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Orthopaedic complications of Lyme disease in children.

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Lyme disease is transmitted by the tick Ixodes dammini ("deer tick") or a related ixodid tick. Early diagnosis of children with
Lyme disease is difficult because the bite of the ixodid tick often goes unnoticed. Furthermore, erythema chronicum migrans, the characteristic rash of the
disease, occurs in less than 50% of cases. However, an awareness of orthopaedic complications of
Lyme disease may facilitate an early diagnosis of this
disease. Orthopaedic complications of
Lyme disease include those which are oligoarticular in nature. Brief intermittent attacks of swelling and pain in one or more joints–primarily large ones–is the pattern of
disease most frequently presented. The knee is the joint most commonly affected. In most cases, pain is not severe enough to debilitate the patient or prevent weight-bearing activity. An elevated sedimentation rate is the only consistently abnormal routine laboratory finding in
Lyme disease. The only radiographic abnormalities noted in children are effusion and osteopenia. However, the radiograph of a patient known to have
Lyme disease may not show any abnormalities at all.
Lyme disease shares symptoms in common with septic arthritis and juvenile rheumatoid arthritis. Whenever a distinction between
Lyme arthritis and septic arthritis is difficult to make, treatment should be directed at septic arthritis while serological tests for
Lyme disease are pending. The physician should consider
Lyme disease to be a possible diagnosis of any patient with arthritis and a history of rash or fever, idiopathic neurological
disease, or a cardiac conduction defect–especially if there is a history of possible exposure to the carrier tick.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomed Pharmacother. 1989;43(6):405-8. Review

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