaluation led to a new diagnosis of Lyme disease.     

Lyme disease

Diagnosis of Lyme disease is problematic and results in both overtreatment and mistreatment. Attention to epidemiology and physical findings will prevent inappropriate investigations and therapies. The disease has tropisms for specific tissues, and medical care should be tailored to the site and severity of infection.