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Questionnaire permettant d’aider au diagnostic de la maladie de Lyme
Oui Non
1.

Piqûre de tique

2.

Rougeurs au niveau de la piqûre ou érythème migrant

3.

Rougeurs ou boutons sur d'autres endroits du corps

4.

Douleurs articulaires (genou, poignet, doigts, coude,
hanche...)

5.

Orteils et pieds gonflés

6.

Douleurs aux chevilles

7.

Sensation de brûlures sous les pieds ou aux mains

8.

Crampes au pied

9.

Accès de fièvre, de transpiration ou frissons

10. Douleurs musculaires et crampes, difficulté de marcher
11. Fatigue, épuisement, manque d'endurance
12. Perte de cheveux anormale
13. Inflammation de glandes
14. Mal à la gorge
15. Douleurs au pelvis ou aux testicules
16. Menstruations irrégulières
17. Seins douloureux, production de lait (lactation)
18. Troubles de la vessie et de la fonction urinaire
19. Troubles de la libido
20. Estomac irritable et sensible
21. Troubles de la fonction intestinale(constipation, diarrhée)
22. Douleurs dans la poitrine et les côtes
23. Souffle court, toux
24. Palpitations cardiaques, extrasystoles, arythmie...
25. Douleurs et/ou inflammations des articulations (arthrite)
26. Raideurs/craquements de la nuque, du cou et du dos
27. Lancements ou douleurs lancinantes dans les muscles
28. Picotements, engourdissements
29. Tremblements d'un ou de plusieurs membres
30. Douleur dans les mâchoires, les dents ou/et à la mastication
31. Tics nerveux au visage, à la paupière
32. Paralysie faciale
33. Yeux/vision: double, trouble, douleurs
34. Oreilles/ouïe: bourdonnements, sifflements, douleurs
35. Etourdissements, perte de l'équilibre, mal de mer accru
36. Cerveau pas clair, qui a du mal à fonctionner
37. Mal à la tête
38. Confusion
39.

Difficultés pour penser (pensée confuse), se concentrer et
lire

40. Perte de mémoire court terme et oublis
41.

Problèmes d'orientation: se perdre ou aller là où on ne voulait
pas

42. Problèmes pour écrire et/ou pour parler
43. Dépression, irritabilité, sautes d'humeur
44.

Troubles du sommeil: trop, pas assez, se réveiller la nuit ou
trop tôt

45. L'alcool provoque des effets renforcés
46. Changement de poids (perte ou gain) inexpliqué
TOTAL

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Questionnaire lyme symptomes

  • 1. Questionnaire permettant d’aider au diagnostic de la maladie de Lyme Oui Non 1. Piqûre de tique 2. Rougeurs au niveau de la piqûre ou érythème migrant 3. Rougeurs ou boutons sur d'autres endroits du corps 4. Douleurs articulaires (genou, poignet, doigts, coude, hanche...) 5. Orteils et pieds gonflés 6. Douleurs aux chevilles 7. Sensation de brûlures sous les pieds ou aux mains 8. Crampes au pied 9. Accès de fièvre, de transpiration ou frissons 10. Douleurs musculaires et crampes, difficulté de marcher 11. Fatigue, épuisement, manque d'endurance 12. Perte de cheveux anormale 13. Inflammation de glandes 14. Mal à la gorge 15. Douleurs au pelvis ou aux testicules 16. Menstruations irrégulières 17. Seins douloureux, production de lait (lactation) 18. Troubles de la vessie et de la fonction urinaire 19. Troubles de la libido 20. Estomac irritable et sensible 21. Troubles de la fonction intestinale(constipation, diarrhée) 22. Douleurs dans la poitrine et les côtes 23. Souffle court, toux 24. Palpitations cardiaques, extrasystoles, arythmie... 25. Douleurs et/ou inflammations des articulations (arthrite) 26. Raideurs/craquements de la nuque, du cou et du dos 27. Lancements ou douleurs lancinantes dans les muscles 28. Picotements, engourdissements 29. Tremblements d'un ou de plusieurs membres 30. Douleur dans les mâchoires, les dents ou/et à la mastication 31. Tics nerveux au visage, à la paupière 32. Paralysie faciale 33. Yeux/vision: double, trouble, douleurs 34. Oreilles/ouïe: bourdonnements, sifflements, douleurs 35. Etourdissements, perte de l'équilibre, mal de mer accru 36. Cerveau pas clair, qui a du mal à fonctionner
  • 2. 37. Mal à la tête 38. Confusion 39. Difficultés pour penser (pensée confuse), se concentrer et lire 40. Perte de mémoire court terme et oublis 41. Problèmes d'orientation: se perdre ou aller là où on ne voulait pas 42. Problèmes pour écrire et/ou pour parler 43. Dépression, irritabilité, sautes d'humeur 44. Troubles du sommeil: trop, pas assez, se réveiller la nuit ou trop tôt 45. L'alcool provoque des effets renforcés 46. Changement de poids (perte ou gain) inexpliqué TOTAL