Lyme Disease Essays - Rheumatology, Lyme Disease, RTT, Arthritis

Lyme Disease Essays - Rheumatology, Lyme Disease, RTT, Arthritis Lyme Disease Lyme Arthritis Lyme disease is a tick-transmitted inflammatory disorder characterized by an early focal skin lesion, and subsequently a growing red area on the skin (erythema chronicum migrans or ECM). The disorder may be followed weeks later by neurological, heart or joint abnormalities. Symptomatology The first symptom of Lyme disease is a skin lesion. Known as erythema chronicum migrans, or ECM, this usually begins as a red discoloration (macule) or as an elevated round spot (papule). The skin lesion usually appears on an extremity or on the trunk, especially the thigh, buttock or the under arm. This spot expands, often with central clearing, to a diameter as large as 50 cm (c. 12 in.). Approximately 25% of patients with Lyme disease report having been bitten at that site by a tiny tick 3 to 32 days before onset of ECM. The lesion may be warm to touch. Soon after onset nearly half the patients develop multiple smaller lesions without hardened centers. ECM generally lasts for a few weeks. Other types of lesions may subsequently appear during resolution. Former skin lesions may reappear faintly, sometimes before recurrent attacks of arthritis. Lesions of the mucous membranes do not occur in Lyme disease. The most common symptoms accompanying ECM, or preceding it by a few days, may include malaise, fatigue, chills, fever, headache and stiff neck. Less commonly, backache, muscle aches (myalgias), nausea, vomiting, sore throat, swollen lymph glands, and an enlarged spleen may also be present. Most symptoms are characteristically intermittent and changing, but malaise and fatigue may linger for weeks. Arthritis is present in about half of the patients with ECM, occurring within weeks to months following onset and lasting as long as 2 years. Early in the illness, migratory inflammation of many joints (polyarthritis) without joint swelling may occur. Later, longer attacks of swelling and pain in several large joints, especially the knees, typically recur for several years. The knees commonly are much more swollen than painful; they are often hot, but rarely red. Baker's cysts (a cyst in the knee) may form and rupture. Those symptoms accompanying ECM, especially malaise, fatigue and low-grade fever, may also precede or accompany recurrent attacks of arthritis. About 10% of patients develop chronic knee involvement (i.e. unremittent for 6 months or longer). Neurological abnormalities may develop in about 15% of patients with Lyme disease within weeks to months following onset of ECM, often before arthritis occurs. These abnormalities commonly last for months, and usually resolve completely. They include: 1. lymphocytic meningitis or meningoencephalitis 2. jerky involuntary movements (chorea) 3. failure of muscle coordination due to dysfunction of the cerebellum (cerebellar ataxia) 4. cranial neuritis including Bell's palsy (a form of facial paralysis) 5. motor and sensory radiculo-neuritis (symmetric weakness, pain, strange sensations in the extremities, usually occurring first in the legs) 6. injury to single nerves causing diminished nerve response (mononeuritis multiplex) 7. inflammation of the spinal cord (myelitis). Abnormalities in the heart muscle (myocardium) occur in approximately 8% of patients with Lyme disease within weeks of ECM. They may include fluctuating degrees of atrioventricular block and, less commonly, inflammation of the heart sack and heart muscle (myopericarditis) with reduced blood volume ejected from the left ventricle and an enlarged heart (cardiomegaly). When Lyme Disease is contracted during pregnancy, the fetus may or may not be adversely affected, or may contract congenital Lyme Disease. In a study of nineteen pregnant women with Lyme Disease, fourteen had normal pregnancies and normal babies. If Lyme Disease is contracted during pregnancy, possible fetal abnormalities and premature birth can occur. Etiology Lyme disease is caused by a spirochete bacterium (Borrelia Burgdorferi) transmitted by a small tick called Ixodes dammini. The spirochete is probably injected into the victim's skin or bloodstream at the time of the insect bite. After an incubation period of 3 to 32 days, the organism migrates outward in the skin, is spread through the lymphatic system or is disseminated by the blood to different body organs or other skin sites. Lyme Disease was first described in 1909 in European medical journals. The first outbreak in the United States occurred in the early 1970's in Old lyme, Connecticut. An unusually high incidence of juvenile

The Battle of Bataan - World War II

