Lyme Disease No More

Lyme Strategies

This latest updated text, in digital eBook form and available for immediate download, has been expanded nearly eightfold over the original guide of 2004 in terms of the exact, step-by-step lue-print and essential information designed to maximize this protocol. Just some of the valuable information contained in this 193-page guide includes: How to do the protocol, including the exact, specific method or procedure that is critical to its success. Schedule chart, measurements guide, tips and recommendations. The basic elements of the protocol are actually five, not just salt and vitamin C what these are and why Understanding what a Jarisch-Herxheimer reaction (or Herx) is. Particular djunct items found to be extremely helpful and particular items for special issues. A Technical Section detailing why the protocol works (posited mechanisms), including scientific citations and and studies. The right salt versus wrong salt and why. the low-salt, no-salt myth and scientific truth. the historical, medicinal use of natural salt. Did you know salt was used to treat syphilis, caused by Lyme's bacterial cousin, in the 1800s? Why Vitamin C and what does it do? The protocol and specific body considerations (heart, adrenals, etc.) Key Characteristics of the Lyme bacterium (Borrelia burgdorferi), including nearly 20 extraordinary mechanisms and features it uses to elude the immune and proliferate in the body

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Lyme Disease

Lyme disease is caused by the spirochetal bacterium Borrelia burgdorferi. Ixodes ticks are responsible for transmitting Lyme disease bacteria to humans. In the United States, Lyme disease is mostly localized to states in the northeastern, mid-Atlantic, and upper north-central regions, as well as northwestern California. Lyme disease most often manifests with a characteristic bull's-eye rash (erythema migrans) accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, muscle aches, and joint aches (Figure 16-9). Lyme disease spirochetes disseminate from the site of the tick bite, causing multiple (secondary) erythema migrans lesions. Other manifestations of dissemination include lymphocytic meningitis, cranial neuropathy (especially facial nerve palsy), radiculoneuritis, migratory joint and muscle pains, myocarditis, and transient atrioventricular blocks of varying degree. If left untreated, the disease can progress to intermittent swelling and pain of one or a few...

The Tcc As A Defence System Against Bacteria

Shed (Joiner, 1983 Joiner, 1988), Finally, bacteria may synthesize molecules capable of preventing the assembly of an efficient MAC that requires multimeric C9 for the damage of the inner membrane (Block, 1987). Fernie-king et al. (2001) have recently reported the presence of an inhibitor in a strain of Streptococcus that acts at the level of C5b-7 preventing its uptake onto cell membranes. More recently, we have documented a CD59-like molecule on C-resistant strains of Borrelia burgdorferi that inhibits the polymerization of C9 in the C5b-9 complex and is recognized by various antisera to human CD59 (Pausa, 2003). This molecule differs from human CD59 by having a higher molecular weight (-80 kDa) and by interacting preferentially with C8P rather than with C8a beside C9.

Clinical Manifestations

Lyme borreliosis is a multisystem disease. Its primary target organs include the skin initially and later, potentially, the neurological, cardiac, and articular systems. Lyme borreliosis is categorized in three phases. Arbitrarily Erythema chronicum migrans (ECM) is pathognomonic for Stage I Lyme borreliosis. The average incubation period is 1 to 3 weeks (range 3 days to 16 weeks). This rash is a diagnostic marker of the dis ease and begins as a small flat (macule) or swollen (papule) spot at the site of the tick bite and then expands to a very large (10 to 20 centimeters) oval or round lesion with a red to pink outer border and a very clear central area. Viable B. burgdorferi occasionally can be cultured in the advancing margins. Blood-borne spread of the spirochete may produce multiple, secondary lesions days to weeks later. The rash persists for a few days to weeks, and is usually unaccompanied by systemic symptoms, although occasionally fever, chills, and fatigue may occur....

