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Eugene D. Shapiro - One of the best experts on this subject based on the ideXlab platform.
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Borrelia burgdorferi (Lyme Disease).
Pediatrics in review, 2014Co-Authors: Eugene D. ShapiroAbstract:1. Eugene D. Shapiro, MD* 1. *Departments of Pediatrics, Epidemiology of Microbial Diseases, and Investigative Medicine, Yale University Schools of Medicine and of Public Health and Graduate School of Arts and Sciences, New Haven, CT. * Abbreviations: DEET: : N,N-diethyl-meta-toluamide ELISA: : enzyme-linked immunosorbent assay EM: : erythema migrans STARI: : southern tick–associated rash illness 1. Although Lyme Disease, caused by Borrelia burgdorferi , is the most common vector-borne Disease in the United States, there is considerable misunderstanding about the clinical manifestations and consequences of this infection. (1)(2) 2. When to perform diagnostic tests and how to interpret the results for antibodies against B burgdorferi are common sources of confusion for physicians and patients. (3)(4)(5) 3. Misinformation about chronic Lyme Disease on the Internet and in popular media has led to publicity and anxiety about Lyme Disease that is out of proportion to the actual morbidity that it causes. (6)(7)(8) After completing this article, readers should be able to: 1. Understand the ecology and the epidemiology of Lyme Disease. 2. Know when to order and how to interpret serologic tests for the diagnosis of Lyme Disease. 3. Understand the clinical manifestations of Lyme Disease and appropriate treatment Lyme Disease is the most common vector-borne Disease in the United States. In the United States, the spirochete Borrelia burgdorferi sensu stricto (hereafter termed B burgdorferi ) is the only pathogen that causes Lyme Disease. However, in Europe and Asia, Borrelia afzelii , Borrelia garinii, and other related species, in addition to B burgdorferi , cause Lyme Disease. In the United States, these bacteria are transmitted by hard-bodied ticks, including Ixodes scapularis (the black-legged tick, commonly called a deer …
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Implications of Gender in Chronic Lyme Disease
Journal of women's health (2002), 2009Co-Authors: Gary P. Wormser, Eugene D. ShapiroAbstract:Abstract Background: “Post-Lyme Disease syndrome” refers to prolonged subjective symptoms after antibiotic treatment and resolution of an objective manifestation of Borrelia burgdorferi infection (Lyme Disease). “Chronic Lyme Disease” is a vaguely defined term that has been applied to patients with unexplained prolonged subjective symptoms, whether or not there was or is evidence of B. burgdorferi infection. Objective: To determine if the population of patients with chronic Lyme Disease differs from the populations of patients with either Lyme Disease or post-Lyme Disease syndrome by examining the gender of patients with these diagnoses. Methods: Data on gender were compiled in this cross-sectional study based on a systematic review of published studies of antibiotic treatment in United States patients with post-Lyme Disease syndrome (n = 184) or chronic Lyme Disease (n = 490), and on cases of adults with Lyme Disease reported to the Centers for Disease Control and Prevention from 2003 to 2005 (n = 43,282...
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A Critical Appraisal of “Chronic Lyme Disease”
The New England journal of medicine, 2007Co-Authors: Henry M. Feder, Eugene D. Shapiro, Allen C. Steere, Gary P. WormserAbstract:“Chronic Lyme Disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme Disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme Disease.
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Lyme Disease in children.
Seminars in neurology, 1997Co-Authors: Eugene D. Shapiro, Elyse G. SeltzerAbstract:Neurologic manifestations of Lyme Disease are common in children, among whom the incidence of Lyme Disease is higher than among adults. Cranioneuropathies, in particular palsy of the facial nerve, occur in approximately 3-5% of children with Lyme Disease, followed in frequency by meningitis (1% of symptomatic children). Children with only non-specific symptoms such as headache, arthralgia or fatigue commonly are misdiagnosed as having Lyme Disease. Although such non-specific symptoms often accompany more specific signs and symptoms (e.g., erythema migrans, arthritis) in children with Lyme Disease, very rarely are non-specific symptoms the sole manifestation of Lyme Disease. A number of carefully conducted follow-up studies have indicated that the prognosis is excellent for children with Lyme Disease who have been treated with standard antimicrobial regimens.
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Lyme Disease in children.
