Lyme disease - secondary

Definition:

An inflammatory disease characterized by cardiac and neurological symptoms caused by the bacterium Borrelia burgdorferi, which is transmitted by the bite of a deer tick.

Alternative Names:

Early disseminated Lyme disease; Stage 2 Lyme disease

Causes, incidence, and risk factors:

See Lyme disease for a description of the initial stages of the disease. Secondary Lyme disease develops within days to months after the tick bite, when the infection spreads via the lymph system or bloodstream.

The central nervous system and cardiac system may be affected. Symptoms may be intermittent and may disappear after days, weeks, or months. Involvement of the heart occurs in 8% of people with untreated Lyme disease. Neurologic involvement occurs in 10% of patients with untreated Lyme disease.

Symptoms:

headache
fatigue
general discomfort, uneasiness, or ill feeling (malaise)
lethargy
muscle pains
stiff neck
joint inflammation in the knees and other large joints
heart palpitations
syncope (passing out)
blurred vision

Additional symptoms that may be associated with this disease:

speech impairment
numbness and tingling
nausea and vomiting
muscle pain
muscle function/feeling loss
movement, dysfunctional
hallucinations
facial paralysis (also called Bell's Palsy)
eyelid drooping
consciousness, decreased
confusion
abnormal sensitivity to light

Signs and tests:

a physical examination to reveal signs of neurologic or cardiac involvement
ELISA test to screen for antibodies to Borrelia burgdorferi
Western blot to confirm the presence of antibodies to Borrelia burgdorferi
tests that detect cardiac abnormalities
- ECG (also called EKG)
- chest X-ray may show heart failure
- CSF analysis may show inflammation

Treatment:

The objective of treatment is to eliminate the infection by antibiotic therapy. Penicillin, doxycycline, cefuroxime, and ceftriaxone are frequently used. Ceftriaxone is often used to treat secondary Lyme disease.

Note: Oral doxycycline is usually not prescribed for children until after all the permanent teeth have erupted -- it can permanently discolor teeth that are still forming.

Expectations (prognosis):

Symptoms of arthritis may fail to respond to treatment. Other symptoms should improve with treatment.

Complications:

tertiary Lyme disease or late persistent infection

Calling your health care provider:

Call your health care provider if symptoms of this disorder develop.

Prevention:

Early diagnosis and appropriate antibiotic treatment of Lyme disease is the most effective way to prevent secondary Lyme disease.

Review Date: 2/22/2002
Reviewed By: Camille Kotton, M.D., Infectious Diseases Division, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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