Psychosocial Adjustment

In a study conducted by Healy (2000), the child's adjustment was found to be highly variable and depended on the severity of the Lyme disease as well as the organ systems affected. Premorbid cognitive, behavioral, and psychological functioning as well as family stability greatly affected a child's reaction to his or her illness. After illness onset, children have to adjust to changes in their ability to participate in many aspects of daily life. A child's mood, school performance, and energy level can all be affected. Adolescents with undiagnosed Lyme disease are seen more often for psychiatric illnesses such as de pression than children without Lyme disease. Many of the behavioral changes caused by Lyme disease are similar to depression and other psychiatric illnesses such as anxiety (Fallon et al. 1998). Fatigue is a major issue for most children with Lyme disease. Many children need to alter their schedules and decrease their activity level so they are not overexerting themselves,...

Concluding Comments

Significant medical advancements in the detection and treatment of meningitis, Lyme disease, PANDAS, and HIV infection have dramatically increased the survival rate of children infected with these diseases. However, dissemination of the infection into the CNS as well as the fear, trauma, and overall psychological distress associated with the serious nature of these illnesses can result in significant psychiatric morbidity, affecting multiple domains of the child's and his or her family's life. Comprehensive multidisciplinary care, including psychiatric evaluation and treatment, may improve the quality of life for pediatric patients afflicted by infectious diseases by decreasing discomfort and increasing functioning. The severity and duration of psychiatric symptoms and overall level of functional impairment will determine treatment plans.

Inflammatory Neuropathies

Lyme Disease The early stages of disseminated Lyme disease have resulted in Bell's palsy or an inflammation of CN VII (facial nerve) in approximately 11 of Lyme disease patients (Wilkinson, 1998). In the later stages of Lyme disease, a neuropathy mimicking CIDP can occur. The differential diagnosis of a rapid-onset polyradiculo-neuropathy includes botulism, diphtheria, hypophospha-temia, acute intermittent porphyria, poliomyelitis, Lyme disease, poisoning from contaminated shellfish (e.g., tetro-dotoxin), and toxic neuropathies (e.g., arsenic, mercury, thallium).

Chronic Progressive External Ophthalmoplegia and Kearns Sayre Syndrome

Conditions to exclude include other mitochondrial diseases, primarily MERRF and MELAS any disease causing ophthalmoplegia when that is the sole presenting symptom, especially myasthenia gravis other diseases that cause multisystem involvement, such as collagen vascular diseases, particularly systemic lupus erythematosus and in the appropriate setting, Lyme disease (caused by infection with Borrelia burgdorferi) or Whipple's disease. The ultimate diagnosis is made by muscle biopsy and mtDNA analysis. There is no proven specific treatment, although coenzyme Q10 and carnitine have been used. Implanted cardiac pacemakers can be used for conduction defects. Associated endocrine abnormalities--growth hormone deficiency, diabetes mellitus, or hypoparathyroidism--can be treated medically. Although these conditions are considered chronic, complete heart block may result in sudden death.

Avoidance of Eradication

Acquisition of host complement regulators has been shown for a number of microbes, including Bordetella pertussis, Borrelia species, such as Borrelia burgdorferi (51-57), Escherichia coli (58), Neisseria meningitides (59, 60), N. gonorrhoeae (60-62), Streptococcus pyogenes (63-68), S. pneumoniae (69-71), Hi-Virus (72), Candida albicans (73), Onchocerca volvulus (74) and Echinococcus granulosus (75). These gram-positive or gram-negative bacteria, viruses, fungi and parasites acquire soluble host complement inhibitor proteins which regulate the alternative pathway, such as complement Factor H and the Factor H like protein 1 (FHL-1), and proteins which control the classical pathway of complement, i.e. the C4 binding protein (C4BP) (Table 1). The pattern of acquired host regulators varies between strains and even further between clinical isolates of one species. Some microbes, like Borrelia species, bind specifically the alternative pathway regulators Factor H and FHL-1, and no Borrelia...

