Borrelioosin oireet diagnosoidaan usein virheellisesti

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"Viime kesänä 3-vuotias Colin McMahon alkoi käyttäytyä oudosti. Hän ei kyennyt kohdistamaan huomiotaan oikein, hän pyyhki käsillään kasvojaan kekskeytymättä ja oli erittäin ahdistunut, hän ei kyennyt esim. menemään huoneeseensa yksinään.

Borrelioosi on USA:ssa yleisin hyönteisten välittämä sairaus. Bakteeria levittävät hyttyset, punkit ja kirput. Uusia tautitapauksia arvioidaan olevan 20 000 vuodessa. Diagnosoimattomien tapausten määrä on todennäköisesti erittäin suuri.

Tautitapauksia on eniten ikäryhmissä 55-69 ja 5-14. Borrelioosin oireet ovat moninaiset jonka vuoksi niitä on vaikea tunnistaa esim. lapsissa, sanoo tri Kari Bovenzi joka hoitaa Borrelioosiin sairastuneita lapsia. Lapset eivät osaa kertoa oireistaan eivätkä he tiedä mikä on epänormaalia.

Harva tartunnan saanut on nähnyt punkkia ihollaan ja ihomuutos tulee vain noin 7%:lle. Sen lisäksi borreliatestit ovat epäluotettavia. On vaikea saada selville oireiden todellista syytä. Borrelia-bakteeri menee mihin tahansa elimeen, myös aivoihin jossa se aiheuttaa laajan oireiden kirjon esim. keskittymisvaikeuksia, muistiongelmia, ärtyneisyyttä, uupumusta, kuumetta, kipuja, puhevaikeuksia, kasvohalvauksen jne, sanoo Bovenzi.

Borrelia-bakteerin aiheuttamat oireet diagnosoidaan usein virheellisesti esim. tarkkaavaisuushäiriöksi, erilaisiksi käyttäytymisongelmiksi, jopa autismiksi.

Bovenzi järjesti juuri luennon Borrelioosista käytännön työtä tekeville lääkäreille mutta paikalle saapui vain muutamia. Bovenzin mukaan lääkäreiden tulee lisätä tietojaan Borrelioosista. Borrelia-bakteerin osuus potilaiden oireisiin tulee huomioida entistä paremmin.

Teini-ikäinen Allison Accetella alkoi voida huonosti. Hänellä oli toistuvia kuumeita, hän nukkui 14-16 tuntia vuorokaudessa, nivelet kipeytyivät ja kävely vaikeutui. Hänen täytyi lopettaa urheileminen. Lääkäreiden mukaan Allison oli masentunut ja kuvitteli oireensa. Syyskuussa Allison heräsi eräänä aamuna kovaan kasvokipuun. Kasvojen vasen puoli oli halvaantunut - tyypillinen oire Borrelioosissa.

Laboratoriotestit vahvistivat kliinisen diagnoosin. Allison sai 3 viikon antibioottihoidon. Hoito ei auttanut.

Borrelioosin hoidossa on toisistaan poikkeavia näkemyksiä. Amerikan infektiolääkärien yhdistyksen (IDSA) jäsenistä osa suosittelee lyhyitä hoitoja, Kansainvälinen Borrelioosijärjestö suosittelee hoitojen jatkamista kunnes potilas voi hyvin.

Allison kävi usean infektiolääkärin vastaanotolla eri puolilla maata. Häntä kehotettiin hakeutumaan psykologiseen arviointiin. Yksi kehotti häntä syömään enemmän vihanneksia ja nukkumaan vähemmän. "Oli erittäin turhauttavaa kun oireisiini ei uskottu, hän sanoo."

Viimein Allison tapasi tri Bovenzin joka aloitti antibioottihoidot uudelleen. Nyt Allison kykenee taas kävelemään. Myös Colin saa antibiootteja ja voi 90% paremmin. Colinin äiti on perustanut valtakunnallisen Borrelioosijärjestön Borrelioosiin sairastuneille perheille (info@childrenslymenetwork.org).

Borrelia-bakteerin aiheuttamia oireita lapsissa: Esim. ihomuutos (ei tarvitse olla rengasmainen, muutkin ihomuutokset ovat mahdollisia), nuhaoireet, päänsärky, niskajäykkyys, lihaskivut, nivelkivut, uupumus, ruokahaluttomuus, kipeä kurkku, turvonneet rauhaset, neurologiset ongelmat, silmäoireet, heikotus, keskittymisvaikeus, ahdistus, pakko-oireet jne."

http://www.timesunion.com/local/article ... z1MKLKRI9T
Lyme disease: Focus on a shadowy ailment

Pediatrician seeks to raise awareness of prevalence of Lyme disease among youth

By CATHLEEN F. CROWLEY Staff writer

Updated 09:24 a.m., Thursday, May 12, 2011

Last summer, 3-year-old Colin McMahon started acting strange. He couldn't focus, he swiped his hands over his face nonstop, and he became anxious -- to the point where he wouldn't go into a room by himself.

