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.
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)
if positive, obtain Western Blot
cultures, serologies
LP for patients with neuro findings (lymphocytic pleocytosis, elevated protein, normal glucose)
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)