Facial Nerve Paralysis

Although the most common cause of facial paralysis is indeed Bell's palsy, it is incumbent to rule out other potentially serious causes of facial paralysis before making this diagnosis of exclusion. Initially, a complete history and physical examination are required, including otologic and neurologic evaluation. The patient should be questioned regarding history of recurrent cold sores, which suggest her-petic involvement. Recent travel (especially camping) should be noted because Lyme disease is an often-overlooked cause of facial paralysis. Involvement of facial nerves is a concern in patients with a history of chronic otitis media or choles-teatoma. Other symptoms should be noted. Otalgia is common with Bell's palsy and does not always imply that the ear Mastoiditis, otitis media, direct cranial nerve VII infection, Lyme disease

Prevention of Tick Borne Disease

Appropriate antibiotic therapy should be initiated immediately when there is suspicion of Rocky Mountain spotted fever, ehrlichiosis, or relapsing fever rather than waiting for laboratory confirmation (Bratton and Corey, 2005 Spach et al., 1993) (SOR C). Treatment with doxycycline (Vibramycin) or tetracycline is recommended for RMSF, Lyme disease, ehrlichiosis, and relapsing fever (Bratton and Corey, 2005 Spach et al., 1993) (SOR C). Recommended actions to prevent tick-borne disease include avoidance of tick-infested areas wearing long pants and tucking the pant legs into socks applying diethyltoluamide (DEET) insect repellents using bed nets when camping and carefully inspecting oneself frequently while in an at-risk area (Bratton and Corey, 2005 Spach et al., 1993) (SOR C). Antibiotic prophylaxis is not routinely recommended for a tick bite to prevent Lyme disease, unless the risk of infection is high (Wormser et al., 2006) (SOR B).

Acute Disseminated Encephalomyelitis

Parainfectious ADEM usually follows onset of the infectious illness, often during the recovery phase, but because of the latency between pathogen exposure and illness it may precede clinical symptoms of infection or the two may occur simultaneously. The most commonly reported associated illness is a nonspecific upper respiratory tract infection. There have been a vast number of specific infections associated with ADEM, such as virus infections (including rubella, mumps, herpes simplex, varicella-zoster, Epstein-Barr, cytomegalovirus, influenza, and coxsackievirus) and infection with Mycoplasma, Borrelia burgdorferi, and Leptospira. Measles carries the highest risk for ADEM of any infection, occurring in 1 per 400 to 1,000 cases. Although ADEM has been reported in association with measles immunization, the risk is far lower than the risk of acquiring measles and its neurological complications.

Meningitis as a cause of stroke

Other bacterial infections that have been implicated in stroke are the spirochetes Treponema pallidum and Borrelia burgdorferi. Meningovascular syphilis, caused by T. pallidum, is now a rare complication, since syphilis is most often recognized and treated at an earlier stage.

Headache And Facial Pain Sleep Disorders

Acute bacterial meningitis recurrent bacterial meningitis abscess (bacterial, fungal, paracytic) intracranial thrombophlebitis subdural empyema (bacterial, fungal, paracytic) extradural abscess (cranial and spinal epidural) myelitis (Lyme disease) neuritis (Lyme disease) syphilitic dorsal root ganglion disease cyst formation (echinococcus), myopathy (parasites) tick paralysis

Physical Examination

Caveau Double

Infectious agents such as parvovirus B19, human immunodeficiency virus (HIV), Neisseria gonorrhoeae, Borrelia burgdorferi (Lyme disease), and streptococci (rheumatic fever) are all well-known causes of arthritides. Some speculate that dietary factors might contribute to autoimmune syndromes, and fasting or a vegan diet (or both) can lead to improvement in RA (Kjeldsen-Kragh et al., 1991 McDougall et al., 2002). The imbalance of omega-6 and omega-3 fatty acids in the standard American diet (a ratio of 30 1, as opposed to the ratio of 1 2 that is thought to have been present in Paleolithic diets) is also postulated to contribute to a more inflammatory state. Omega-6 fatty acids are preferentially converted to more inflammatory prostaglandins such as ara-chidonic acid, whereas omega-3 fatty acids can be converted into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which contribute to anti-inflammatory series-3 prostaglandin production (Fig. 32-4). Omega-3 fatty acids are...