The Battle of Bataan - World War II Battle of Bataan - Conflict Dates: The Battle of Bataan was fought January 7 to April 9, 1942, during World War II (1939-1945). Forces Commanders Allies General Douglas MacArthurLieutenant General Jonathan WainwrightMajor General Edward King79,500 men Japanese Lieutenant General Masaharu Homma75,000 men Battle of Bataan - Background: Following the attack on Pearl Harbor on December 7, 1941, Japanese aircraft began conducting an aerial assault on American forces in the Philippines. In addition, troops moved against Allied positions on Hong Kong and Wake Island. In the Philippines, General Douglas MacArthur, commanding United States Army Forces in the Far East (USAFFE), began making preparations to defend the archipelago from the inevitable Japanese invasion. This included calling up numerous Filipino reserve divisions. Though MacArthur initially sought to defend the entire island of Luzon, prewar War Plan Orange 3 (WPO-3) called for USAFFE to withdraw to the highly defensible ground of the Bataan Peninsula, west of Manila, where it would hold out until relieved by the US Navy. Due to the losses sustained at Pearl Harbor, this was unlikely to occur. Battle of Bataan - The Japanese Land: On December 12, Japanese forces began landing at Legaspi in southern Luzon. This was followed by a larger effort in the north at Lingayen Gulf on December 22. Coming ashore, elements of Lieutenant General Masaharu Hommas 14th Army began driving south against Major General Jonathan Wainwrights Northern Luzon Force. Two days after the landings at Lingayen commenced, MacArthur invoked WPO-3 and began shifting supplies to Bataan while Major General George M. Parker prepared the peninsulas defenses. Steadily pushed back, Wainwright retreated through a succession of defensive lines over the next week. To the south, Major General Albert Jones Southern Luzon Force fared little better. Concerned about Wainwrights ability to keep the road to Bataan open, MacArthur directed Jones to move around Manila, which had been declared an open city, on December 30. Crossing the Pampanga River on January 1, the SLF moved towards Bataan while Wainwright desperately held a line between Borac and Guagua. On January 4, Wainwright began retreating towards Bataan and three days later USAFFE forces were within the peninsulas defenses. Battle of Bataan - The Allies Prepare: Stretching from north to south, the Bataan Peninsula is mountainous down its spine with Mount Natib in the north and the Mariveles Mountains in the south. Covered in jungle terrain, the peninsulas lowlands stretch to cliffs overlooking the South China Sea in west and beaches in the east along Manila Bay. Due to the topography, the peninsulas only natural harbor is Mariveles at its southern tip. As USAFFE forces assumed their defensive position, roads on the peninsula were limited a perimeter route that ran along the east coast from Abucay to Mariveles and then north up the west coast to Mauban and an east-west route between Pilar and Bagac. Defense of Bataan was divided between two new formations, Wainwrights I Corps in the west and Parkers II Corps in the east. These held a line stretching from Mauban east to Abucay. Due to the open nature of the ground around Abucay, fortifications were stronger in Parkers sector. Both corps commanders anchored their lines on Mount Natib, though th e mountains rugged terrain prevented them from being in direct contact forcing the gap to be covered by patrols. Battle of Bataan - The Japanese Attack: Though the USAFFE was supported by a large amount of artillery, its position was weakened due to a tenuous supply situation. The speed of the Japanese advance had prevented the large scale stockpiling of supplies and the number of troops and civilians on the peninsula exceeded prewar estimates. As Homma prepared to attack, MacArthur repeatedly lobbied leaders in Washington, DC for reinforcements and aid. On January 9, Lieutenant General Akira Nara opened the assault on Bataan when his troops advanced on Parkers lines. Turning back the enemy, II Corps endured heavy attacks for the next five days. By the 15th, Parker, who had committed his reserves, requested assistance from MacArthur. Anticipating this, MacArthur had already put the 31st Division (Philippine Army) and Philippine Division in motion towards II Corps sector. The following day, Parker attempted to counterattack with the 51st Division (PA). Though initially successful, the division later broke allowing the Japanese to threaten II Corps line. On January 17, Parker desperately attempted to restore his position. Mounting a series of attacks over the next five days, he managed to retake much of the lost ground. This success proved brief as intense Japanese air attacks and artillery forced II Corps back. By the 22nd, Parkers left was under threat as enemy forces moved through the rough terrain of Mount Natib. That night, he received orders to retreat south. To the west, Wainwrights corps fared somewhat better against troops led by Major General Naoki Kimura. Holding off the Japanese at first, the situation changed on January 19 when Japanese forces infiltrated behind his lines cutting off supplies to the 1st Regular Division (PA). When efforts to dislodge this force failed, the division was withdrawn and lost most of its artillery in the proces s. Battle of Bataan - Bagac-Orion