Lyme Disease - Diagnosis and Management Summary

1 .EarIy localized disease:, Erythema Chronicum Migrans, Flu-like illness/fatigue, swollen lymph nodes, headache/ stiff neck, sore throat

2. EarIy disseminated (Weeks to months): Neurological, Carditis

3. Late disease (Months-years): Arthritis, neurological features

Epidemiology:

 - Spirochete

 - Reservoir: small mammals & birds

 - Transmitted by Ixodes tick

 - Ixodes Scapularis in eastern and north regions North America

 - Bimodal distribution:

   • 5-14 years old

   • 45-55 years old

 - Peak incidence: Summer months

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

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



- Dr. Ravi Singh @rav7ks



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