Colin's parents finally figured out what was wrong: The boy had Lyme disease.

Lyme is the most common of all the diseases in the United States transmitted by mosquitoes, ticks and fleas, with approximately 20,000 cases reported each year nationally. New York has the second-highest rate of Lyme in the United States, with nearly 6,000 cases reported in 2009. Public health officials say the number of undiagnosed cases is probably higher than that.

Most illness occurs in June, July and August, when the infected ticks are most active. Bartholomew Forlano, a veterinarian at the Glenville Veterinary Clinic, said this year's cool, wet spring is the perfect climate for ticks, and he is seeing many of the critters in his practice.

The incidence of Lyme among humans is highest in two age groups: adults between 55 and 69 and children between 5 and 14, particularly boys.

"He was so young, and I thought he was going through a phase," said Darlene McMahon, Colin's mother, who lives near Plattsburgh.

Lyme symptoms come in many forms and are hard to pin down in children, said Dr. Kari Bovenzi, an Albany pediatrician who treats many kids with the ailment.

Children have trouble explaining their symptoms and don't have a reference point for what is normal, Bovenzi said. The tick itself is rarely seen and the bull's-eye rash associated with Lyme only appears in 7 percent of cases, she said. On top of that, tests for Lyme are unreliable.

"It's tricky to prove what is going on," Bovenzi said.

Lyme can attack any organ in the body, including the brain, leading to a befuddling spectrum of symptoms in children that might include poor concentration, short-term memory problems, irritability, fatigue, fever, body pain, speech problems, facial paralysis and seizures.

Consequently, Lyme has been misdiagnosed as attention deficit disorder, behavioral problems and even autism, Bovenzi said.

The pediatrician has organized lectures aimed at training physicians about Lyme, but only a handful of doctors showed up.

She said pediatricians need to be educated about the disease, especially in New York where Lyme is widespread. And if they have a patient with inexplicable symptoms, "You better think about Lyme."

Doctors told Allison Accettella that she was depressed, and that her aches and pains were in her head.

But the Saratoga Springs teenager knew something was wrong physically. Last summer, she started sleeping 14 to 16 hours a day, she had reoccurring fevers, and her joints hurt so much she could barely walk. Allison gave up lacrosse, a sport she loved, and had to be tutored at home because she physically couldn't make it to Saratoga Springs High School.

In September, Allison woke up with an excruciating pain in her face. The left side of her face was paralyzed, a sign of Bell's palsy and a trademark of Lyme disease. Blood tests confirmed that she had Lyme, and Allison was put on three weeks of antibiotics, the mainstream treatment for the illness. It didn't help.

There is a split in the medical community over Lyme disease. The Infectious Disease Society of America recommends treating suspected Lyme cases with a short course of antibiotics and, if the symptoms persist, with another four weeks of antibiotics. The International Lyme and Associated Diseases Society recommends longer courses of antibiotics that end when the patient feels better.

Allison went to several infectious disease experts across the state. They told her she needed a psychological evaluation. One instructed her "to eat more vegetables and stop sleeping so much."

It broke her heart.

"It was so upsetting that nobody believed me," she said.

Then Allison found Dr. Bovenzi, who put her back on antibiotics. Allison is walking again and attends school as much as she can in addition to receiving home tutoring.

Colin is also on antibiotics and 90 percent of his symptoms are gone, his mother said. McMahon has started a national group to connect families of children infected by Lyme and educate people about the variety of symptoms that accompany the disease. The group is called the Children's Lyme Disease Network and can be reached at info@childrenslymenetwork.org.

"Our hope is to really promote awareness, specifically for children," McMahon said.

Reach Cathleen F. Crowley at 454-5348 or ccrowley@timesunion.com. Visit her blog at http://blogs.timesunion.com/healthcare

Staying healthy

Tips for preventing Lyme disease in children:

At the end of the day, remove clothing outside the bedroom to prevent a tick on the clothing from finding its way to the child.

Check the skin for ticks, particularly the underarms, belly button, groin, back of the head, and in and around the ears.

Avoid leaf piles and stacks of wood.

When outdoors, wear long sleeves and tuck pants into socks. Ticks can be spotted more easily on light colored clothing.

Walk on cleared paths and pavement through wooded areas and fields when possible.

Use insect repellent safely. The American Academy of Pediatrics says repellant with DEET should not be used on infants under 2 months old.

Shower after all outdoor activities. It may take up to four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.

Symptoms of Lyme in children: Bull's-eye rash, any rash, flu-like symptoms, headache, stiff neck, muscle aches, joint pain, fatigue, poor appetite, sore throat, swollen glands, joint selling, neurological problems, skin disorders, eye problems, weakness, problems with coordination, poor concentration, anxiety, and obsessive-compulsive behaviors.


Source: Centers for Disease Control and Prevention, Children's Hospital Boston and Dr. Kari Bovenzi


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