| JWissmille 2004-10-24, 2:08 am |
| "......A patient had chronic septic Lyme arthritis of the knee for seven years
despite multiple antibiotic trials and multiple arthroscopic and open
synovectomies...."
Title: Chronic septic arthritis caused by Borrelia burgdorferi.
Authors: Battafarano DF, Combs JA, Enzenauer RJ, Fitzpatrick JE
Source: Clin Orthop 1993 Dec;(297):238-41
Organization: Department of Medicine, Fitzsimons Army Medical Center, Aurora,
Colorado 80045-5001.
Abstract:
Chronic arthritis occurs in 10% of Lyme disease patients. A patient had
chronic
septic Lyme arthritis of the knee for seven years despite multiple antibiotic
trials and multiple arthroscopic and open synovectomies. Spirochetes were
documented in synovium and synovial fluid (SF). Polymerase chain reaction
(PCR)
analysis of the SF was consistent with Borrelia infection. Persistent
infection
should be excluded with silver stains and cultures in any patient with chronic
monoarticular arthritis and a history of Lyme disease.
Keywords:
Adult, Antibiotics, Combined, THERAPEUTIC USE, Arthritis, Infectious,
MICROBIOLOGY, THERAPY, Borrelia burgdorferi, ISOLATION & PURIF, Case Report,
Chronic Disease, Female, Human, Knee Joint, Lyme Disease, DIAGNOSIS, DRUG
THERAPY, Synovial Fluid, MICROBIOLOGY, Synovial Membrane, SURGERY, Synovitis,
MICROBIOLOGY
Language: Eng
Unique ID: 94062207
__________________
".......Diagnosis of Lyme arthritis may be difficult; exposure in an endemic
area and clinical findings may help distinguish it from septic arthritis..."
Title: Emergency department presentations of Lyme disease in children.
Authors: Bachman DT, Srivastava G
Source: Pediatr Emerg Care 1998 Oct;14(5):356-61
Organization: Pediatric Emergency Services, Maine Medical Center, Portland,
USA.
Abstract:
OBJECTIVE: To review the clinical characteristics and diagnostic evaluation of
children with Lyme disease evaluated in an emergency department (ED) in an
endemic area. DESIGN: A retrospective review of the demographic, historical,
clinical, and laboratory data of pediatric patients with a final diagnosis of
Lyme disease. SETTING: The pediatric ED of an urban university hospital.
PARTICIPANTS: Children with Lyme disease evaluated during the three-year
period
from 1992 to 1994. RESULTS: Twenty-nine children ranging in age from three to
19 years who were diagnosed with Lyme disease subsequent to a visit to a
pediatric ED were identified. Four patients had early localized disease with
erythema migrans and varying degrees of systemic symptoms. Ten had early
disseminated Lyme disease, with multiple erythema migrans, neurologic
involvement (including three patients with pseudotumor cerebri), or carditis.
Fifteen cases of late Lyme disease with arthritis were identified. Recognition
of Lyme arthritis proved particularly difficult; seven children were initially
diagnosed as having septic arthritis, six of whom underwent arthrotomy. Marked
elevations of the erythrocyte sedimentation rate and synovial fluid white
blood
cell counts were observed in these patients, making it difficult to
distinguish
Lyme disease from septic arthritis on the basis of laboratory findings.
CONCLUSION: Lyme disease is an infrequent, often difficult, diagnosis in
children who present to an ED. Early disseminated and late disease
predominate;
classic erythema migrans is uncommon in the ED in comparison with other
ambulatory venues. Diagnosis of Lyme arthritis may be difficult; exposure in
an
endemic area and clinical findings may help distinguish it from septic
arthritis. Overall, underdiagnosis of Lyme disease may actually be more of a
problem than overdiagnosis in the ED setting. Recognition of Lyme disease by
emergency medicine practitioners requires familiarity with its epidemiology
and
its multiple manifestations.
Keywords:
Adolescence, Adult, Child, Child, Preschool, Emergency Service, Hospital,
STATISTICS & NUMER DATA, Endemic Diseases, Female, Hospitals, University,
Hospitals, Urban, Human, Lyme Disease, COMPLICATIONS, DIAGNOSIS, DRUG THERAPY,
EPIDEMIOLOGY, Maine, EPIDEMIOLOGY, Male, Retrospective Studies
Language: Eng
Unique ID: 99029544
_______________
".....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..."
Title: Orthopaedic complications of Lyme disease in children.
Authors: Davidson RS
Source: Biomed Pharmacother 1989;43(6):405-8
Organization: Department of Orthoapedic Surgery, Childrens' Hospital
Philadelphia, PA 19104.
Abstract:
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)
Keywords:
Acute Disease, Adolescence, Arthritis, Infectious, DIAGNOSIS, Arthritis,
Juvenile Rheumatoid, DIAGNOSIS, Child, Child, Preschool, Diagnosis,
Differential, Human, Joint Diseases, ETIOLOGY, Knee Joint, Lyme Disease,
COMPLICATIONS, DIAGNOSIS, Pain, ETIOLOGY
Language: Eng
Unique ID: 90074693
___________________________
"..... diagnosis of Lyme disease remains clinical. Knowledge of the
orthopaedic
manifestations of Lyme disease may aid in early diagnosis and help
differentiate from possible cases of juvenile rheumatoid arthritis and septic
arthritis..."
Title: Orthopaedic manifestations of Lyme disease.
Authors: Jouben LM, Steele RJ, Bono JV
Source: Orthop Rev 1994 May;23(5):395-400
Organization: Albert Einstein Medical Center, Philadelphia, Pennsylvania.
Abstract:
Lyme disease is caused by the spirochete Borrelia burgdorferi and is
transmitted by the Ixodes tick. Early diagnosis is difficult because the tick
bite may go unnoticed and the distinguishing rash, erythema chronicum migrans,
often does not occur. Serologic tests are both sensitive and specific in the
later stages of the disease but not in stage 1. Thus diagnosis of Lyme disease
remains clinical. Knowledge of the orthopaedic manifestations of Lyme disease
may aid in early diagnosis and help differentiate from possible cases of
juvenile rheumatoid arthritis and septic arthritis. If septic arthritis is
suspected, appropriate antibiotic therapy should be initiated while awaiting
serology for Lyme disease. ..... Lyme disease should be considered in any
patient with arthritis and a history of rash, fever, or neurologic or cardiac
abnormality.
Language: Eng
Unique ID: 94316439
__________________
Title: [Localized scleroderma (morphea) and septic arthritis. Clinical
manifestations of Lyme borreliosis seen in El Ferrol]
Authors: Maestre JR, Almagro M, Mart:inez P, de Casas R, Quesada R, Egido J
Source: Enferm Infecc Microbiol Clin 1991 Aug-Sep;9(7):394-8
Organization: Servicio de Microbiolog:ia Cl:inica, Hospital Naval de El
Ferrol.
Abstract:
Two cases of Lyme's disease seen at El Ferrol (Spain) were described. One of
them developed a recurrent knee arthritis and the other had a localized
sclerodermia (morphea) syndrome. Diagnosis was established by means of
clinical
picture and serologic tests (enzyme-linked analysis and/or indirect
immunofluorescence tests). Joint involvement has often been described in
patients diagnosed of having Lyme's disease in Spain, however, the
relationship
between morphea and borreliosis is still a matter of controversy. We believe
that patients with localized sclerodermia and high significant titers of
specific antibodies against B. burgdorferi should be treated with
antimicrobial
agents.
Language: Spa
Unique ID: 92190314
__________________________
|