Name
LYME DISEASE
DESCRIPTION
DETAIL
CAUSES Infection with spirochete Borrelia burgdorferi , transmitted by the bite of Ixodid ticks -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Juvenile rheumatoid arthritis β’ Viral syndromes β’ Later stages may mimic many other diseasesLABORATORY β’ ELISA for IgM and IgG B burgdorferi antibodies (frequently negative in stage 1 disease), followed by a Western blot test if positive β’ Culture of CSF for B burgdorferi DIAGNOSTIC PROCEDURES β’ Diagnosis is based on clinical features with exposure to a tick bite or endemic area β’ Lumbar puncture when neurologic findings are present, with ELISA of CSF for B. burgdorferi antibodies
TYPENOTES
RISK FACTORS Exposure to tick infested area, most common from May to SeptemberGENERAL MEASURES Prevention of infection is possible by careful examination of skin for ticks after outdoor activities. Prompt removal of ticks may limit transmission. Clothing that covers the ankles should be worn in endemic areas, and the use of insect repellants is recommended. SURGICAL MEASURES N/A ACTIVITY No restriction DIET No special diet PATIENT EDUCATION β’ In endemic areas, patients should be advised to protect themselves against tick exposure DRUG(S) OF CHOICE . Stage 1: . Doxycycline (Vibramycin) 100 mg po bid for 14-21 days (do not use in children under 12 or in pregnancy); or . Amoxicillin 500 mg po tid for 14-21 days, (pediatric dose 25-100 mg/kg/day) . Cefuroxime (Ceftin) axetil 500 mg bid for 14-21 days . Stage 2: . Normal CSF, treat for 28 days - doxycycline 100 mg po bid; or . Amoxicillin 500 mg po tid . Short course of corticosteroids (5-7 days) may be helpful . With abnormal CSF, treat for 3-4 weeks - ceftriaxone (Rocephin) 2 g IV qd; or cefotaxime (Claforan) 2 g IV q 8 h; or penicillin G 20-24 million units/day IV . Stage 3: . Oral treatment for 28 days with doxycycline 100 mg bid; or . Amoxicillin 500 mg tid . If oral treatment fails, IV treatment for 2-3 weeks with ceftriaxone 2 g qd; or cefotaxime 2 g q 8 hr; or penicillin G 20-24 million units/day IV ALTERNATIVE DRUGS β’ Cefuroxime (Ceftin) 500 mg bid for stage 1 disease, or tid for stage 2 or 3 disease PATIENT MONITORING Stage 2 and 3 disease requires careful monitoring over a period of months to years, based on severity of symptoms PREVENTION/AVOIDANCE β’ Awareness of the disease, protective clothing, and careful skin inspection with timely removal of ticks may reduce the incidence of disease. A 3 dose vaccine, LYMErix, is no longer available. β’ Prophylactic treatment with one dose of 200 mg of doxycycline within 72 hours of a tick bite in endemic areas has been suggested POSSIBLE COMPLICATIONS β’ Recurrent synovitis, tendinitis, bursitis β’ Chronic neurological symptoms β’ Peripheral neuropathies EXPECTED COURSE/PROGNOSIS β’ Early treatment with antibiotics can shorten the duration of symptoms and prevent later disease β’ Response of late stage disease is variable
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, CSF EXAMINATION, ELISA TEST
[LYME DISEASE]