ARTIKKELI BORRELIOOSISTA

[Bb]

Lähettäjä: Soijuv Lähetetty: 1.6.2005 19:23

Tässä artikkelissa 1 vaiheen borrelioosin hoidoksi suositellaan kuukauden antibioottihoitoa ja 2 vaiheen hoidon pituus riippuu oireista. Kroonisen borrelioosin hoito ilmestyy seuraavassa lehdessä.


http://www.metrowestdailynews.com/healt ... eid=100112

MetroWest Daily News (MA)
What's up doc? Treatment for Lyme disease
By Jeff Hersh, Ph.D.
Tuesday, May 31, 2005

I would like to thank those readers who wrote with such positive comments about my column of a couple of weeks ago on ways to minimize tick bites and on how to remove ticks once they have attached. Several people asked me to comment more on Lyme disease.

There was a cluster of cases of juvenile arthritis in the early 1970s in the region around Old Lyme, Conn. A cluster of cases of any uncommon disease is always suspicious, and researchers cleverly came up with the link that these children either remembered having been bitten by a tick (with many having had a rash and flu-like symptoms afterward), or lived in or around wooded areas where tick bites would be expected to be fairly common. Further investigation uncovered the link to the bacteria Borrelia burgdorferi now believed to be responsible for Lyme disease.

Lyme disease is seen worldwide, but most cases occur in Europe and the United States.It is transmitted by a tick bite. Although the very small deer ticks are the most common culprits, any tick may transmit the disease. Most new cases of Lyme disease occur in the summer. There are over 1,500 confirmed cases of Lyme disease each year in Massachusetts.

Treatment for a tick bite depends on the circumstances.If the tick is discovered and removed promptly (within 24 hours), no antibiotic treatment is recommended.If the tick has been attached 24 to 72 hours, one dose of antibiotic (200 mg of doxycycline is a typical choice) may be beneficial to decrease the chances of the patient getting Lyme disease.
Doctors look at Lyme disease as having stages:

Stage 1 (early localized) Lyme disease: Three to 32 days after the tick bite, the patient may develop a rash at the site of the bite which is red and then clears in the middle (so it looks like a bull's eye "target" which we call a "target lesion"). This rash will typically last two to three weeks in untreated patients, and about 20 percent will have this rash recur. After this initial rash about 40 percent of untreated patients get similar rashes at other locations around their body.

About one-third of patients will not develop any symptoms other than the rash. Most (the remaining 67 percent) will develop flu-like symptoms possibly including a headache, fever, chills, stiff neck, muscle and/or joint aches and fatigue. Some people get swollen glands, sore throat or a cough.

Diagnosis of Stage 1 Lyme disease is made clinically based on the symptoms, rash and either a known tick bite or the knowledge that the patient has been at risk for a tick bite (for example, someone from an endemic area who lives or works in a wooded area).

Blood tests are not very useful in early Lyme disease. It is not usually possible to culture the bacteria from the blood of an infected patient so the blood tests look for an antibody response to the infection. Early in the course of the infection the antibody response may be limited and so the blood tests are not reliable.

Treatment of Stage 1 disease is usually quite effective, and typically consists of three to four weeks of antibiotics by mouth, although some research doctors recommend a full 30-day course.

Stage 2 (early disseminated) Lyme disease: Stage 2 can occur weeks to months after the tick bite, and while almost all patients will have malaise and fatigue, many other organ systems can be involved as well.

Most patients with Stage 2 disease will have intermittent, transient bouts of arthritis. This usually begins as a mild arthritis of several joints, which seems to "settle" into a single joint over a day or two -- the knee, ankle and wrist are the most common locations. Untreated, the arthritis will usually last a week or so and then resolve on its own, with most patients having recurrent bouts every two to three months. Subsequent bouts of arthritis are usually less severe than the initial bout, but can involve multiple joints.

Neurologic symptoms manifest in about 15 percent of patients, and can include chorea (irregular spasmodic movement of the muscles), meningitis-like symptoms, Bell's palsy (drooping of one side of the face, including the forehead, which can make it impossible to shut your eye all the way even while sleeping, and can make you drool when you drink since one side of the mouth muscles are also weakened) or other neurologic symptoms.

About 8 percent of patients will develop heart problems including changes in the electrical conduction of the signals that make the heart beat (first- degree, second-degree or even complete heart block), inflammation of the heart muscle or even decreased function (squeeze) of the left ventricle.

In addition to the clinical diagnosis, blood tests are usually done to help confirm the diagnosis. Unfortunately the sensitivity and specificity of these tests is limited, with false-positive tests and false-negative tests not uncommon, so these tests are used primarily as a piece of adjunct information in addition to the clinical picture.

The treatment of Stage 2 Lyme disease is once again antibiotics. The specific length of treatment and route of administration (by mouth or intravenous) of antibiotics depends on the specific symptoms the patient has, and whether the patient has already been treated with an appropriate course of antibiotics.

I will discuss Stage 3 (chronic) Lyme disease next week, since this is the most controversial aspect of the disease.

The take home message for today is that anyone who is at risk for Lyme disease (those with a known tick bite or those at risk for having been bitten) and who develops symptoms suggestive of Lyme disease should be seen by their doctor for ongoing evaluation and treatment. Furthermore, infection from other tick-transmitted diseases should be considered, as it is possible that more than one disease may be transmitted from a single tick bite. Other diseases includes human granulocytic ehrlichiosis (HGE), Rocky Mountain spotted fever (RMSF), babesiosis, and tularemia, as well as one I failed to mention in the tick removal column -- Bartonella. As always, having a high index of suspicion is the first step in ensuring the correct diagnosis is made.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.