Arthritis of Systemic Disease

Lyme arthritis caused by Borrelia burgdorferi can cause migratory monoarthritis or oligoarthritis in the knees or shoulders weeks to months after the rash of erythema chron-icum migrans has developed. Poorly controlled diabetes (affecting foot, ankle, and knee), hyperthyroidism (affecting fingers and toes), hypothyroidism (causing noninflammatory effusions in knees, wrists, and hands), and parathyroid disease (causing chondrocalcinosis) are all endocrine disorders that can cause arthritis.

Etiology and Epidemiology

Tick-borne relapsing fever tends to be more severe than the louse-borne variety, but both types vary greatly in severity and fatality. In 1912, for example, louse-borne relapsing fever was very severe in Indochina and India but very mild in Turkey and Egypt. There are also indications that levels of individual and residual immunity are important. Illustrative are Borrelia infections, which are severe in European populations in North and East Africa, but mild in the local populations. On the other hand, in West Africa the disease is equally severe among Europeans and the local inhabitants. Case fatality depends not only on the type of infection and the availability of treatment, but also on the individual's nutritional status and resilience. Thus after World War II, adult fatalities from the disease averaged 8.5 percent among the poorer classes but only 3.6 percent among the well-to-do. Children suffered the most, with death the outcome for 65 percent of cases.

The risk to the individual

Skin infections of different kinds are common in sports, usually in the form of infected chafing sores, athlete's foot, infected eczema and plantar warts. Dermal borreliosis (erythema migrans in Lyme disease) is common among sportsmen who are exposed to ticks. Myocarditis is a rare but well-known complication of borreliosis. Sometimes even minor skin infections, on account of their location, can form a hindrance to sports activities and in occasional cases can constitute a port of entry for bacteria that give rise to septicemia. Small superficial skin infections are seldom contraindications to training and competitions. One exception is herpes infection in the skin, particularly in wrestlers. During wrestling viruses can easily be transmitted to other wrestlers via skin lesions.

Reviews And Selected Updates

In Roos KL (ed) Central Nervous System Infectious Diseases and Therapy. New York, Marcel Dekker, 1997, pp 213-236. Marra CM Neurosyphilis. In Roos KL (ed) Central Nervous System Infectious Diseases and Therapy. New York, Marcel Dekker, 1997, pp 237-252. Roos KL Meningitis 100 Maxims in Neurology. London, Arnold, 1997, pp 1-208.

Associated Medical Findings

Proptosis or periorbital fullness suggests an orbital process such as Graves' disease, orbital meningioma, or orbital pseudotumor. The patient's general appearance may suggest an underlying chromosomal, endocrinological, or metabolic disorder. For instance, the disfiguring frontal bossing and enlargement of the mandible and hands are characteristic of acromegaly associated with a growth hormone-secreting pituitary adenoma. The heart rate, blood pressure, and carotid and cardiac examinations are important in any patient with a possible ischemic event. Patients with pseudotumor cerebri tend to be young females with obesity or a history of recent weight gain. Skin lesions such as erythema migrans (Lyme disease) or malar rash (systemic lupus erythematosus), and abnormal discolorations, such as cafe(c)-au-lait spots and axillary freckling (neurofibromatosis), or hypopigmented ash-leaf spots (tuberous sclerosis) also may be helpful in guiding the evaluation of patients with visual...

Clinical History

The exact areas of weakness should be noted, because sparing of forehead motion or emotional facial expression suggests a central etiology, whereas palsy of both the upper and lower face suggests a peripheral lesion. If only one or two distal branches of the facial nerve are affected, possible etiologies include parotid gland tumors, facial surgery, or facial trauma. Bilateral involvement, which are called facial diplegia, can be found in Lyme disease, Mobius' syndrome, Bell's palsy, and Guillain-Barre(c) syndrome. y , y Associated features A history of other neurological disorders or any evidence of neurological symptoms (e.g., headache, hemiplegia, loss of sensation, cranial nerve dysfunction, changes in balance or tendency to veer toward the same side) should be elicited, while seeking evidence of central pathology. In addition, it is imperative to check for signs and symptoms referable to the ear (e.g., otalgia, otorrhea, hypersensitivity to sound,...

