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Identification of Lyme disease.

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Abstract

The identification of
Lyme disease is an important, rewarding process. In early
disease, the presence of EM, the geographic location of the patient, and the time of year are critical in assessing the likelihood of
Lyme disease. Beyond this, it is important to have a high index of suspicion in early
Lyme disease, because the rash may be atypical or absent, the early flu-like features can be nonspecific, and at this stage seroreactivity to B. burgdorferi may be lacking. Treatment is always with antibiotics and is highly successful. In late
Lyme disease, the issues are different. Most individuals presenting with questions about late
Lyme disease do not have the disorder. The clinician must recognize characteristic, objective
disease manifestations such as oligoarthritis or chronic meningitis and avoid the diagnosis in individuals with “chronic fatigue” alone. Serologic testing is useful because few, if any, individuals with late
Lyme disease will be seronegative. Serologic testing should not be indiscriminate, however, because false positives are common. Most patients with late
Lyme disease are cured with antibiotics, but the response to successful treatment may be slow. In a minority of patients, there is a role for managing
disease that cannot be cured (for example, anti-inflammatory medication, physical therapy, reassurance) as in other rheumatic diseases.

Rheum Dis Clin North Am. 1994 May;20(2):361-9. Review

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