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Lyme Disease
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facial expression and cause memory loss or
difficulty with speech.

Complications
* Neuropathy and facial
palsy
* Heart rhythm
irregularities
* Cognitive defects, such
as impaired memory
* Chronic joint inflammation
(Lyme arthritis) especially in the knee

Less common signs and
symptoms
* Heart problems, such as irregular
heartbeat
* Eye inflammation
* Liver inflammation (hepatitis)

The good news is that with treatment
over half of the late Lyme encephalopathy
patients will improve. Relapse occurs in
less than a quarter of patients, but with
antibiotic therapy neurological symptoms
such as vertigo, dizziness, and hearing
loss as well as balance instability found
in neuroborreliosis can be ameliorated.
While examining PTLDS, it is important
to evaluate for peripheral neuropathy and
abnormal vibratory sensations.

Diagnosis
According to Mayo Clinic Proceedings,
the diagnosis of Lyme disease is described
as "clinical judgment" since it is based on
factual evidence. The clinical features can
be observed in a person who has traveled
to or lives in an area where the disease is
common. It is appropriate to treat patients
that have early disease and use high pretest
probability diagnostic measures based on
signs and symptoms after a bite by the
Ixodes tick. Compared to other tick-borne
diseases, only 30-50% of patients can rarely
recall the bite because the deer tick nymphs
are small and can go unnoticed.

* Severe fatigue

Physical
Examination
When a person is
being examined for Lyme
disease, special attention
should be given to the
musculoskeletal system and
to joint inflammation or
swelling. Most people when
bitten by a tick present
with erythema migrans.
If there is an infection
it should be tested by arthrocentesis for
the presence of B. burgdorferi. The aim
of providing at this stage is to control
inflammation at the joints and to use
therapies to manage rheumatoid arthritis.
In physical examination of late Lyme
encephalopathy, cranial nerve damage is
inspected. Cranial nerve damage, such as
seventh cranial palsy, can affect a person's

of infection. If the test shows presence
of both antibodies, then the patient has
Lyme disease stated by The British Journal
of Medicine. Due to slow replication of
Borrelia, two-tiered antibody test cannot
detect early stages of infection, but ELISA
can detect active infection and can be used
for early diagnosis as depicted in figure 7.

There are several diagnostic tests
that can be used such as two-tiered
serology, PCR (to examine for Borrelia
DNA), CSF (to look at antibodies
and early biomarkers), Enzyme-linked
immunosorbent assay (ELISA), and
immune response tests. The two most
common methods of diagnosing Lyme
disease include two-tiered antibody
western blot and ELISA. The two-tiered
method of analysis tests for presence of
antibodies from beginning to current state

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Treatment
As per CDC, there is no proven
treatment for Lyme disease. However, early
diagnosis can help patients through intense
antibiotics therapy, as per the guidelines
laid out by Infectious Disease Society of
America. Antibiotics such as doxycycline
or amoxicillin are the most used for
treatment.
Doxycycline is recommended for
patients aged 9 years and over and
amoxicillin for those aged 8 years and
younger. Pregnant patients can be treated
with amoxicillin, cefuroxime axil, or
erythromycin.
Different treatment strategies are
implemented based on the severity and
stages of Lyme disease. Early stages should
continue for 14 days, the second stage
for 21 days, and arthritis for 30-60 days
(8). PTLDS with neuroborreliosis or
cardiovascular manifestations requires
treatment with intravenous antibiotics
such as ceftriaxone (2g/d), cefotaxime (2
g every 8 hours) or penicillin G (5 million
U every 6 hours) each for at least 4 weeks.
Serious bacterial infections and hemolytic
anemia are adverse effects due to long term
antibiotic treatment for Lyme disease.

Prognosis
The likelihood of survival from Lyme
disease is high when proper treatment
is given, and the individual recovers. Of
those with early stage Lyme disease who are
treated, approximately 10-20% can develop
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