Disease Confirmation
- Disease name: "Lyme disease (라임병)" — This is the medically accurate disease name. It is an infectious disease transmitted by ticks of the Ixodes group that carry Borrelia species bacteria, mainly Borrelia burgdorferi and others.
1) Disease Description (Causes and Symptoms)
- Causes and pathophysiology
- Causative organism: Borrelia species (spirochete) bacteria. The vector is mainly ticks of the Ixodes genus, which belong to the house dust mite lineage.
- Transmission: When an infected tick bites a person and remains attached for several dozen hours or longer, the bacteria may penetrate through the skin into the bloodstream and lymphatic system and spread throughout the body.
- Pathophysiology: Initial localized infection (skin) → hematogenous spread → invasion of the nervous system, joints, heart, and other areas, causing various systemic symptoms and chronic inflammation.
- Main symptoms
- Early stage (localized): Erythema migrans (a typical circular or expanding rash) — develops within several days to several weeks after a tick bite.
- Systemic symptoms: Fever, chills, headache, muscle pain, joint pain, fatigue, sleep disturbance, nausea, malaise, and others.
- Nervous system: Facial paralysis (Bell’s palsy), meningitis-like symptoms, peripheral neuropathy, and reduced memory or concentration.
- Heart: Myocarditis or cardiac conduction disorders (AV block) may occur.
- Joints: Recurrent or chronic arthritis (especially of the knee) — the likelihood increases when treatment is delayed.
- Eye involvement: Eye-related symptoms such as conjunctivitis or uveitis may occur (reported in some cases).
- Clinical course (generally 3 stages)
- Stage 1 (early localized, several days to several weeks): Erythema migrans + systemic symptoms.
- Stage 2 (early disseminated, several weeks to several months): Skin, neurological, and cardiac symptoms in multiple areas.
- Stage 3 (late/chronic, several months to several years): Recurrent arthritis, chronic neurological symptoms, and others.
2) Treatment Methods
- Basic principles
- When diagnosed early, the likelihood of a cure with antibiotic treatment is high.
- The medications and treatment duration vary depending on the disease stage (localized/systemic/severe neurological or cardiac involvement).
- Medication treatment (general standard)
- Mild early localized or non-severe systemic disease: Doxycycline, Amoxicillin, or Cefuroxime axetil — usually for 10–21 days.
- Severe neurological or cardiac involvement (e.g., neuroborreliosis, myocarditis, high-grade AV block): After hospitalization, intravenous antibiotics (e.g., Ceftriaxone) for 14–28 days or longer.
- Children and pregnancy: Age and pregnancy status should be considered when selecting medication (e.g., Amoxicillin or another alternative may be used in children and pregnant women). The exact medication and dosage should be determined by the treating physician.
- Non-medication treatment
- Analgesic anti-inflammatory drugs to relieve symptoms, and physical therapy for the purpose of functional recovery after joint symptoms.
- Treatment by cardiology or neurology specialists in cases of severe complications (cardiac monitoring, cerebrospinal fluid testing, and others).
- Other
- Rarely, a Jarisch–Herxheimer reaction (temporary worsening such as fever and muscle pain) may occur after starting antibiotics.
- Preventive antibiotics (a single dose of Doxycycline) may be considered when specific criteria are met (tick species, attachment time, infection rate in the area, and others) — local guidelines and the treating physician’s judgment are required.
3) Checkpoints Before an Outpatient Visit (Including Example Questions)
- Items and records to prepare
- A list of all medications currently being taken (including prescription drugs, over-the-counter medications, herbal medicines, and supplements)
- Medical history (especially immunosuppression, allergies or a history of antibiotic side effects, and pregnancy status)
- The time symptoms began and their course (whether there was tick exposure; whether there was a rash, and if possible, take photographs and bring them)
- Records of changes in major symptoms such as fever, headache, facial paralysis, and joint swelling
- Results of previously performed blood tests, imaging, or serologic tests, if available
- Tests that may be performed during an outpatient visit
- Physical examination (checking for skin rash), serologic testing (ELISA → if usually positive, a confirmatory Western blot), and, if necessary, joint fluid, cerebrospinal fluid, or PCR testing.
- Example questions (items patients can prepare themselves)
- The exact date of the tick bite (or the period of exposure that can be remembered)
- When the rash began and how its size changed (photographs recommended)
- Fever patterns and whether other systemic symptoms occurred at the same time
4) General Examples of Questions to Ask the Doctor
- "What antibiotic will I be given if I am taking my current medications (or have a history of allergies)?"
- "How long will treatment last, and what course can I expect after treatment?"
- "What side effects or complications should I watch for during or after treatment?"
5) Examples of Disease-Specific Questions
- "Does this rash (including the photograph) look like erythema migrans? Do I need to start antibiotics?"
- "I have neurological symptoms (such as facial paralysis or reduced memory). Do I need additional tests (such as serologic testing or cerebrospinal fluid testing)? If so, which tests should I undergo and when?"
References and Precautions
- Clinical findings, especially erythema migrans, are the most important for diagnosis, and serologic tests may be negative in the early stage. If symptoms are suspicious, early treatment is important, so consult your treating physician.
- Prevention: Avoiding ticks (wearing long clothing and socks, using insect repellent containing DEET, treating clothing with Permethrin, and checking the entire body for ticks after outdoor activities), and promptly removing ticks (using tweezers to grasp the tick close to the skin and pull it out) are effective.
- Because there are regional endemic areas (e.g., the northeastern and central regions of the United States), inform your doctor of the location where exposure occurred.