22 - Lyme Disease Flashcards
Lime disease overview?
Infection - spirochete
- borrelia burgdorferi
- Ixodes ticks (deer ticks)
Common locations of lyme disease?
Maryland to maine
Wisconsonsin and minnesota
Some - N california
How long does the tick need to be attached?
2-3 days
Pathophys of lime disease?
Tick feeds
- bacteria multiply in gut of tiick
- migrate to salavary glands
- inject bacteria into the victim
Times of lime disease infection?
Nymph stage - 85% of tome
- spring - summer
Adult stage - 15%
- fall
False positive for lyme disease?
False pos or asymptomatic infection
5-10% of pts in endemic pts are positive w no hx of symptoms
After initial bacterial invasion 3 things can happen?
- Clear the infection
- no manifestations - B burgdorferi spreads -> the body
- symptoms by direct invasion
- evidence of bacterial infection - Induces an immune response
- little evidence of bacterial invasion
Stages of lyme disease?
3 stages Early - localized - Disseminated Late - persistent
Persistent lyme disease is considered?
Late infection
- w/in 1 yr of infection
Early/localized s/s of lyme?
7-14 days of bite
- erythema migrans (EM)
- fever
- chills
- myalgias
- arthralgias
- tender adenopathy
Describe the erythemia migrans (EM) rash
2/3 of pts get it
- confluent patch of erythema
- may have central clearing
- typically expands over days
S/s of late disease?
Weeks to months later
- arthritis (differentiate arthritis from arthralgia)
Usually no hx of EM
Hallmark of late lyme disease?
Arthritis
- usually large joints
- knee 90%
- rarely destructive disease
Progression of the lyme arthritis?
Begins as a migratory polyarticular process
Evolves over 1-2 days
- monoarticular process
- knee-> ankle -> wrist
2/3 of patients
- 1st episode w/in 6 o of EM
- last approx 1 week
- become less freq and sever
- resolve over 10 yr period
Chronic manifestations of lime?
Arthritis
Possible association
- meningoencephalitis
(Mood, memory, sleep)
- fibromyalgia and chronic fatigue
- chronic neuropathy
(Paresthesias, radicular pain)
Pregnancy and lyme disease?
NO DOXY
No good documentation of birth defects
Possible association w spontaneous abortions
Bottom line - not devastating like its spirochete friends
Lyme disease case definition for national surveillance?
Physician diagnosed EM
Clinically compatible late manifestations and lab confirmation of infection
Lyme disease testing?
Antibody test
- no standards
- many fals pos/neg
Culture doesnt work
Up to 2 months before antibodies can be detected
CDC testing recommendation?
Two step (many ppl are antibody pos but not sick)
- EIA/IFA
- Western blot (confirmatory)
Non diagnostic labs for lyme?
ECG - AB block
CBC - WBC can be high
ESR - High
Joint fluid - WBCs
Lyme diseas tx?
Tick bite (endemic area) - doxy Tick bite (non endemic) - no tx
EM - doxy and amoxicillin
Carditis - ceftriaxone, doxy
Facial nerve paralysis - doxy
Meningitis - ceftriaxone IV
Arthritis = doxycycline
Lyme disease prevention?
Avoid ticks
- clothes
- pets
- tick checks
No longer have a vaccine
You have chronic lime disease? Thats an easy cure
There is no such thing as “chronic” lyme disease. I know because i read it on the internet
