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

2003; Elsevier BV; Volume: 114; Issue: 1 Linguagem: Inglês

10.1016/s0002-9343(02)01440-7

1555-7162

Allen C. Steere, Alpana Dhar, Jesus Hernandez, Peter Fischer, Vijay K. Sikand, Robert T. Schoen, John Nowakowski, Gail McHugh, David H. Persing,

Viral Infections and Vectors

Patients with Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi( 1 Steere A.C. Lyme disease. N Engl J Med. 2001; 345: 115-125 Crossref PubMed Scopus (1030) Google Scholar ), may present during summer with systemic symptoms without the initial skin lesion erythema migrans ( 2 Feder H.M. Gerber M.A. Krause P.J. et al. Early Lyme disease a flu-like illness without erythema migrans. Pediatrics. 1993; 91: 456-459 PubMed Google Scholar ). The same tick may also transmit Anaplasma phagocytophila, which causes human granulocytic ehrlichiosis ( 3 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. Ann Intern Med. 1996; 125: 904-908 Crossref PubMed Scopus (167) Google Scholar , 4 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 Crossref PubMed Scopus (399) Google Scholar , 5 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. Int J Syst Evol Microbiol. 2001; 51: 2145-2165 Crossref PubMed Scopus (1514) Google Scholar ), or Babesia microti, a red blood cell parasite ( 6 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 Crossref PubMed Scopus (123) Google Scholar , 7 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). J Med Entomol. 1979; 15: 218-234 Crossref PubMed Scopus (160) Google Scholar ). These organisms, as well as several viral infections, may cause nonspecific systemic symptoms.