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In honor of a rosh review question that I got wrong, lets review Lyme disease!

 

Lyme disease is caused by the spirochete Boriella burgdorferi, transmitted to humans through tick bites from ixodes ticks.

Location: US, endemic in NE coast, midatlantic region, and north central states.
Transmission: transmission of the spirochete occurs during feeding which happens approximately two days after attachment ot the person.
Symptoms:
stage 1 – erythema migrans rash and viral syndrome (1-2 weeks)
stage 2 – early disseminated infection with multiple annular lesions sparing the palms and soles, AV blocks and dysrhythmais, radiculopathy, cranial nerve palsies, conjunctivitis, optic neuritis, (days to weeks)
stage 3 – late disseminated infection with arthritis, encephalopathy, fatigue, polyneuropathy, (months to years)
Evaluation:
ELISA
if positive, obtain Western Blot
PCR
cultures, serologies
LP for patients with neuro findings (lymphocytic pleocytosis, elevated protein, normal glucose)
Treatment:
Doxycyline 200mg x 1 for prophylaxis (if tick attached >24 hrs)
Doxycycline 100mg PO BID x 14-21 days
Amoxicillin 500mg PO TID x 14-21 days if pregnant
Treat lyme meningitis for longer duration with doxy (14-28 days)
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