Case Study 2

Boy with Fever and Rash


Question 6 of 6

Why is it important to give patients with Lyme disease adequate treatment?
A. To prevent further spread of the disease
Treatment of an infected individual would not have much impact on the spread of the disease. The disease is spread by ticks infected by feeding on wild animals, such as white-footed mouse, white-tailed deer which are hosts for Borrelia burgdorferi.
B. The patient can develop complications if untreated
(eg. cranial palsy, peripheral neuropathy, cardiac defects)

Lyme disease often occurs in several stages separated by symptom-free periods. However, not every patient experiences all phases or symptoms.
Stage 1
Stage 1 begins 3 days to 1 month after infection and lasts for several weeks. It is characterized by the symptoms described by the patient: rash, headache, neck stiffness, fever, chills, severe headaches, joint and musculoskeletal pain, and fatigue.
Stage 2
If left untreated, stage 2 occurs after several weeks or months with meningitis, musculoskeletal pain, and neurological abnormalities (encephalitis, cranial neuritis, facial palsy etc). A small number of patients also develops cardiac problems during this time. Neurologic symptoms usually disappear completely within months.
Stage 3
Within weeks to 2 years after onset of infection 60% of untreated patients develop arthritis with brief bouts of pain and swelling in joints (eg. knees). Many patients also suffer from fatigue.

The course of Lyme disease, caused by Borrelia burgdorferi, is very similar to that of syphilis, caused by Treponema pallidum. Both bacteria are members of the same family, the spirochetes and both diseases occur in several stages: primary syphilis, like the primary stage of Lyme disease, is characterized by a skin lesion at the site of infection which disappears spontaneously. Secondary syphilis is characterized by fever and rash. Tertiary syphilis can occur years later and symptoms include heart damage, neurologic symptoms and fatigue.

C. The rash can ulcerate if left untreated
The rash (Erythema migrans) can expand to a large size and sometimes many patches appear which can vary in shape. The center of the lesion can sometimes become necrotic (with dead tissue). Even in untreated patients the early symptoms, including the rash, usually improve or disappear within several weeks. Therefore, the rash usually is not the major concern in Lyme disease.

The Biology Project
University of Arizona
Tuesday, August 4, 1998
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