Lyme Disease - Diagnosis and Management Summary Lyme Disease Epidemiology: - Spirochete - Reservoir: small mammals & birds - Transmitted by Ixodes tick - Ixodes Scapularis in eastern and north regions of North America - Bimodal distribution: - 5-14 years old - 45-55 years old - Peak incidence: Summer months Lyme Disease Clinical Progression 1. Early Localized Disease: - Erythema Chronicum Migrans - Flu-like illness/fatigue - Swollen lymph nodes - Headache/stiff neck - Sore throat 2. Early Disseminated - Weeks to Months: - Neurological - Carditis 3. Late Disease (Months to Years): - Arthritis - Neurological features Lyme Disease Complications: • Neuroborreliosis: - Meningococcal-radiculitis - Meningitis - Meningo-encephalitis - Bell’s palsy - Vision changes - Pain, weakness, numbness • Carditis: - AV block: Fluctuating first-second-third degree block - Myopericarditis - LV failure - Pericarditis • Ocular: - Conjunctivitis - Keratitis - Iridocyclitis - Retinal vasculitis - Uveitis • Neuro: - Lyme encephalopathy - Polyneuropathy • Arthritis: - Large joints - Joint swelling/pain Lyme Disease Diagnosis: 1. Rash: distinctive enough to make diagnosis if living in an endemic area 2. ELISA: detects antibodies to B. Burgdorferi 3. WESTERN BLOT: to confirm the dx. Detects antibodies to proteins of B. Burgdorferi 4. LP-CSF: lymphocytic pleocytosis Lyme Disease Treatment: 1. Early: Doxycycline, amoxicillin 10-14 days 2. Early Disseminated: Doxycycline, amoxicillin or ceftriaxone for 14-28 days 3. Late: - IV ceftriaxone, cefotaxime or PCN G for 21 days for Neuro involvement - Oral doxycycline without Neuro disease By Dr. Ravi Singh @rav7ks #Lyme #Disease #Diagnosis #Management #treatment
