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lye

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(lī) 1. Liquid from leaching of wood ashes. 2. Any strong alkaline solution, esp. sodium or potassium hydroxide. SEE: alkali; potassium hydroxide; sodium hydroxide.

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lying-in

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1. Historical term for the puerperal state. 2. Being hospitalized for the purpose of childbearing.

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Lyme disease

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(līm) [Lyme, CT, where a cluster of cases was reported in 1975] ABBR: LD. A multisystem disorder caused by the spirochete Borrelia burgdorferi and the most common tick-borne disease in the U.S.

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INCIDENCE: The disease is endemic in New England, but cases have been reported in all 50 states and in 20 other countries, including Germany, Switzerland, France, and Australia. It occurs most often in the spring and summer, when its deer tick vectors (genus Ixodes) are most active. An estimated 300,000 cases of Lyme Disease occur each year in the U.S.

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CAUSES: The infected tick injects its spirochete-laden saliva into the bloodstream, where they incubate for 3 to 32 days and then migrate to the skin, causing the characteristic erythema migrans (EM) rash.

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SYMPTOMS AND SIGNS: The course of Lyme disease is divided into three stages: 1) localized infection, which begins with the tick bite and proceeds as above; 2) disseminated infection, which begins weeks to months later. The spirochetes spread to the rest of the body through the blood, in some cases causing arthritis (esp. of the knee joints), muscle pain, cardiac dysrhythmias, pericarditis, lymphadenopathy, or meningoencephalitis. Nonprotective antibodies develop during this stage; and 3) chronic infection, which begins weeks to years after the initial bite. Patients develop mild to severe arthritis, encephalitis, or both, which are rarely fatal.

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DIAGNOSIS: The disease is best diagnosed by the presence of EM, which begins as a red macule or papule at the site of the tick bite and expands in a red ring, leaving a clear center like a target or bull's eye. The lesion usually feels hot and itchy and may grow to over 20 in (50.8 cm) as more lesions erupt. The lesion is later replaced by red blotches or diffuse urticaria. Conjunctivitis, malaise, fatigue, and flulike symptoms and lymphadenopathy may occur. Positive blood cultures, or cultures of joint fluid or skin biopsy specimens are also diagnostic. Antibody tests for B. burgdorferi with an enzyme-linked immunosorbent assay (ELISA) test are also used for diagnosis in patients with a history of exposure and signs and symptoms of Lyme disease but with no evidence of rash. The antibodies are developed against flagellar and outer surface proteins on the spirochete.

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PREVENTION: The CDC recommends that people should discuss with their health care providers the possibility of getting a Lyme disease vaccination if they are between 15 and 70 years old; live, work, or vacation in endemic areas; or ...

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