Advertisement

Systemic symptoms without erythema migrans as the presenting picture of early Lyme disease

      Patients with Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi(
      • Steere A.C.
      Lyme disease.
      ), may present during summer with systemic symptoms without the initial skin lesion erythema migrans (
      • Feder H.M.
      • Gerber M.A.
      • Krause P.J.
      • et al.
      Early Lyme disease a flu-like illness without erythema migrans.
      ). The same tick may also transmit Anaplasma phagocytophila, which causes human granulocytic ehrlichiosis (
      • Aguero-Rosenfeld M.E.
      • Horowitz H.W.
      • Bittker S.
      • et al.
      Human granulocytic ehrlichiosis a case series from a medical center in New York State.
      ,
      • Goodman J.L.
      • Nelson C.
      • Vitale B.
      • et al.
      Direct cultivation of the causative agent of human granulocytic ehrlichiosis.
      ,
      • Dumler J.S.
      • Barbet A.F.
      • Bekker C.P.
      • et al.
      Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsialesunification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and ‘HGE agent’ as subjective synonyms of Ehrlichia phagocytophila.
      ), or Babesia microti, a red blood cell parasite (
      • Ruebush T.K.D.
      • Juranek D.D.
      • Chisholm E.S.
      • et al.
      Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections.
      ,
      • Spielman A.
      • Clifford C.M.
      • Piesman J.
      • Corwin M.D.
      Human babesiosis on Nantucket Island, USA description of the vector, Ixodes (Ixodes) dammini, n. sp. (Acarina: Ixodidae).
      ). These organisms, as well as several viral infections, may cause nonspecific systemic symptoms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Steere A.C.
        Lyme disease.
        N Engl J Med. 2001; 345: 115-125
        • Feder H.M.
        • Gerber M.A.
        • Krause P.J.
        • et al.
        Early Lyme disease.
        Pediatrics. 1993; 91: 456-459
        • Aguero-Rosenfeld M.E.
        • Horowitz H.W.
        • Bittker S.
        • et al.
        Human granulocytic ehrlichiosis.
        Ann Intern Med. 1996; 125: 904-908
        • Goodman J.L.
        • Nelson C.
        • Vitale B.
        • et al.
        Direct cultivation of the causative agent of human granulocytic ehrlichiosis.
        N Engl J Med. 1996; 334: 209-215
        • Dumler J.S.
        • Barbet A.F.
        • Bekker C.P.
        • et al.
        Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales.
        Int J Syst Evol Microbiol. 2001; 51: 2145-2165
        • Ruebush T.K.D.
        • Juranek D.D.
        • Chisholm E.S.
        • et al.
        Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections.
        N Engl J Med. 1977; 297: 825-827
        • Spielman A.
        • Clifford C.M.
        • Piesman J.
        • Corwin M.D.
        Human babesiosis on Nantucket Island, USA.
        J Med Entomol. 1979; 15: 218-234
      1. Recommendations for test performance and interpretation from the Second International Conference on serologic diagnosis of Lyme disease.
        MMWR Morb Mortal Wkly Rep. 1995; 44: 590-591
        • Engstrom S.M.
        • Shoop E.
        • Johnson R.C.
        Immunoblot interpretation criteria for serodiagnosis of early Lyme disease.
        J Clin Microbiol. 1995; 33: 419-427
        • Wormser G.P.
        • Horowitz H.W.
        • Nowakowski J.
        • et al.
        Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis.
        Am J Clin Pathol. 1997; 107: 142-147
        • Craft J.E.
        • Grodzicki R.L.
        • Steere A.C.
        The antibody response in Lyme disease.
        J Infect Dis. 1984; 149: 789-795
        • Dressler F.
        • Whalen J.A.
        • Reinhardt B.N.
        • Steere A.C.
        Western blotting in the serodiagnosis of Lyme disease.
        J Infect Dis. 1993; 167: 392-400
        • Liang F.T.
        • Steere A.C.
        • Marques A.R.
        • et al.
        Sensitive and specific serodiagnosis of Lyme disease by enzyme-linked immunosorbent assay with a peptide based on an immunodominant conserved region of Borrelia burgdorferi vlsE.
        J Clin Microbiol. 1999; 37: 3990-3996
        • Steere A.C.
        • Sikand V.K.
        • Meurice F.
        • et al.
        Vaccination against Lyme disease with recombinant Borrelia burgdorferi outer-surface lipoprotein a with adjuvant.
        N Engl J Med. 1998; 339: 209-215
        • Krause P.J.
        • Spielman A.
        • Telford S.R.
        • et al.
        Persistent parasitemia after acute babesiosis.
        N Engl J Med. 1998; 339: 160-165
        • Persing D.H.
        • Herwaldt B.L.
        • Glaser C.
        • et al.
        Infection with a babesia-like organism in northern California.
        N Engl J Med. 1995; 332: 298-303
        • Steere A.C.
        • Bartenhagen N.H.
        • Craft J.E.
        • et al.
        The early clinical manifestations of Lyme disease.
        Ann Intern Med. 1983; 99: 76-82
        • Luft B.J.
        • Steinman C.R.
        • Neimark H.C.
        • et al.
        Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection.
        JAMA. 1992; 267: 1364-1367
        • Krause P.J.
        • Telford S.R.
        • Spielman A.
        • et al.
        Concurrent Lyme disease and babesiosis.
        JAMA. 1996; 275: 1657-1660
        • Dattwyler R.J.
        • Volkman D.J.
        • Conaty S.M.
        • et al.
        Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis.
        Lancet. 1990; 336: 1404-1406
        • Massarotti E.M.
        • Luger S.W.
        • Rahn D.W.
        • et al.
        Treatment of early Lyme disease.
        Am J Med. 1992; 92: 396-403
        • Nadelman R.B.
        • Luger S.W.
        • Frank E.
        • et al.
        Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease.
        Ann Intern Med. 1992; 117: 273-280
        • Dattwyler R.J.
        • Luft B.J.
        • Kunkel M.J.
        • et al.
        Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease.
        N Engl J Med. 1997; 337: 289-294
        • Wormser G.P.
        • Nadelman R.B.
        • Dattwyler R.J.
        • et al.
        Practice guidelines for the treatment of Lyme disease.
        Clin Infect Dis. 2000; 31: S1-S14
        • Walker D.H.
        • Task Force on Consensus Approach for Erhlichiosis
        Diagnosing human ehrlichiosis.
        ASM News. 2000; 66: 287-289
        • Krause P.J.
        • Lepore T.
        • Sikand V.K.
        • et al.
        Atovaquone and azithromycin for the treatment of babesiosis.
        N Engl J Med. 2000; 343: 1454-1458