The American Journal of Medicine, 1995Co-Authors: Eugene D. ShapiroAbstract:Lyme Disease is the most common vector-borne Disease among children in the United States; the incidence of Lyme Disease is higher among children than among adults. Extensive publicity in the lay press about the effects of Lyme Disease has led to widespread anxiety about this illness that is out of proportion to the actual frequency of severe consequences, especially among children. The problem is exacerbated by the difficulty of documenting the diagnosis (or more often of ruling but the diagnosis in children with vague symptoms), especially when the diagnosis depends on serologic tests that are often inaccurate. This caveat applies particularly to commercial laboratories using prepackaged kits, which often give inaccurate results that should not be relied on by themselves to make a diagnosis. Careful prospective studies have found that nearly 90% of children with Lyme Disease have erythema migrans. Although there has been great concern about congenital Lyme Disease, no data suggest that it is a significant problem, nor has transmission of Lyme Disease through breast milk been documented. Virtually all children will respond well to treatment for any stage of Lyme Disease. Misdiagnosis is the most common reason for treatment failure. Long-term follow-up studies indicate that the prognosis for children with Lyme Disease is excellent.
Gary P. Wormser - One of the best experts on this subject based on the ideXlab platform.
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Management approaches for suspected and established Lyme Disease used at the Lyme Disease diagnostic center
Wiener klinische Wochenschrift, 2018Co-Authors: Gary P. Wormser, Donna Mckenna, John NowakowskiAbstract:2015 marks the 27th year that the Lyme Disease Diagnostic Center, located in New York State in the United States, has provided care for patients with suspected or established deer tick-transmitted infections. There are five deer tick-transmitted infectious in this geographic area of which Lyme Disease is the most common. For patients with erythema migrans, we do not obtain any laboratory testing. However, if the patient is febrile at the time of the visit or reports rigors and high-grade fevers, we consider the possibility of a co-infection and order pertinent laboratory tests. Our preferred management for Lyme Disease-related facial palsy and/or radiculopathy is a 2-week course of doxycycline. Patients who are hospitalized for Lyme meningitis are usually treated at least initially with ceftriaxone. We have not seen convincing cases of encephalitis or myelitis solely due to Borrelia burgdorferi infection in the absence of laboratory evidence of concomitant deer tick virus infection (Powassan virus). We have also never seen Lyme encephalopathy or a diffuse axonal peripheral neuropathy and suggest that these entities are either very rare or nonexistent. We have found that Lyme Disease rarely presents with fever without other objective clinical manifestations. Prior cases attributed to Lyme Disease may have overlooked an asymptomatic erythema migrans skin lesion or the diagnosis may have been based on nonspecific IgM seroreactivity. More research is needed on the appropriate management and significance of IgG seropositivity in asymptomatic patients who have no history of Lyme Disease.
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Implications of Gender in Chronic Lyme Disease
Journal of women's health (2002), 2009Co-Authors: Gary P. Wormser, Eugene D. ShapiroAbstract:Abstract Background: “Post-Lyme Disease syndrome” refers to prolonged subjective symptoms after antibiotic treatment and resolution of an objective manifestation of Borrelia burgdorferi infection (Lyme Disease). “Chronic Lyme Disease” is a vaguely defined term that has been applied to patients with unexplained prolonged subjective symptoms, whether or not there was or is evidence of B. burgdorferi infection. Objective: To determine if the population of patients with chronic Lyme Disease differs from the populations of patients with either Lyme Disease or post-Lyme Disease syndrome by examining the gender of patients with these diagnoses. Methods: Data on gender were compiled in this cross-sectional study based on a systematic review of published studies of antibiotic treatment in United States patients with post-Lyme Disease syndrome (n = 184) or chronic Lyme Disease (n = 490), and on cases of adults with Lyme Disease reported to the Centers for Disease Control and Prevention from 2003 to 2005 (n = 43,282...
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A Critical Appraisal of “Chronic Lyme Disease”
The New England journal of medicine, 2007Co-Authors: Henry M. Feder, Eugene D. Shapiro, Allen C. Steere, Gary P. WormserAbstract:“Chronic Lyme Disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme Disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme Disease.
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Reinfection in Patients with Lyme Disease
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2007Co-Authors: Robert B. Nadelman, Gary P. WormserAbstract:Lyme Disease is the most common tick-borne infection in the United States and Europe. A surprising number of patients experience a subsequent episode of Lyme Disease after the first episode has resolved. Reinfection has been well-documented only after successfully treated early infection (nearly always erythema migrans) and can often be recognized clinically by the development of a repeat episode of erythema migrans occurring at a different location on the skin during months when the principal tick vectors are abundant in the environment. Limited data suggest that the clinical and laboratory manifestations of reinfection in patients with Lyme Disease with erythema migrans are not very different from those of initial infection. Patients with recurrent infections afford an opportunity to study the role of the immune response in this illness. Because patients with early Lyme Disease continue to remain at high risk for reinfection, this population should be targeted for education about prevention of Lyme Disease.
