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Query: UMLS:C0015674 (chronic fatigue syndrome)
 2,978 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Any patient who has a Bell's palsy (unilateral or bilateral), aseptic meningitis, chronic fatigue syndrome, atypical radiculoneuropathy, presenile dementia, atypical myopathy, or symptoms of atypical rheumatoid arthritis should be asked specifically about the following: visits to highly endemic areas, any known tick bites, any skin lesion suggestive of erythema migrans, any history of palpitations or of prior Bell's palsy, aching in joints (especially the knees), paresthesias, chronic fatigue and depression, forgetfulness, and eye problems. Any patient showing a chronic iritis with posterior synechiae, vitritis in one or both eyes, an atypical pars planitis-like syndrome, big blind spot syndrome, and swollen or hyperemic optic discs should be asked the same questions. The physician should send one red-top tube of blood containing 2 to 3 ml serum to Microbiology Reference Laboratory, 10703 Progress Way, Cypress, CA 90630-4714, requesting a Lyme/treponemal panel. For $90 the patient will receive an RPR test with titer, serum FTA-ABS test, serum Lyme IFA IgG and IgM, and a serum Lyme ELISA test. If these tests are within normal limits and the physician is still suspicious, a Western blot can be ordered on serum. A green top tube with fresh white blood cells sent out by overnight express on a Monday or Tuesday will produce a Lyme PCR and a lymphocyte stimulation test. Finally, R.K. Porschen, director of MRL Laboratory, will provide information on the urine antigen test on an investigational basis. A careful history with emphasis on the specific questions noted above, a complete neuro-ophthalmological and physical examination ruling out other causative problems, and the laboratory studies here discussed will usually provide sufficient data to choose therapy. Much further active research into Lyme borreliosis is an important priority in medicine.
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PMID:Neuro-ocular Lyme borreliosis. 201 Nov 11

The microbiology, transmission, epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Lyme disease are reviewed. Lyme disease, a tick-borne syndrome, was first described in 1975. The etiologic agent of Lyme disease is Borrelia burgdorferi, a slow-growing spirochete. Lyme disease is the most prevalent tick-borne disease in this country; endemic areas in the United States include the northeastern, north central, and western regions. Both infectious and immunologic mechanisms are important factors in the pathogenesis of Lyme disease. The primary mechanism, however, is thought to be infectious. Three stages of Lyme disease have been described; stage I, characterized by erythema chronicum migrans and flu-like symptoms; stage II, characterized by dermatologic, ophthalmologic, neurologic, and cardiac disorders; and stage III, characterized by arthritis, a multiple sclerosis-like syndrome, psychiatric disorders, and a chronic fatigue syndrome. Therapy with penicillin or tetracycline hastens the resolution of stage I symptoms. Treatment duration normally ranges between 10 days and three weeks. Tetracycline or doxycycline appears to be more effective than penicillin in preventing the development of late Lyme disease. Although intravenous penicillin G and ceftriaxone are both effective for the treatment of late Lyme disease, many clinicians consider ceftriaxone to be the agent of choice. Whether exposed patients from endemic areas should receive antimicrobial prophylaxis is controversial. Further clinical studies are needed to determine optimal therapy for the various stages of Lyme disease, particularly Lyme arthritis.
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PMID:Management of Lyme disease. 218 Jun 24

A survey of the members of the Canadian Infectious Disease Society was carried out to determine the content of an infectious diseases consultative practice in the 1990s. Respondents were asked to identify all new inpatient, outpatient, and telephone consultations during a 1-week period in 1990. Consultations were categorized by the infectious disease syndrome of the patient and by the microorganism that was identified. Bacterial infections were the most common cause of inpatient consultations, while viral infections were more common in outpatients. Consultations for parasitic infections were primarily for Pneumocystis carinii pneumonia related to infection with the human immunodeficiency virus (HIV). "Newer" infectious disease syndromes such as chronic fatigue syndrome, toxic shock syndrome, and Lyme disease were all represented in the responses for the 1-week study period. The significant impact of HIV infection on the overall consultative load suggests that there will be a continuing need for newly trained infectious disease consultants into the 21st century.
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PMID:The practice of infectious diseases in the 1990s: the Canadian experience. 774 32

Two important studies in which nuclear magnetic resonance spectroscopy was used convincingly demonstrated that muscle is not the primary pathologic factor in fibromyalgia. There were further studies reporting that fibromyalgia-chronic fatigue syndrome may follow well treated Lyme disease or mimic Lyme disease. The longest therapeutic trial to date in fibromyalgia demonstrated an initial modest effect of tricyclic medications, but at 6 months that efficacy was no longer evident. Investigation in both fibromyalgia and chronic fatigue syndrome now focuses on the central nervous system. The use of new technology, eg, neurohormonal assays and imaging such as single-photon emission computed tomography scan, may be important in understanding these elusive conditions.
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PMID:Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. 776 93

