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)