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Estimation of the Incidence of Lyme Disease
American journal of epidemiology, 1998Co-Authors: Grant L. Campbell, Robert B. Nadelman, John Nowakowski, Curtis L. Fritz, Durland Fish, Gary P. WormserAbstract:The incidence of Lyme Disease in most endemic areas is unknown but will be an important factor in determining the cost-effectiveness of Lyme Disease vaccines in those areas. The authors developed a deterministic model with nine components to estimate the frequency of Ixodes scapularis tick bites and the resulting incidence of Lyme Disease in residents of endemic areas. For each component, best point estimates and plausible ranges of values were based on the published literature, unpublished data, expert opinion, or a combination of the above. By using the mean, crude, annual total of 3,827 Lyme Disease cases reported from the endemic county of Westchester, New York, in 1991-1994, a mean of 178,889 scapularis bites (20.4 per 100 person-years) and a mean of 10,632 incident Lyme Disease cases (1.2 per 100 person-years) were estimated to have occurred per year. Results of a sensitivity analysis that used two different methods suggested that this deterministic model is reasonably robust. In conclusion, according to this model, the incidence of Lyme Disease in Westchester County is several-fold higher than suggested by the current passive reporting system. Am J Epidemiol 1998;148:1018-26.
John N. Aucott - One of the best experts on this subject based on the ideXlab platform.
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early disseminated Lyme Disease with carditis complicated by posttreatment Lyme Disease syndrome
Case reports in infectious diseases, 2017Co-Authors: Cheryl Novak, Andrew Harrison, John N. AucottAbstract:Lyme Disease is an infectious Disease caused by the bacterium Borrelia burgdorferi. When untreated, infection may spread to the heart, nervous system, and joints. Cardiac involvement usually manifests as abnormalities of the conduction system and bradycardia. Treatment of Lyme Disease is generally effective, with a subset of patients experiencing persistent, sometimes long-term symptoms called posttreatment Lyme Disease syndrome.
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Posttreatment Lyme Disease Syndrome
Infectious disease clinics of North America, 2015Co-Authors: John N. AucottAbstract:The prognosis following appropriate antibiotic treatment of early or late Lyme Disease is favorable but can be complicated by persistent symptoms of unknown cause termed posttreatment Lyme Disease syndrome (PTLDS), characterized by fatigue, musculoskeletal pain, and cognitive complaints that persist for 6 months or longer after completion of antibiotic therapy. Risk factors include delayed diagnosis, increased severity of symptoms, and presence of neurologic symptoms at time of initial treatment. Two-tier serologic testing is neither sensitive nor specific for diagnosis of PTLDS because of variability in convalescent serologic responses after treatment of early Lyme Disease. Optimal treatment of PTLDS awaits more precise understanding of the pathophysiologic mechanisms involved in this illness and future treatment trials.
Adriana R. Marques - One of the best experts on this subject based on the ideXlab platform.
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Lyme Disease: A Review
Current Allergy and Asthma Reports, 2010Co-Authors: Adriana R. MarquesAbstract:Lyme Disease is the most common vector-borne illness in the United States and is also endemic in Europe and Asia. It is caused by the spirochete Borrelia burgdorferi and transmitted by the bite of the Ixodes (deer) tick. It occurs most frequently during spring and summer and may involve the skin, nervous system, heart, and joints. This article reviews the pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of Lyme Disease.
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Lyme Disease: An update
Current Allergy and Asthma Reports, 2001Co-Authors: Adriana R. MarquesAbstract:Lyme Disease is a multisystem illness caused by the spirochete Borrelia burgdorferi , and it is the most common vector-borne illness in the United States. Lyme Disease is also endemic in Europe and Asia. There have been major advances in the field since the Disease was first described, including the sequencing of the B. burgdorferi genome; an increase in understanding of the interactions among the spirochete, the tick, and the mammalian host; new and improved laboratory tests; and a vaccine for prevention of the Disease. Still, the diagnosis of Lyme Disease remains based on history and clinical findings, supplemented by careful use of laboratory tests, and requires that the physician be familiar with the Disease’s clinical manifestations and the shortcomings of the available diagnostic tests.
Henry M. Feder - One of the best experts on this subject based on the ideXlab platform.
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Lyme Disease in children.
Infectious disease clinics of North America, 2008Co-Authors: Henry M. FederAbstract:This article reviews pediatric Lyme Disease in the United States. The agent of Lyme Disease includes three pathogenic species (Borrelia burgdorferi, B afzelii, and B garinii), but only B. burgdorferi strains are found in the United States. The article's discussion is limited to the single species B burgdorferi.
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A Critical Appraisal of “Chronic Lyme Disease”
The New England journal of medicine, 2007Co-Authors: Henry M. Feder, Eugene D. Shapiro, Allen C. Steere, Gary P. WormserAbstract:“Chronic Lyme Disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme Disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme Disease.
