Dermatology lecture

2021-02-05 12:00 AM

Lyme disease can be divided into 3 clinical periods, but the periods are sometimes not clearly separated but may overlap.

Outline

Lyme disease is a disease that is transmitted from animals to humans (by tick bites), caused by the spirochete Borrelia burgdorferi (Bb), which damages mainly the skin, nervous system, heart, and joints.

Taylor (1876), Buchwald (1883), and Pick (1894) described it as an atrophic skin disease, then Kaposi (1897) called atrophic dermatitis. Herxheimer and Hartmann (1902) called it "chronic atrophic chronic dermatitis", or "Pick-Herxheimer" disease.

This disease used to be common in Central Europe and Alsacl (France); Lyme Connecticut (USA) recently met a disease called Lyme disease.

Pathogenesis

Lyme disease can be acquired by all ages. The highest time of illness is from June to October, but can also be infected year-round.

Pathogens

Borrelia burgdorferi spirochetes is 10 - 30µm long, 0.2 - 0.25µm wide. Unlike T. pallidum: B. burgdorferi can be cultured in artificial media, the reproductive cycle (when at a temperature of 30- 34 0 C) is 7- 20 hours. The pathogen can be found in blood, skin, cerebrospinal fluid, eyes, joint fluid, and myocardium in Lyme patients.

Clinical symptoms

Lyme disease can be divided into 3 clinical periods, but the periods are sometimes not clearly separated but may overlap. 

Stage 1 (appearing after a few weeks - months after being infected with Bb): migratory erythema is a type of rash that develops centrifugally and can be relocated. This rash may be uniform but is usually a coronary rash and can go away on its own after a few weeks or months. It may be purpura or not moving and is accompanied by a systemic flu-like symptom. Cerebrospinal fluid usually shows no signs of inflammation. 

Stage 2: weeks or months after infection. Neurological manifestations can be meningitis-nerve roots, inflammation of the cranial nerve (mainly facial nerves), plexitis, solitary polyneuritis, and, more rarely, encephalitis. marrow and cerebrovascular inflammation. Bannwarth syndrome is the most common neurological manifestation (in Europe) characterized by lymphocytosis in the cerebrospinal fluid and nerve root pain. Meningitis is often possible and is most pronounced in children.

Heart damage is a transient atrioventricular block of different degrees, arrhythmia, myocarditis, heart failure. Lymphoma manifests as a skin infiltrate resembling a lump, a red-green-green color commonly found in the earlobe or nipple. Arthralgia (seen in the first months of the disease) and myalgia indicate muscle bone damage. Other signs of phase 2 may be eye lesions (conjunctivitis, iritis of the eyelids, choroiditis, optic neuritis with popular edema, systemic inflammation), liver enlargement, hepatitis, and, more rarely, a dry cough and swelling of the testicles.

Stage 3: lesions appear slowly every month, every year after being infected with Bb. In the US, about 60% of untreated patients have multiple or one joint inflammation, with joints as large as the pillow most commonly affected. Patients in Europe often have ACA (acrodermatitis Chronique atropine: chronic atrophic dermatitis, also known as Pick-Herxheimer disease). ACA causes damage mainly on the extensor surfaces of the extremities. The red-green color will initially progress to atrophy-wrinkling of the skin. A fibrous knot may appear next to the joint and fibrous process may occur. 
Chronic Lyme encephalitis and encephalitis-spinal inflammation are possible, but very rare. 

Testing and diagnosis

Test

Inoculation of B. burgdorferi is difficult to perform. Often used the diagnostic serum. The biopsy specimen can detect spirochetes by silver staining method and immunological-organization technique. ELISA or IFA (indirect immunofluorescence) or Western blot can be used. Serum test results depend on the stage of the disease.

Implementing the quadrants

Based on clinical and laboratory images.

Differential diagnosis

Erythema multiforme.

Other medical diseases: nerves, arteries, joints ...

Sterre Treatment
Regimen (1989):

Early period (periods 1 and 2 with no major lesions).

Adults:

Amoxilline 500 mg x 4 tablets / day (divided into 4 times a day) x 10-30 days.

Tetracycline 250 mg x 4 tablets / day (divided into 4 times a day) x 10 30 days.

Doxycycline 100 mg x 2 tablets / day (divided into 2 times a day) x 10 - 30 days.

Children (<8 years old):

Amoxicillin or Penicillin 250 mg 3 times a day or 20 mg/kg/day. Divide several times x 10 - 30 days.

When the disease manifests itself in the nervous system, heart, and joints.

Intravenous ceftriaxone x 2 grams x 1 time / day for 14 days.

Penicillin G intravenously 3 million units x 6 times/day for 14 days.

Penicillin G intravenously 3 million units x 6 times/day for 14 days.

ACA (chronic atrophic chronic dermatitis) is treated as an early stage for 1 month.

Prevention: 

In forestry workers, cattle breeding on grasslands should be careful to avoid ticks causing infection.