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. 1984 Jul-Aug;57(4):453–464.

The clinical spectrum and treatment of Lyme disease.

A C Steere, S E Malawista, N H Bartenhagen, P N Spieler, J H Newman, D W Rahn, G J Hutchinson, J Green, D R Snydman, E Taylor
PMCID: PMC2590003  PMID: 6516448

Abstract

Lyme disease was recognized as a separate entity because of close geographic clustering of affected children in Lyme, Connecticut, with what was thought to be juvenile rheumatoid arthritis. It then became apparent that Lyme disease is a complex, multisystem disorder. The illness usually begins in summer with erythema chronicum migrans and associated symptoms (stage 1). Weeks to months later, some patients develop neurologic or cardiac abnormalities (stage 2), and weeks to years later, many patients develop intermittent attacks of arthritis (stage 3), which may become chronic, with erosion of cartilage and bone. Patients with severe and prolonged illness have an increased frequency of the B-cell alloantigen, DR2. For patients with early Lyme disease, tetracycline appears to be the most effective drug, then penicillin, and finally erythromycin. High-dose intravenous penicillin is effective for the later stages of the disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. HOLLSTROM E. Successful treatment of erythema migrans Afzelius. Acta Derm Venereol. 1951;31(2):235–243. doi: 10.2340/0001555531235243. [DOI] [PubMed] [Google Scholar]
  2. Hörstrup P., Ackermann R. Durch Zecken übertragene Meningopolyneuritis (Garin-Bujadoux, Bannwarth. Fortschr Neurol Psychiatr Grenzgeb. 1973 Nov;41(11):583–606. [PubMed] [Google Scholar]
  3. Mast W. E., Burrows W. M., Jr Erythema chronicum migrans in the United States. JAMA. 1976 Aug 16;236(7):859–860. [PubMed] [Google Scholar]
  4. Reik L., Steere A. C., Bartenhagen N. H., Shope R. E., Malawista S. E. Neurologic abnormalities of Lyme disease. Medicine (Baltimore) 1979 Jul;58(4):281–294. doi: 10.1097/00005792-197907000-00001. [DOI] [PubMed] [Google Scholar]
  5. Scrimenti R. J. Erythema chronicum migrans. Arch Dermatol. 1970 Jul;102(1):104–105. [PubMed] [Google Scholar]
  6. Steere A. C., Bartenhagen N. H., Craft J. E., Hutchinson G. J., Newman J. H., Rahn D. W., Sigal L. H., Spieler P. N., Stenn K. S., Malawista S. E. The early clinical manifestations of Lyme disease. Ann Intern Med. 1983 Jul;99(1):76–82. doi: 10.7326/0003-4819-99-1-76. [DOI] [PubMed] [Google Scholar]
  7. Steere A. C., Batsford W. P., Weinberg M., Alexander J., Berger H. J., Wolfson S., Malawista S. E. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980 Jul;93(1):8–16. doi: 10.7326/0003-4819-93-1-8. [DOI] [PubMed] [Google Scholar]
  8. Steere A. C., Brinckerhoff C. E., Miller D. J., Drinker H., Harris E. D., Jr, Malawista S. E. Elevated levels of collagenase and prostaglandin E2 from synovium associated with erosion of cartilage and bone in a patient with chronic Lyme arthritis. Arthritis Rheum. 1980 May;23(5):591–599. doi: 10.1002/art.1780230511. [DOI] [PubMed] [Google Scholar]
  9. Steere A. C., Hutchinson G. J., Rahn D. W., Sigal L. H., Craft J. E., DeSanna E. T., Malawista S. E. Treatment of the early manifestations of Lyme disease. Ann Intern Med. 1983 Jul;99(1):22–26. doi: 10.7326/0003-4819-99-1-22. [DOI] [PubMed] [Google Scholar]
  10. Steere A. C., Malawista S. E., Hardin J. A., Ruddy S., Askenase W., Andiman W. A. Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Ann Intern Med. 1977 Jun;86(6):685–698. doi: 10.7326/0003-4819-86-6-685. [DOI] [PubMed] [Google Scholar]
  11. Steere A. C., Malawista S. E., Newman J. H., Spieler P. N., Bartenhagen N. H. Antibiotic therapy in Lyme disease. Ann Intern Med. 1980 Jul;93(1):1–8. doi: 10.7326/0003-4819-93-1-1. [DOI] [PubMed] [Google Scholar]
  12. Steere A. C., Malawista S. E., Snydman D. R., Shope R. E., Andiman W. A., Ross M. R., Steele F. M. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum. 1977 Jan-Feb;20(1):7–17. doi: 10.1002/art.1780200102. [DOI] [PubMed] [Google Scholar]
  13. Steere A. C., Pachner A. R., Malawista S. E. Neurologic abnormalities of Lyme disease: successful treatment with high-dose intravenous penicillin. Ann Intern Med. 1983 Dec;99(6):767–772. doi: 10.7326/0003-4819-99-6-767. [DOI] [PubMed] [Google Scholar]

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