The first case of Lyme disease-related
stroke occurred in a forest worker.
(Translated by Lei Sheu, Pittsburgh ,PA)
On May 6, a Yuli
resident who worked for the Forest department was rushed to
the Tzu Chi Medical center because of a persistent, high fever
and loss of sensation over the right side of his body. He was
diagnosed as having Lyme disease. After emergency treatment,
the patient's critical condition resolved, and was transferred
to regular care. In addition to typical Lyme disease symptoms,
namely high fever and organ failure, he also suffered from a
stroke (blood clot in the brain), an unusual complication.
Mr. Chu, a fifty-six year old forest worker,
complained of episodic fevers, coughing, and sore throat since
he came home one day after work in late April. A week later,
he felt very weak and had difficulty raising his arms or talking.
On May 6, he was sent to the Haulian Tzu Chi Medical center
emergency room. A brain MRI demonstrated cerebral hemorrhage
in the left hemisphere consistent with a stroke. The patient
was immediately transferred to the intensive care unit in the
general medicine division.
Physical examination revealed that the patient
had a 4 cm2 lesion over his scrotum. Initial laboratory studies
indicated that he had a very low platelet count and was suffering
from liver failure. The patient was given antibiotics without
improvement. Further review of his medical history revealed
that he worked in the Yulin Forest, an area endemic for Lyme
disease. Based on the symptoms of high fever, organ failure,
and a scab over a sore, the patient was diagnosed as suffering
from Lyme disease. A special medication was given. Within one
day after treatment began, the patient exhibited significant
improvement. He was transferred out of the intensive care unit
on May 9.
According to Dr. Wang Li Sing, Vice President
of Tzu Chi Medical Center, Mr. Chu's symptoms are typical of
Lyme disease. Lyme disease is also known as Jungle Typhus. The
disease is transmitted to humans by infected ticks when they
bite the skin and pass the organisms through saliva entering
the wound. Ticks usually gather in warm humid bushes and overgrowth.
Once in a human host, the organism incubates for about 9 to
12 days. The bite area appears as an expanding rash known as
erythema migrans. Signs and symptoms can include meningitis,
lymphadenopathy (abnormal enlargement of the lymph nodes, persistent
fever, headache, liver failure, and severe anemia, as well as
low leukocyte and platelet counts.
Dr. Wang advocates prevention for Lyme diease.
Eastern Taiwan is an endemic area. He urges those who frequently
work and travel outdoors not to enter bushy or overgrown areas
unless necessary. Always wear long clothing, boots, and avoid
exposing skin. When entering the ticks' habitat, be sure to
put on insect repellant and re-apply it every 4 to 8 hours,
or take doxycycline, an antibiotic, as prescribed by your doctor.
Once leaving potentially dangerous areas, one should bath and
scrape the skin. Change and examine all clothing for ticks.
Mr. Chu's case was unusual because he suffered a stroke, a complication
of Lyme disease which has never been reported in the medical
literature. The patient's low platelet count may have allowed
a ruptured artery to continue bleeding without clotting. Mr.
Chu is now able to control his arms and legs. Although still
weak, he appears alert and oriented. Mr. Chu suffers from some
amnesia due to his stroke. His initially uncertain diagnosis
almost cost him his life. Luckily, a physician reviewed his
medical history and made a correct diagnosis.
(Note: More information about Lyme
Disease regarding symptoms, diagnosis, treatment, and prevention
can be found in the American Lyme Disease Foundation, Inc web
site http://www.aldf.com/templates/Lyme.cfm
)
