Retired Adjunct Faculty, Physical Therapy Department, Springfield College, 263 Alden Street, Springfield, MA 01109 USA.
Phys Ther. 2021 Aug 1;101(8). doi: 10.1093/ptj/pzab128.
The most commonly reported vector-borne and tick-borne disease in the United States is Lyme disease. Individuals with Lyme disease may present with a wide array of symptoms with resultant musculoskeletal, neurological, and cardiac manifestations that may cause them to seek physical therapist services. The symptoms may develop insidiously and with a variable presentation among individuals. Many persons with Lyme disease do not recall a tick bite or present with an erythema migrans rash, which is considered pathognomonic for the disease. Even if they do, they may fail to associate either with their symptoms, making the diagnosis elusive. It is important to diagnose individuals early in the disease process when antibiotic treatment is most likely to be successful. Physical therapists are in a unique position to recognize the possibility that individuals may have Lyme disease and refer them to another practitioner when appropriate. The purpose of this article is to (1) present an overview of the etiology, incidence, and clinical manifestations of Lyme disease, (2) review evaluation findings that should raise the index of suspicion for Lyme disease, (3) discuss the use of an empirically validated tool for differentiating those with Lyme disease from healthy individuals, (4) discuss the current state of diagnostic testing, and (5) review options for diagnosis and treatment available to individuals for whom referral is recommended.
在美国，最常见的虫媒和蜱传疾病是莱姆病。莱姆病患者可能出现多种症状，导致肌肉骨骼、神经和心脏表现，这可能使他们寻求物理治疗师的服务。这些症状可能会逐渐出现，且在个体之间表现形式多样。许多莱姆病患者不记得被蜱叮咬过，或者没有出现被认为是该病特征性的游走性红斑皮疹。即使他们有这些症状，也可能不会将其与自己的症状联系起来，从而使诊断变得难以捉摸。重要的是要在疾病早期进行诊断，因为此时抗生素治疗最有可能成功。物理治疗师具有独特的地位，可以识别出患者可能患有莱姆病，并在适当的时候将其转介给其他医生。本文的目的是：（1）介绍莱姆病的病因、发病率和临床表现概述；（2）回顾应引起莱姆病怀疑的评估结果；（3）讨论用于区分莱姆病患者和健康个体的经验证工具的使用；（4）讨论当前的诊断检测状态；（5）审查为推荐转诊的患者提供的诊断和治疗选择。
