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      Third-Degree Atrioventricular Block Secondary to Lyme Disease: A Case Report

      case-report
      1 , , 2
      ,
      Cureus
      Cureus
      temporary pacemaker, erythema migrans, ixodes ticks, carditis, atrioventricular heart block, lyme's disease

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          Abstract

          Lyme carditis  is a disseminated infection caused by the bite of an  Ixodes tick with the transfer of  Borrelia burgdorferi. It is characterized by flu-like symptoms, syncope, palpitations, and at times, erythema migrans. It is a rare systemic complication of Lyme disease that occurs when the initial infection is not promptly and completely treated. It is usually seen in patients who spend time outdoors and are thus more likely to get bitten by a tick, though anyone could be affected. This manuscript reports a case of Lyme carditis in a 26-year-old Caucasian male who suffered from flu-like symptoms, syncope, erythema migrans, and third-degree atrioventricular block after a known tick bite. The patient recovered with temporary pacing, doxycycline, and ceftriaxone. Having clinical suspicion of Lyme disease allows for early diagnosis and treatment, thus preventing more serious and systemic complications.

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          Lyme borreliosis.

          Lyme borreliosis (Lyme disease) is caused by spirochaetes of the Borrelia burgdorferi sensu lato species complex, which are transmitted by ticks. The most common clinical manifestation is erythema migrans, which eventually resolves, even without antibiotic treatment. However, the infecting pathogen can spread to other tissues and organs, causing more severe manifestations that can involve a patient's skin, nervous system, joints, or heart. The incidence of this disease is increasing in many countries. Laboratory evidence of infection, mainly serology, is essential for diagnosis, except in the case of typical erythema migrans. Diagnosed cases are usually treated with antibiotics for 2-4 weeks and most patients make an uneventful recovery. No convincing evidence exists to support the use of antibiotics for longer than 4 weeks, or for the persistence of spirochaetes in adequately treated patients. Prevention is mainly accomplished by protecting against tick bites. There is no vaccine available for human beings. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Diagnosis and Treatment of Lyme Carditis

            The incidence of Lyme disease, a tick-borne bacterial infection, is dramatically increasing in North America. The diagnosis of Lyme carditis (LC), an early disseminated manifestation of Lyme disease, has important implications for patient management and preventing further extracutaneous complications. High-degree atrioventricular block is the most common presentation of LC, and usually resolves with antibiotic therapy. A systematic approach to the diagnosis of LC in patients with high-degree atrioventricular block will facilitate the identification of this usually transient condition, thus preventing unnecessary implantation of permanent pacemakers in otherwise healthy young individuals.
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              Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

              It has long been observed in clinical practice that a subset of patients with Lyme disease report a constellation of symptoms such as fatigue, cognitive difficulties, and musculoskeletal pain, which may last for a significant period of time. These symptoms, which can range from mild to severe, have been reported throughout the literature in both prospective and population-based studies in Lyme disease endemic regions. The etiology of these symptoms is unknown, however several illness-causing mechanisms have been hypothesized, including microbial persistence, host immune dysregulation through inflammatory or secondary autoimmune pathways, or altered neural networks, as in central sensitization. Evaluation and characterization of persistent symptoms in Lyme disease is complicated by potential independent, repeat exposures to B. burgdorferi, as well as the potential for co-morbid diseases with overlapping symptom profiles. Antibody testing for B. burgdorferi is an insensitive measure after treatment, and no other FDA-approved tests currently exist. As such, diagnosis presents a complex challenge for physicians, while the lived experience for patients is one marked by uncertainty and often illness invalidation. Currently, there are no FDA-approved pharmaceutical therapies, and the safety and efficacy of off-label and/or complementary therapies have not been well studied and are not agreed-upon within the medical community. Post-treatment Lyme disease represents a narrow, defined, mechanistically-neutral subset of this larger, more heterogeneous group of patients, and is a useful definition in research settings as an initial subgroup of study. The aim of this paper is to review the current literature on the diagnosis, etiology, risk factors, and treatment of patients with persistent symptoms in the context of Lyme disease. The meaning and relevance of existing patient subgroups will be discussed, as will future research priorities, including the need to develop illness biomarkers, elucidate the biologic mechanisms of disease, and drive improvements in therapeutic options.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                1 December 2023
                December 2023
                : 15
                : 12
                : e49803
                Affiliations
                [1 ] Medicine, Philadelphia College of Osteopathic Medicine, Moultrie, USA
                [2 ] Cardiology, Wellstar Cardiology Group, Atlanta, USA
                Author notes
                Article
                10.7759/cureus.49803
                10757855
                554559bf-7525-4e60-a79c-dffe13ef36fa
                Copyright © 2023, Ivey et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 December 2023
                Categories
                Internal Medicine
                Cardiology
                Infectious Disease

                temporary pacemaker,erythema migrans,ixodes ticks,carditis,atrioventricular heart block,lyme's disease

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