Line: With the collapse of the Abucay-Mauban Line, USAFFE established a new position running from Bagac to Orion on January 26. A shorter line, it was dwarfed by the heights of Mount Samat which provided the Allies with an observation post overseeing the entire front. Though in a strong position, MacArthurs forces suffered from a lack of capable officers and reserve forces were minimal. As fighting had raged to the north, Kimura dispatched amphibious forces to land on the southwest coast of the peninsula. Coming ashore at Quinauan and Longoskayan Points on the night of January 23, the Japanese were contained but not defeated. Seeking to exploit this, Lieutenant General Susumu Morioka, who had superseded Kimura, dispatched reinforcements to Quinauan on the night of the 26th. Becoming lost, they instead established a foothold on Canas Point. Obtaining additional troops on January 27, Wainwright eliminated the Longoskayan and Quinauan threats. Tenaciously defending Canas Point, the Japanese w ere not expelled until February 13. As the Battle of the Points raged, Morioka and Nara continued assaults on the main USAFFE line. While attacks on Parkers corps were turned back in heavy fighting between January 27 and 31, Japanese forces succeeded in breaching Wainwrights line via the Toul River. Quickly closing this gap, he isolated the attackers into three pockets which were reduced by February 15. As Wainwright was dealing with this threat, a reluctant Homma accepted that he lacked the forces to break MacArthurs defenses. As a result, he ordered his men to fall back to a defensive line on February 8 to await reinforcements. Though a victory that boosted morale, USAFFE continued to suffer from a critical shortage of key supplies. With the situation temporarily stabilized efforts continued to relieve the forces on Bataan and the fortress island of Corregidor to the south. These were largely unsuccessful as only three ships were able to run the Japanese blockade while submarines and aircraft lacked the carrying capa city to bring the needed quantities. Battle of Bataan - Reorganization: In February, the leadership in Washington began to believe that USAFFE was doomed. Unwilling to lose a commander of MacArthurs skill and prominence, President Franklin D. Roosevelt ordered him to evacuate to Australia. Reluctantly leaving on March 12, MacArthur traveled to Mindanao by PT boat before flying to Australia on a B-17 Flying Fortress. With his departure, USAFFE was reorganized into the United States Forces in the Philippines (USFIP) with Wainwright in overall command. Leadership on Bataan passed to Major General Edward P. King. Though March saw efforts to better train USFIP forces, disease and malnutrition badly depleted the ranks. By April 1, Wainwrights men were living on quarter rations. Battle of Bataan - Fall: To the north, Homma took February and March to refit and reinforce his army. As it regained strength, it began to intensify artillery bombardments of the USFIP lines. On April 3, Japanese artillery unleashed the most intense shelling of the campaign. Later in the day, Homma ordered a massive assault on the 41st Division (PA)s position. Part of II Corps, the 41st was effectively broken by the artillery bombardment and offered little resistance to the Japanese advance. Overestimating Kings strength, Homma moved forward cautiously. Over the next two days, Parker fought desperately to save his crumbling left as King attempted to counterattack north. As II Corps was overwhelmed, I Corps began falling back on the night of April 8. Later that day, seeing that further resistance would be hopeless, King reached out to the Japanese for terms. Meeting with Major General Kameichiro Nagano the next day, he surrendered the forces on Bataan. Battle of Bataan - Aftermath: Though pleased that Bataan had finally fallen, Homma was angry that the surrender did not include the USFIP forces on Corregidor and elsewhere in the Philippines. Massing his troops, he landed on Corregidor on May 5 and captured the island in two days of fighting. With the fall of Corregidor, Wainwright surrendered all remaining forces in the Philippines. In the fighting on Bataan, American and Filipino forces sustained around 10,000 killed and 20,000 wounded while the Japanese sustained approximately 7,000 killed and 12,000 wounded. In addition to the casualties, USFIP lost 12,000 American and 63,000 Filipino soldiers as prisoners. Though suffering from combat wounds, disease, and malnutrition, these prisoners were marched north to prisoner of war camps in what became known as the Bataan Death March. Lacking food and water, prisoners were beaten or bayoneted if they fell behind or were unable to walk. Thousands of USFIP prisoners died before reaching the camps. Following the war, Ho mma was convicted of war crimes relating to the march and was executed on April 3, 1946. Selected Sources: Corregidor Historical Society: BataanHistoryNet: Battle of Bataan - Brigadier General Clyde A. Selleck Commands the Layac LineUS Army: Bataan Death March