Bacterial Meningitis

In contrast, patients with subacute or chronic meningitis may have the same symptoms with a much more gradual onset, lower fever, and associated lethargy and disability. Mycobacterium tuberculosis, Treponema pallidum (syphilis), Borrelia burgdorferi (Lyme disease), and fungi (e.g., Crypto-coccus neoformans, Coccidioides spp.) are the most common agents (Tunkel et al., 2010).

Relapsing Fever

Relapsing fever is a disease characterized by one or more relapses after the primary febrile paroxysm has subsided. Various types of relapsing fever are caused by blood parasites of the Borrelia group. There are two chief forms of the disease endemic relapsing fever, transmitted to humans by various ticks of the genus Ornithodoros and maintained among a variety of rodents and epidemic relapsing fever, caused by a parasitic spirochete, Borrelia recur-rentis, which is transmitted by human head and body lice. B. recurrentis is less virulent than the tick-borne forms. Under favorable conditions,

Ehrlichiosis

Ehrlichia are small gram-negative pleomorphic coccobacilli that primarily infect circulating leukocytes and other cells derived from the hematopoietic system. There are two species of ehrlichia that cause human disease. Ehrlichia chaffeensis is the causative organism of human monocytic ehrlichiosis, and an organism that is closely related to or nearly identical to E. equi and E. phagocytophila is the causative agent of granulocytic ehrlichiosis. 104 105 106 E. chaffeensis infects mononuclear phagocytes in the blood and tissues, and the granulocytic Ehrlichia species infects granulocytic phagocytes in blood and tissues. 104 The infectious agents of human ehrlichiosis and Lyme disease are both transmitted by tick bites. Most cases of human granulocytic ehrlichiosis have been identified in Wisconsin, Minnesota, New York, Connecticut, and Massachusetts, and most cases of human monocytic ehrlichiosis have been identified in the southeastern and south-central United States. 106 The...

Cognitive Issues

Adams et al. (1999) assessed the cognitive functioning of 25 children 4 years after the onset of Lyme disease compared with matched sibling control subjects and found no difference in cognitive functioning between the two groups. Cognitive domains associated with neuropsychological sequelae commonly reported in adults with Lyme disease were tested using the following neuropsychological measures IQ, information processing speed, fine-motor dexterity, executive functioning, memory, reaction time, and depression screening. Overall, no cognitive impairments in children 4 years after diagnosis and treatment were found (Adams et al. 1999). In children with late Lyme disease, the most prevalent neurocognitive symptoms were behavioral changes, including changes in mood, forgetfulness, declining school performance, headache, and fatigue (Healy 2000). In the review conducted by Healy (2000), teachers noticed that after Lyme disease, children exhibited behaviors that interfered with learning in...

Norwegian Scabies

Pemphigus Vegetans

Lyme disease is an infection caused by the spirochete Borrelia burgdorferi that is transmitted by the usually asymptomatic bite of certain ticks of the genus Ixodes. Lyme borreliosis occurs in northeastern, mid-Atlantic, north-central, and far western regions of the United States. Erythema migrans is the clinical, distinctive hallmark of Lyme disease. It is a dynamic lesion whose appearance can change dramatically over a period of days. The rash is recognized in 90 of patients with objective evidence of B. burgdorferi infection. The erythema begins as a red macule or papule at the site of the tick bite that occurred 7 to 10 days earlier. The rash expands as an annular erythematous plaque as the spirochetes spread centrifugally through the skin. Central clearing may or may not be present. Local symptoms of pruritus or tenderness are hardly noticeable. Systemic symptoms are common and include fatigue (54 ), myalgia (44 ), arthralgia (44 ), headache (42 ), fever and chills (39 ), and...

