Treatment of Erythema Migrans
Malnutrition Any disorder of nutrition specifically, either the deficit of efficient or substantive food substances in the body or the inability of the body to properly absorb food substances. Physical signs of malnutrition and deficiency state in adolescents and adults include nasolabial sebaceous plugs sores at the corners of the mouth Vincent's angina red, swollen lingual papillae glossitis papillary atrophy of tongue stomatitis spongy, bleeding gums muscle tenderness in extremities poor muscle tone loss of vibratory sensation increase or decrease of tendon reflexes hyperesthesia of skin bilateral symmetrical dermatitis purpura dermatitis thickening and pigmentation of skin over bony prominences nonspecific vaginitis follicular hyperkeratosis of extensor surfaces of extremities rachitic chest deformity anemia not responding to iron fatigue of visual accommodation vasculariza-tion of cornea and conjunctival changes.
The tongue may be affected by squamous cell carcinoma and herpes simplex infection (see Chapter 1). Occasionally the tongue may be pigmented, which is not pathological. Glossitis, manifest by a smooth, red, swollen, painful tongue occurs for example, with B-vitamin deficiencies.
Clinical signs of deficiency are often associated with damage to the epithelium but are non-specific. For example, cracks in the corners of the mouth (angular stomatitis) are frequently linked to riboflavin deficiency but can also occur in other water-soluble, vitamin-deficient states e.g. niacin, pyridoxine and folate. Cracked lips (cheilosis), swollen red beefy tongue (glossitis) and scrotal dermatitis are also associated with the deficiency. In experimental studies, growth inhibition is a typical sign of severe deficiency. In developing countries, poor growth is characteristic in many infants and children and riboflavin deficiency undoubtedly contributes to the problem.
Bennet and Berglund (2002) studied all patients diagnosed with erythema migrans (EM) following vector-borne infection by Lyme borreliosis (LB) some 10 years earlier. They contacted all these patients and asked if they had had any new tick bites over the period May 1993 to May 1998. From the 976 infected and eligible for the study, 708 participants replied and from these a reinfection rate of 4 was computed.
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