No major pathophysiologic or therapeutic findings have appeared over the past year regarding fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome, three poorly understood, controversial, and overlapping syndromes. The frequent prevalence of these disorders in association with Lyme disease and other medical and psychiatric illness was emphasized. New studies demonstrated the potential role for central nervous system activation in fibromyalgia and chronic fatigue syndrome.
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PMID:Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. 802 71

Lyme disease or Lyme borreliosis, which is caused by three groups of the spirochete Borrelia burgdorferi, is transmitted in North America, Europe, and Asia by ticks of the Ixodes ricinus complex. The primary areas around the world that are now affected by Lyme disease are near the terminal moraine of the glaciers 15,000 years ago. The emergence of Lyme disease in the United States in this century is thought to have occurred because of ecological conditions favorable for deer. From 1982 through 1991, 40,195 cases occurring in 47 states were reported to the Centers for Disease Control, but enzootic cycles of B. burgdorferi have been identified in only 19 states. During the last several decades, the disease has spread to new areas and has caused focal outbreaks, including locations near Boston, New York, and Philadelphia. Lyme disease is like syphilis in its multisystem involvement, occurrence in stages, and mimicry of other diseases. Diagnosis of late neurologic abnormalities of the disorder has created the most difficulty. A recent phenomenon is that a number of poorly understood conditions, such as chronic fatigue syndrome or fibromyalgia, are misdiagnosed as "chronic Lyme disease." Part of the reason for misdiagnosis is due to problems associated with diagnostic tests. The various manifestations of Lyme disease can usually be treated successfully with oral doxycycline or amoxicillin, except for objective neurologic manifestations, which seem to require intravenous therapy. Vector control of thick-borne diseases has been difficult and, therefore, reduction of the risk of infection has been limited primarily to personal protection measures.
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PMID:Lyme disease: a growing threat to urban populations. 814 26

It is now the most common vector-borne disease in the United States. But because of misdiagnosis, the spread of this disease may also be more apparent than real. Lack of standardized serologic tests and varying clinical presentations do create confusion. Nevertheless, it is possible to distinguish Lyme disease from look-alike disorders, such as chronic fatigue syndrome and fibromyalgia.
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PMID:Current understanding of Lyme disease. 846 65

A multidisciplinary referral center was established at a university hospital for prospectively assessing patients with possible Lyme disease. Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public. Sixty-five patients were referred for suspected Lyme borreliosis. Detailed histories were obtained and physical examinations were performed; patients were investigated aggressively in accordance with their symptom complexes. Strict diagnostic criteria consistent with published standards were applied. Only two of the 65 patients were judged to have probable Lyme disease. Definite major alternate diagnoses were made for 50 patients (77%); firm medical diagnoses (11 dermatologic, 9 rheumatologic, 9 infectious disease, 6 gastrointestinal, 4 neurological, and 2 miscellaneous) were made for 41 patients (63%); and major psychiatric diagnoses were made for 9 patients (14%). Probable diagnoses of chronic fatigue syndrome and fibromyalgia were made for 11 patients (17%). The conditions of four patients (6%) were undiagnosed. A referral center for patients with suspected Lyme disease can be useful even in an area of nonendemicity, and careful clinical assessment will reveal treatable alternate diagnoses for many patients with suspected Lyme disease.
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PMID:Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. 851 65

A new version of Lyme's disease classification based on the authors' experience and other classifications is proposed. It distinguishes periods of the disease (acute, subacute, chronic) and stages (I--isolated erythema migrans, II--local disseminated infection, III--generalized disseminated infection) as well as the signs which are significant in Lyme's disease diagnosis: erythematous and nonerythematous form, seropositivity or seronegativity against Borrelia burgdorferi. Subclinical (latent) infection, complications of Lyme's disease (fibromyalgia syndrome, chronic fatigue syndrome, etc.) and mixed-infection with tick-borne viral encephalitis are included as well.
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PMID:[The classification of Lyme borreliosis (Lyme disease)]. 857 Dec 52

The involvement of the nervous system is common during Lyme's disease, and the term neuroborreliosis has been established. All structures of the nervous system, from meninges to periferial nerves, can be involved. Neurological manifestations are most common in the second stage (dissemination). The article deals with the most important neurological manifestations, as well as with the contemporary pathogenetic considerations and therapy. Eleven patients with neuroborreliosis who were treated at Dr. Kosta Todorovitsh Institute of Infectious and Tropical Diseases, are reviewed. Five of them had acute meningoencephalitis, of whom two had concurrent neuritis; one patient had Banawart's syndrome with arthralgias, arthritis and fatigue syndrome; two patients had neuritis; one had bilateral facial palsy; two had chronic fatigue syndrome.
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PMID:[Neural manifestations in Lyme disease (Lyme borreliosis of the nervous system)]. 910 26


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