Labyrinthitis

As with vestibular neuronitis, labyrinthitis causes sudden and severe vertigo. In contrast to vestibular neuronitis, the patient also has tinnitus and hearing loss. The hearing loss is sensorineural, is often severe, and can be permanent. Laby-rinthitis is caused by inflammation within the inner ear. The cause is most often a viral infection but can be bacterial. Bacterial labyrinthitis usually results from extension of a bacterial otitis media into the inner ear. A noninfectious serous labyrinthitis can also occur after an episode of acute otitis media. Other, less common causes include treponemal infections (syphilis) and rickettsial infection (Lyme disease).

Shih Ching

It does not always follow that the organs referred to in descriptions (in the three preceding cases liver, spleen, and lungs, respectively) were those to which we might refer the diseases today. Rather these were the organs concerned with the six tracts already spoken of, each one of which was connected with an organ. Of the malarial types of fever (chiai nio) we have already spoken. The terminology now continued with little change, but one disease, tan nio, may be identified with relapsing fever caused by Borrelia spirochetes as Sung Ta-jen has suggested.

Arthritis

A second general category of arthritis is that of the inflammatory erosive joint diseases. This category includes such syndromes as Reither's syndrome, psoriatic arthritis, and three that are examined in this paper rheumatoid arthritis, ankylosing spondylitis, and gout. Some syndromes of inflammatory erosive joint disease have a known association with bacterial infection of the bowel or genitourinary track. Lyme disease, for example, is initiated by a tick bite that introduces a bacteria (spirochete) into the host. If untreated, the disease produces severe erosive joint destruction in some patients. The prevailing theory is that other erosive arthropathies are probably initiated by infectious agents as well. Inflammatory erosive joint disease occurs in some people when an infectious triggering agent operates in combination with an individual's defective immune response. The major problem in inflammatory erosive joint disease is that the immune response to the infectious agent is not...

Neuromyelitis Optica

An occasional patient may need prone and supine myelography to exclude a spinal dural-based AVM. Laboratory investigations reveal an elevated erythrocyte sedimentation rate in one third, positive antinuclear antibodies in nearly one half, and occasionally other autoantibodies. y It is reasonable to exclude syphilis, Lyme disease, and human immunodeficiency virus by laboratory testing. A chest radiograph helps to exclude pulmonary tuberculosis and sarcoidosis. CSF examination is an essential part of the evaluation for Devic's syndrome, and repeated studies are sometimes necessary to ensure that there is no infection in that the CSF findings are sometimes atypical for inflammatory demyelination. In contrast to MS, a minority of patients with Devic's syndrome (17 percent) have a normocellular CSF during the acute phase. A marked pleocytosis is often present, sometimes exceeding 100 cells. Moreover, neutrophils are commonly seen in CSF and may predominate, a...

Medical Overview

Lyme disease is a tick-borne infection transmitted to humans via deer ticks and is caused by the spiro-chete Borrelia burgdorferi (Healy 2000). Lyme disease initially enters the bloodstream and can disseminate into the musculoskeletal, neurological, and cardiovascular systems (Eppes et al. 1999 Gus-taw et al. 2001). Prompt diagnosis and treatment of Lyme disease commonly result in full recovery (Sood 2006). However, in cases in which treatment and or diagnosis is delayed, chronic Lyme disease, which can cause neurological, rheumatoid, and cardiovascular sequelae, may occur (Dandache and Nadelman 2008). The diagnosis of Lyme disease is based on clinical symptoms and in some cases is supported by findings from serological and cerebrospinal fluid tests (Dandache and Nadelman 2008). The CDC has defined Lyme disease as the presence of an erythema migrans rash 5 cm or larger in diameter or laboratory confirmation of infection with B. burgdorferi and at least one objective sign of...

Multiple Sclerosis

The eye is the only organ outside the nervous system that is sometimes involved in MS. Uveitis and retinal periphlebitis each occur in at least 10 percent of MS patients. The uveitis can involve the posterior, intermediate (pars planitis), or rarely anterior portion and resembles that seen in other inflammatory (e.g., sarcoid, Reiter's syndrome, Behcyet's syndrome, inflammatory bowel disease, systemic lupus erythematosus) and infectious (e.g., syphilis, tuberculosis, Lyme disease) conditions. Periphlebitis is seen as venous sheathing on funduscopic examination and is histologically identical to the perivascular inflammation present in brain white matter. It is interesting that inflammation commonly occurs in the retina, which has a peripheral type of myelin produced by Schwann cells. A few infections must also be considered in the differential diagnosis of MS. Both Lyme disease and syphilis may cause multifocal white matter lesions. HTLV-I causes a chronic progressive myelopathy...

