Neuropsychiatric manifestations of Lyme disease.

Lyme disease is a multisystem illness that may affect the central nervous system and subsequently produce mild to severe psychiatric disorders. Physicians who treat patient with Lyme disease need to be aware of its neuropsychiatric symptoms, which may emerge months to years after the initial infection. Prompt diagnosis and effective treatment are needed to avoid the debilitating and possibly irreversible mental illness associated with the neurologic involvement of this spirochetal infection. The author reviews the neuropsychiatric manifestations of Lyme disease and provides diagnostic and therapeutic approaches for the management of the central nervous system disease that may cause them.

Cardiovascular manifestations of Lyme disease.

Lyme disease is a multisystem illness that may affect the heart. Borrelia burgdorferi infection should be suspected in all patients with unexplained cardiac symptoms who are or who have been exposed to endemic areas. Prompt diagnosis and treatment are needed to avoid potentially life-threatening complications, as well as the inappropriate insertion of a permanent pacemaker. The author reviews the cardiac complications associated with Lyme disease, and provides diagnostic and therapeutic approaches for effective patient care.

Case report: neurocysticercosis in pregnancy.

The signs and symptoms of neurocysticercosis range from a single convulsion to coma and death. Medical treatment with new anticysticercus drugs can be effective, while surgery may be indicated in selected cases. This report describes a case of neurocysticercosis in pregnancy.

Hypothyroidism with concurrent Lyme disease.

Lyme disease can be seen as localized, disseminated, acute, or chronic and can mimic other, more serious diseases. Even though it is a multisystemic illness, very few spirochetes are present; yet, once established in the host, it can persist for years. The antibody response is slow and variable, and the spirochete is difficult to isolate from clinical specimens, even those obtained from the pathognomonic skin lesion. These variables, together with nonspecific symptoms, make the diagnosis of Lyme disease difficult. The author describes an unusual case of Lyme disease superimposed on severe primary hypothyroidism in which the thyroid disorder was so advanced and pronounced that the diagnosis of Borrelia infection could easily have been missed.

Ehrlichiosis with pancytopenia and ARDS.

As illustrated by the case described in this report, the possibility of ehrlichiosis should be considered in the differential diagnosis of sulfasalazine toxicity/drug fever and other febrile illnesses presenting with pancytopenia/leukopenia and pulmonary abnormalities, when patients have been exposed to known tick-infested areas. Furthermore, the possibility of delayed serologic confirmation of Ehrlichia infection should be integrated into the diagnostic process as well.

Polymyalgia rheumatica or Lyme disease? How to avoid misdiagnosis in older patients.

This case report demonstrates the need to consider Lyme disease in older patients who present with nonspecific signs and symptoms often seen in polymyalgia rheumatica, particularly a markedly elevated erythrocyte sedimentation rate (ESR). ESRs greater than 100 mm/hr are common in polymyalgia rheumatica, but rates higher than 85 mm/hr are also possible in Borrelia infection. Because positive serologic findings for Lyme disease have been noted in patients with polymyalgia rheumatica who have been exposed to endemic areas, differential diagnosis must be based on clinical manifestations. Response to therapy should be monitored closely to confirm the diagnosis and avoid the adverse consequences of inappropriate treatment. The potentially deleterious effect that corticosteroids can have on Lyme disease must be considered in the decision to treat polymyalgia rheumatica.

Lyme disease with concurrent ehrlichiosis.

Lyme disease constitutes a major health hazard with an increased incidence throughout the United States, in particular the eastern states. Human ehrlichiosis, also a tick-borne illness, has recently been identified. It is characterized by fever, headache, malaise, leukopenia, thrombocytopenia, and elevated liver enzyme titers, and has been reported to occur mainly in the South Central and South Atlantic states. As with Lyme disease, most patients have a history of tick exposure. These two diseases may be difficult to differentiate clinically. Physicians must consider the possibility of both infections when patients become ill with a systemic illness after tick exposure. Although certain demographic and clinical features are characteristic of these diseases, they can be misleading. Only serologic evidence can confirm the diagnosis. Two cases of concurrent Borrelia and Ehrlichia infections have been previously reported. The authors herein describe a third case that further illustrates the potential diagnostic dilemma posed by the concurrence of these two entities.

Variable cutaneous manifestations of Lyme disease.

Lyme disease is a complex, multisystem illness that primarily affects the skin, nervous system, heart, and joints. Physicians must learn to recognize the various possible presentations of the pathognomonic skin lesion to diagnosis this disease in the absence of reliable laboratory methods.