BORRELIOOSIN HOITO ALOITETTAVA VÄLITTÖMÄSTI

[Bb]

Lähettäjä: Soijuv Lähetetty: 9.3.2005 8:26

Artikkelin mukaan borrelioosin diagnosoinnissa ei tule odottaa laboratoriovastauksien saapumista sillä ne kestävät useimmiten 2 viikosta kuuteen viikkoon. Lisäksi niiden tulokset eivät ole luotettavia.

Antibioottihoito (tässä tapauksessa henkilö sai 3 viikon hoidon varhaisvaiheen oireisiin) tulee aloittaa mikäli borrelioosia on syytä epäillä ja henkilöllä esiintyy yksi seuraavista varhaisvaiheen oireista: fatiikki, vilunväristyksiä ja kuumetta, päänsärkyä, lihas/nivelkipua, ihomuutos, turvonneet imurauhaset. Borrelioosin diagnosointi on vaikeaa ja siksi on parempi "pelata varman päälle" kuin odotella - eli antibioottihoito on aloitettava välittömästi.


Early Diagnosis Of Symptoms Suggest Lyme Disease Present
By Sally Maxwell, Managing Editor
Friday, March 4, 2005 3:23 PM CST

A Sallisaw resident faces a diagnosis of Lyme disease after being bitten by a tick last weekend.

The patient sought medical attention at Sequoyah Memorial Hospital in Sallisaw where a presumptive diagnosis was made for Lyme disease.

A three-week antibiotic series was prescribed for the patient, who most likely will suffer no continuing symptoms because of the early treatment, Charles Wade, Sequoyah Memorial Hospital administrator, said.

Wade confirmed the hospital did have a "presumptive diagnosis" of Lyme disease, but due to confidentiality ethics, he could not reveal the name of the patient.

Wade reviewed the symptoms and dangers of tick bites.

"Physicians now believe that, what they call a presumptive diagnosis, is better than waiting for two to four weeks for blood tests to come back," Wade said, "especially if the patient has at least one of the six symptoms associated with Lyme disease." He explained that treatment protocols now call for the patient with a Lyme disease symptom to be put on antibiotics immediately.

"If any one of the six indicators are there," Wade said, "therapy is started immediately.

"It takes two to six weeks to confirm the Lyme disease diagnosis through blood tests," Wade said.

He said, "Lyme disease is difficult to diagnose, and physicians now believe that, if we are going to err, it is best to err on the side of caution."

Wade said healthcare professionals are concerned about tick bites this year, because of the mild winter. Ticks are already showing up with winter's mild temperatures.

Laurence Burnsed, epidemiologist with the Communicable Disease Division of the Oklahoma Department of Health, said Thursday that the department tracks tick-borne diseases, and a confirmed case of a tick-borne disease will be reported to the state. He said March is when ticks are first seen.

"We are early in the season," Burnsed said. "The season runs from March through October or November, depending on the weather."

A Lyme disease case is unusual for Oklahoma though, Burnsed said. "In general the southwest and Oklahoma are considered low risk for Lyme disease as compared to the northeast, in states like Connecticut."

However, Burnsed reported, "Oklahoma is among the top five states for diseases like Rocky Mountain spotted fever, tularemia and human ehrlichiosis. They are very common, and should be considered dangerous."

Burnsed cautioned, "As we get into the warmer months, if a person develops symptoms of a tick-borne disease, they should see a doctor immediately, and, if they can remember when they were bitten by a tick, be sure to give that information to their physician."

Lyme Disease

Wade offered the following information on Lyme disease from the American College of Physicians.

Doctors diagnose Lyme disease based on the patient's symptoms, history and blood test results. Lyme disease has three stages: early, early disseminated, and late Lyme disease.

The first-stage symptoms are:

Fatigue

Chills and fever

Headache

Muscle and joint pain

Swollen lymph nodes

Erythema migrans

Erythema migrans, according to the college of physicians, is a skin rash associated with Lyme disease. The rash occurs in a circular pattern that continues to grow. It may appear anywhere from one day to one month after the infected tick's bite, but it usually appears in about seven days. The center of the rash may clear as it grows, giving it the appearance of a bull's-eye. The rash may be warm, but it is usually not painful. Sometimes the rash includes many red patches that appear in different shapes and sizes around the body.

The rash is different from that caused by an allergic reaction to a tick or insect bite. Those symptoms usually appear as a redness within hours to a day after a bite, do not grow, and disappear within a day or two.

The second stage of Lyme disease, known as early disseminated Lyme disease, means the infection of bacteria is beginning to spread and is affecting certain body functions. This stage occurs weeks to months after the bite of an infected tick.

Problems include:

Numbness and pain in arms or legs

Paralysis of facial muscles, usually on one side of the face

Meningitis - fever, stiff neck and severe headaches

Abnormal heart beat (rare)

Third-stage symptoms are called late or chronic Lyme disease. This stage can occur weeks, months or even years after infections in patients who either never received antibiotic treatment for early Lyme disease or whose treatment did not kill all of the bacteria that cause Lyme disease.

Patients with late Lyme disease may get:

Chronic Lyme arthritis - brief bouts of pain and swelling usually occurring on one or more of the large joints, especially the knees

Nervous system problems, including memory loss and difficulty concentrating

Chronic pain in muscles and unrestful sleep

The American College of Physicians also points out that reporting a known tick bite to the doctor will help with the diagnosis. However, many people with Lyme disease do not remember being bitten by a tick.

Deer ticks and western black-legged ticks are tiny and often go unnoticed. For example, nymphal deer ticks, the most common transmitters of Lyme disease, are often about two mm, or the size of this dot (?).

Blood tests cannot diagnose Lyme disease alone, but are used to confirm a diagnosis. Other tests can help with the diagnosis but may take up to two to six weeks because the body must first develop antibodies to the disease, and the antibodies are what are sought in the tests. Other bacterial infections and diseases may also cause false positives, and increasing the number of tests also leads to false positive tests.