Lyme carditis can cause a broad range of symptoms. Patients may initially appear to have only a flu-like illness, however the severity of symptoms can change rapidly. In the article “Fatal Lyme carditis in New England: Two case reports,” Marx and colleagues highlight the importance of early recognition and treatment, even empirically, as Lyme carditis can be deadly when left untreated.
There are times when doctors need to consider whether or not to prescribe doxycycline for children with Lyme disease. The antibiotic is indicated for other tick-borne illnesses including Rocky Mountain Spotted Fever, Ehrlichia and Anaplasmosis. But doctors often avoid prescribing doxycycline to young children for fear that it may cause tooth staining, particularly when used in children less than 8 years old.
Bannwarth syndrome is a neurological disease caused by an infection with Borrelia burgdorferi, the bacterial agent of Lyme disease. The disease causes intense nerve pain and is characterized by “painful radiculopathy, neuropathy, varying degrees of motor weakness, lower motor neuron (LMN) facial nerve palsy and cerebrospinal ﬂuid (CSF) lymphocytic pleocytosis,” writes Diaz et al. in the journal Clinical Neurology and Neurosurgery.
In 2000, the Infectious Diseases Society of America (IDSA) published the first set of guidelines for the treatment of Lyme disease. The guidelines were criticized for not recognizing the existence and severity of chronic Lyme disease. The second set of guidelines, released by IDSA in 2006, again failed to recognize chronic Lyme disease.  Now, it would appear that the next set of soon-to-be-released guidelines are in danger of striking out again and not recognizing the existence and severity of chronic Lyme disease.
In reviewing medical records from a Pediatric Health Information System (PHIS) database between 2007 and 2013, clinicians identified 189 children diagnosed with Lyme carditis. “The burden of Lyme disease and Lyme carditis in U.S. children’s hospitals has increased in recent years,” writes Beach and colleagues in Pediatric Cardiology.
Infectious pathogens, including viral, bacterial and parasitic, can impact the central nervous system (CNS), resulting in neurologic disease. “The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified [on a] CT scan and MRI,” explains Alves Simão and colleagues. ¹ Radiology, they argue, is central to the diagnosis and follow-up of these conditions. Therefore, “radiologists should be familiar with these infections.”
The C6 enzyme immunoassay (EIA) is often used to diagnose Lyme disease. The test is based on the C6 peptide of the Borrelia burgdorferi sl VlsE protein. But a recent study suggests the C6 peptide test may also indicate an infection with Borrelia miyamotoi, another tick-borne disease.
Editorial: I am concerned with the subgroup of Lyme arthritis (LA) patients described by Dr. Steere, who “developed a marked inflammatory, proliferative synovitis lasting months to several years after antibiotic treatment.”
Clinicians can now measure neurotransmitter levels in the brains of patients with mild cognitive impairment using magnetic resonance spectroscopy (MRS) with advanced 7 Tesla technology. MRS, also referred to as Nuclear Magnetic Resonance (NMR), shows the “levels of gamma-aminobutyric acid (GABA), glutathione and other neurotransmitters in brain regions of interest with greater precision than previous, lower-strength imaging systems,” explains Oeltzschner and colleagues. ¹
Could antibiotic stewardship lead to delayed treatment for Lyme disease? In a recent article, researchers in England describe the potential consequences of antibiotic stewardship in an elderly population with urinary tract infections (UTI).
Dr. Daniel Cameron, MD, MPH, is a nationally recognized leader for his expertise in the diagnosis and treatment of Lyme disease and other tick-borne illnesses. For more than 30 years, he has been treating adolescents and adults suffering from Lyme disease.