{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:37:02Z","timestamp":1773099422973,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,9]],"date-time":"2023-04-09T00:00:00Z","timestamp":1680998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Lyme disease, caused by Borrelia burgdorferi (Bb) infection, has a broad spectrum of clinical manifestations and severity. Patients with possible Lyme disease may seek out or be referred to rheumatologists. Today, the most common reason to engage a rheumatologist is due to complaints of arthralgia. After skin, neurologic manifestations of Lyme disease are now among the most common. Therefore, it is important for rheumatologists to be aware of clues that suggest neurologic Lyme disease and prompt help from a neurologist experienced with Lyme disease.<\/jats:p>","DOI":"10.3390\/pathogens12040576","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T03:26:06Z","timestamp":1681097166000},"page":"576","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Common Neurologic Features of Lyme Disease That May Present to a Rheumatologist"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-0358","authenticated-orcid":false,"given":"Swati","family":"Govil","sequence":"first","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Capitle","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Lacqua","sequence":"additional","affiliation":[{"name":"Department of Medicine, Florida Atlantic University, Boca Raton, FL 33486, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reena","family":"Khianey","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.K.","family":"Coyle","sequence":"additional","affiliation":[{"name":"Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7893-6509","authenticated-orcid":false,"given":"Steven E.","family":"Schutzer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/art.1780200102","article-title":"Lyme arthritis: An epidemic of oligoarticular arthritis in children and adults in three connecticut communities","volume":"20","author":"Steere","year":"1977","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJM198303313081301","article-title":"The spirochetal etiology of Lyme disease","volume":"308","author":"Steere","year":"1983","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1056\/NEJM198303313081302","article-title":"Spirochetes isolated from the blood of two patients with Lyme disease","volume":"308","author":"Benach","year":"1983","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3201\/eid2702.202731","article-title":"Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010\u20132018","volume":"27","author":"Kugeler","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e01895-20","DOI":"10.1128\/AAC.01895-20","article-title":"Patients with Erythema Migrans: Characterizing the Impact of Initiation of Antibiotic Therapy Prior to Study Enrollment","volume":"65","author":"Wormser","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/0738-081X(93)90090-Y","article-title":"Erythema migrans","volume":"11","author":"Berger","year":"1993","journal-title":"Clin. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1128\/jcm.30.2.359-361.1992","article-title":"Cultivation of Borrelia burgdorferi from erythema migrans lesions and perilesional skin","volume":"30","author":"Berger","year":"1992","journal-title":"J. Clin. Microbiol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S1475","DOI":"10.1093\/clinids\/11.Supplement_6.S1475","article-title":"Dermatologic manifestations of Lyme disease","volume":"11","author":"Berger","year":"1989","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"421","DOI":"10.7326\/0003-4819-136-6-200203190-00005","article-title":"Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans","volume":"136","author":"Smith","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"815","DOI":"10.3201\/eid1905.120796","article-title":"Atypical erythema migrans in patients with PCR-positive Lyme disease","volume":"19","author":"Schutzer","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_11","unstructured":"CDC (2023, March 21). Lyme Disease Rashes and Look-Alikes, Available online: https:\/\/www.cdc.gov\/lyme\/signs_symptoms\/rashes.html."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e00479","DOI":"10.1016\/j.idcr.2018.e00479","article-title":"Acute transverse myelitis-A rare clinical manifestation of Lyme neuroborreliosis","volume":"15","author":"Dumic","year":"2018","journal-title":"IDCases"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3389\/fneur.2017.00146","article-title":"Cerebrovascular Manifestations of Lyme Neuroborreliosis\u2014A Systematic Review of Published Cases","volume":"8","author":"Garkowski","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Teles, C., Gaspar, E., Gon\u00e7alo, M., and Santos, L. (2022). Normocomplementemic urticarial vasculitis secondary to Lyme disease: A rare association with challenging treatment. J. R. Coll. Physicians Edinb., 14782715221144167.","DOI":"10.1177\/14782715221144167"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/S0190-9622(08)81019-5","article-title":"Urticarial vasculitis and Lyme disease","volume":"22","author":"Olson","year":"1990","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Johnson, K.O., Nelder, M.P., Russell, C., Li, Y., Badiani, T., Sander, B., Sider, D., and Patel, S.N. (2018). Clinical manifestations of reported Lyme disease cases in Ontario, Canada: 2005\u20132014. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198509"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1086\/432935","article-title":"Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions","volume":"41","author":"Wormser","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1093\/cid\/ciy614","article-title":"Direct Diagnostic Tests for Lyme Disease","volume":"68","author":"Schutzer","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e00018-19","DOI":"10.1128\/CMR.00018-19","article-title":"Laboratory Diagnosis of Lyme Borreliosis","volume":"34","author":"Branda","year":"2021","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1055\/s-2008-1041176","article-title":"Neurologic Lyme disease","volume":"12","author":"Coyle","year":"1992","journal-title":"Semin. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/ana.25389","article-title":"Lyme Neuroborreliosis: Clinical Outcomes, Controversy, Pathogenesis, and Polymicrobial Infections","volume":"85","author":"Benach","year":"2019","journal-title":"Ann. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/s11910-005-0032-1","article-title":"Central nervous system Lyme disease","volume":"5","author":"Halperin","year":"2005","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1055\/s-2008-1040910","article-title":"Lyme encephalopathy: A neuropsychological perspective","volume":"17","author":"Kaplan","year":"1997","journal-title":"Semin. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1093\/cid\/cix943","article-title":"Advances in Serodiagnostic Testing for Lyme Disease Are at Hand","volume":"66","author":"Branda","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e01943-17","DOI":"10.1128\/JCM.01943-17","article-title":"Evaluation of Modified Two-Tiered Testing Algorithms for Lyme Disease Laboratory Diagnosis Using Well-Characterized Serum Samples","volume":"56","author":"Schriefer","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1056\/NEJM199401273300401","article-title":"Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis","volume":"330","author":"Nocton","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/0163-4453(92)93966-T","article-title":"CSF findings in Lyme meningitis","volume":"25","author":"Lakos","year":"1992","journal-title":"J. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/ana.410280603","article-title":"Cerebrospinal fluid immune complexes in patients exposed to Borrelia burgdorferi: Detection of Borrelia-specific and-nonspecific complexes","volume":"28","author":"Coyle","year":"1990","journal-title":"Ann. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1086\/508667","article-title":"The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America","volume":"43","author":"Wormser","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa1215","article-title":"Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease","volume":"72","author":"Lantos","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1002\/art.1780370616","article-title":"Treatment of lyme arthritis","volume":"37","author":"Steere","year":"1994","journal-title":"Arthritis Rheum."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1056\/NEJM200107123450202","article-title":"Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease","volume":"345","author":"Klempner","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1212\/01.WNL.0000071227.23769.9E","article-title":"Study and treatment of post Lyme disease (STOP-LD): A randomized double masked clinical trial","volume":"60","author":"Krupp","year":"2003","journal-title":"Neurology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1212\/01.WNL.0000284604.61160.2d","article-title":"A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy","volume":"70","author":"Fallon","year":"2008","journal-title":"Neurology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5719081","DOI":"10.1155\/2018\/5719081","article-title":"\"Ticking Bomb\": The Impact of Climate Change on the Incidence of Lyme Disease","volume":"2018","author":"Dumic","year":"2018","journal-title":"Can. J. Infect. Dis. Med. 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