Chapter 179- Lyme borreliosis

Question 1

Lyme disease is caused by

Answer 1

Borrelia burgdorfer

Question 2

The most common cutaneous finding is Lyme Borreliosis

Answer 2

Erythema migrans

Question 3

Matching type

1. Borrelia burgdorferi
2. Borrelia garinii
3. Borrelia afzelii

A. Europe
B. Asia
C. North America
D. A and B
E. A and C

Answer 3

E
D
D

Question 4

Transmission vectors of Lyme Borreliosis in US; in Europe; in Asia

Answer 4

Ixodes scapularis ticks
Ixodes ricinus ticks
Ixodes persulcatus

Question 5

In the US, primary amplifying host of Borrelia burgdorferi; in Europe

Answer 5

White-footed mouse;

Birds, shrews, voles

Question 6

There is transovarial passage of Borrelia burgdorferi.

True or False

Answer 6

False

Question 7

Passage from one stage in the tick life cycle to the next

Answer 7

Transstadial transmission

Question 8

Majority of human transmission is from adult ticks.

True or False

Answer 8

False, nyphal ticks

Question 9

Primary drivers in dispersal of infected ticks

Answer 9

Deers

Birds

Question 10

Lyme disease has a bimodal age distribution with prevalence in ___, onset in ____

Answer 10

5 to 9 years; 55 to 59 years
Males
June, July, August

Question 11

1st symptom to develop with infection of Lyme Disease

Answer 11

Erythema migrans

Question 12

Immunohistochemcial studies indicate the infiltrate to be composed of

Answer 12

CD4 T lymphocytes

Question 13

Minimum of ___ hours is required for transmission of spirochete

Answer 13

36

Question 14

Large, x > 5cm, expanding, erythematous rash along the lines of least skin tension (Langer lines) with central clearing and draker punctate center

Answer 14

Bull’s eye rash

Question 15

Central clearing may be more common in ___

Answer 15

Borrelia garinii

Question 16

Most common manifestation of hematogenous dissemination

Answer 16

Multiple EM rashes

Question 17

Late cutaneous finding of Lyme disease have 2 phases

Answer 17

Inflammatory phase

Cutaneous atrophy phase

Question 18

Bluish red discoloration on extensors with infiltrated purple bands adjacent to joints

Answer 18

Inflammatory phase

Question 19

Particularly indicative of Lyme disease

Answer 19

Swelling of posterior aspect of lower extremities

Question 20

‘Cigarette paper-like’ appearance and prominence of superficial veins

Answer 20

Cutaneous atrophy

Question 21

Least common of cutaneous hallmarks of Lyme disease

Answer 21

Lymphocytic infiltrates

Question 22

Common denominator in patients with Borrelia-associated lymphoma

Answer 22

High titers of antibodies

Question 23

Highest frequency of infection eith Borrelia has been found in

Answer 23

Marginal zone lymphoma

Question 24

Cd5 and Cd10 are often found in Borrelia-associated B cell lymphoma.
True or False

Answer 24

False, centrocytic lymphoma

Question 25

Common areas for dissemination (4)

Answer 25

CNS PNS Heart Joints

Question 26

Most common neurologic manifestations (3)

Answer 26

Meningitis Cranial neuropathy Radiculopathy

Question 27

Most characteristic neuropathy of early Lyme disease

Answer 27

Facial palsy

Question 28

Bannwarth syndrome is a triad characterized by (3)

Answer 28

Lymphocytic meningitis Cranial palsy Radiculoneuritis

Question 29

B. Burgdorferi has predilection for

Answer 29

AV node

Question 30

Most frequent clinical sign of late disseminated Lyme disease

Answer 30

Inflammatory arthritis

Question 31

Antibitic theray can hasten resolution of facial palsy and radiculitis. True or False

Answer 31

False, EM, arthritis

Question 32

Profound depression, myalgia, polyarthralgia, and paresthesia, as well as neurocognitive abnormalities after infection with Borrelia burgdorferi

Answer 32

Posttreatment Lyme disease syndrome

Question 33

Ixodes ticks have ___ year ___ stage life cycle (___)

Answer 33

2 3 Larval —> Nymphal —> Adult

Question 34

Tick salivary protein which helps organism to evade immune response

Answer 34

Salp 15

Question 35

2 of the major regulators of Borrelial gene expression

Answer 35

Histidine kinase 1/ response regulator 1 | Response regulator 2/RNA polymerase sigma S/RNA polymerase sigma N pathway

Question 36

Responsible for hematogenous spread of organism

Answer 36

OspC type A (RST1)

Question 37

Critical element of B. Burgdorferi survival

Answer 37

Motility

Question 38

Gold standard for diagnosis of Borrelia burgdorferi

Answer 38

Culture

Question 39

Main use in detecting B. Burgdorferi in synovial fluid of Lyme arthritis

Answer 39

PCR

Question 40

Increased risk for false positive IgM serologic testing (3)

Answer 40

Autoimmune diseases Epstein Barr virus Bacterial endocarditis

Question 41

Increased risk for false positive IgG serologic testing (5)

Answer 41

``` Syphilis Helicobacter pylori SLE Ehrlichiosis Babesiosis ```

Question 42

Measures only IgG antibody early in course of disease by using constant region of B. Burgdorferi VIsE protein

Answer 42

C6 peptide test

Question 43

1st line treatment due to its excellent penetration to CNS and effectivity against A. Phagocytophilum

Answer 43

Doxycycline

Question 44

Used to treat children or pregnant women with Lyme disease

Answer 44

Cefuroxime

Question 45

Treatment regimen for Lyme disease

Answer 45

Doxycycline 100mg BID x 10 days Amoxicillin 500mg TID x 14 days Cefuroxime 500mg BID x 14 days

Question 46

Prophylaxis for Lyme disease

Answer 46

Doxycycline 200mg 1 dose

Question 47

With neurologic manifestations, treatment regimen is extended to

Answer 47

14 days

Question 48

With cardiac manifestations, treatment regimen is extended to

Answer 48

14-21 days

Question 49

With musculoskeletal manifestations, treatment regimen is extended to

Answer 49

28 days

Question 50

Prophylaxis should be started within

Answer 50

72 hours