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Lyme disease - chronic persistent

Alternative Names: Tertiary Lyme disease; Stage 3 Lyme disease; Late persistent Lyme disease; Lyme arthritis

Chronic persistent Lyme disease is late stage Lyme disease. Lyme disease is a disease spread through tick bites. The condition is also called Stage 3, or tertiary, Lyme disease.

See also: Lyme disease

Causes of Lyme disease - chronic persistent

Lyme disease is caused by bacteria called Borrelia burgdorferi (B. burgdorferi). Certain ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick.

Chronic persistent Lyme disease may develop months or years after you first develop Lyme disease infection.

Lyme disease - chronic persistent Symptoms

Chronic persistent Lyme disease can affect the skin, brain, and nervous system, and muscles, bones, and cartilage.

Symptoms include:

Other symptoms that may occur with this disease:

Tests and Exams

A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most common one used is the ELISA for Lyme disease test. A Western blot test is done to confirm ELISA results.

Other tests that may be done include:

  • Electrocardiogram to look at the brain
  • Echocardiogram to look at the heart
  • Spinal tap (lumbar puncture) to get a sample of spinal fluid for testing

Treatment of Lyme disease - chronic persistent

Antibiotics are used to fight the infection.

  • Antibiotics are taken for for up to 28 days.
  • A second round of antibiotics may be needed if joint pain symptoms do not go away.
  • Antibiotics given by mouth (doxycycline, amoxicillin, or cefuroxime) are used most of the time.
  • Antibiotics may be given through a vein (by IV) if symptoms do not get better.

Prognosis (Outlook)

Arthritis symptoms may not get better with treatment. Other symptoms should improve with treatment.

Rarely, a person will continue to have symptoms that can sometimes interfere with daily life or activities. Some people call this post-Lyme disease syndrome.

Potential Complications

Complications may include long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Brain and nervous system (neurological) problems are also possible.

When to Contact a Health Professional

Call your health care provider if:

  • A rash that looks like a bulls eye
  • Had a tick bite and develop weakness, numbness, or tingling, or heart problems
  • Symptoms of Lyme disease, especially if you may have been exposed to ticks

Prevention of Lyme disease - chronic persistent

Early diagnosis and appropriate antibiotic treatment for primary Lyme disease is the most effective way to prevent tertiary Lyme disease.

Here are some tips for preventing primary Lyme disease:

When walking or hiking in wooded or grassy areas:

  • Spray all exposed skin and your clothing with insect repellent (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.

If possible, ask someone to help you examine your body for ticks. Adults should carefully examine children.

Bratton RL, Whiteside JW, Hoyan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83:566-571.

Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 242.

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;357:1422-1430.

Review Date: 3/11/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital.
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