The skin

Bacteria which metabolize sebum live on the skin and are responsible for a rare form of acne. Acne treatments such as isotretinoin inhibit sebum formation. Breaks in the skin such as small cuts and insect bites are obvious routes of infection, and diseases such as malaria and Lyme disease are spread via insect bites.

Clinical Summary

Ticks are blood-sucking parasites of people and animals. Ticks cause illness by acting as vectors for pathogens, or by secreting toxins or venoms. Ticks carry more types of infectious pathogens than any other arthropods except mosquitoes. The most important of these include Borrelia (responsible for Lyme disease and relapsing fever), Rickettsia (eg, Rocky Mountain spotted fever RMSF ), Ehrlichia (Ehrlichiosis), viral pathogens (eg, Colorado tick fever), and babesiosis. Rashes are prominent in Lyme disease, RMSF, and Southern Tick Associated Rash Illness (STARI), sometimes present in relapsing fever, uncommon in Colorado tick fever, and absent in babesiosis. Clinically important ticks in North America include Ixodes dammini, the deer tick (Lyme disease and babesiosis), Dermacentorandersonii, the wood tick (RMSF and Colorado tick fever), D variabilis, the dog tick (RMSF, Ehrlichiosis), and Amblyomma americanum, the lone star tick (a very widespread tick implicated in the transmission of...

Subject Index

Africa (continued) leishmaniasis, 191-192 leprosy, 192 Lyme disease, 201 malaria, 203, 204-206 Marburg virus, 207-208 meningitis, 215-217 multiple sclerosis, 220 onchocerciasis, 228-230 ophthalmia, 230, 234 osteoarthritis, 235-236 osteoporosis, 238 paragonimiasis, 240 pellagra, 244 pica, 247, 249-250 pneumonia, 258 poliomyelitis, 260-261 protein-energy malnutrition, 262, 264-265 Q fever, 269 rabies, 270-271, 274 relapsing fever, 275-277 rheumatic fever, 279 rickets, 282 arsenic, for leukemia, 198 arteriosclerosis, 17, 136, 138, 155 arthralgias, 163, 200, 202, 279, 287 arthritis, 39-42 in alkaptonuria, 141 in dracunculiasis, 99 gonococcal, 278 in gonorrhea, 150 in histoplasmosis, 163 in inflammatory bowel disease, 175-76 in lupus erythematosus, 200 in Lyme disease, 202 in meningitis, 215 in mumps, 223 atrial fibrillation, 104 Australia and New Zealand AIDS, 1 beriberi, 46 bubonic plague, 63 cirrhosis, 79 dengue, 86 echinococcosis, 110 encephalitides, 36 filariasis, 127 gout, 155-156...

Spinal Cord Strokes

Spinal infarcts can also develop in relation to infections in the meninges and parasitic invasion of the spinal arteries. Syphilis, tuberculosis, and lyme borreliosis can involve the spinal arteries. Adhesive arachnoiditis can also cause obliteration of spinal arteries and lead to cord ischemia, especially in the central portion of the spinal cord. Schistosomiasis can involve feeding spinal arteries. Hypoxic-ischemic injury to the spinal cord also develops in patients with severe systemic hypotension and shock. In these patients, brain damage usually is more severe than spinal injury and makes it difficult to identify the spinal pathology clinically.

Uveitis

Patients suspected of an anterior uveitis should be referred to an ophthalmologist for consultation and treatment. The most common cause of anterior uveitis is idiopathic other common causes include ankylosing spondylitis, inflammatory bowel disease, sarcoidosis, juvenile rheumatoid arthritis, Reiter's syndrome (urethritis, polyarteritis, and ocular inflammation), herpetic keratitis, and Lyme disease.