ID - Lyme Disease and Rashes

Question 0

Erythema marginatum? Seen in?

Answer 0

Non-pruritic, and erythematous papules over trunk - spares the face

Rheumatic fever

Question 1

Early localized stage of Lyme disease?

Answer 1

Within the first month of bite.

Presents with viral like syndrome and erythema migrans usually around belt-line or axilla.

Question 2

Rash of

1. lyme disease
2. rheumatic fever
3. Rocky Mountain spotted fever
4. toxic shock syndrome
5. measles
6. Rubella

Answer 2

1. Erythema migranns
2. Erythema marginatum
3. Rash begins on the wrist and ankles and spreads centrally (also appears in palms and soles)
4. Diffuse erythema followed by desquamation after a week
5. Rash proceeds from the hairline down, sparing palm and soles
6. Same as Measles

Question 3

Rocky Mountain spotted fever symptoms? Treatment?

Answer 3

Headache, myalgias, abdominal pain, rash

Doxycycline, tetracycline

Question 4

Symptoms of measles? Treatment?

Answer 4

Cough, conjunctivitis, coryza,
**Koplik spots

Supportive therapy, antibiotics for otitis and pneumonia

Question 5

Early disseminated Lyme disease?

Answer 5

Days to months after initial tick bite

Joints: Musculoskeletal pain without joint inflammation
Cardiac – conduction disturbances myocarditis, pericarditis, heart block
Neurologic: bilateral facial nerve palsy, meningitis, encephalitis, radicular pain

Question 6

Patient in early disseminated stage of lime disease – most appropriate next step?

Answer 6

Lumbar puncture to evaluate for meningitis and look for antibodies

Question 7

Bannwarth syndrome?

Answer 7

In Asia and Europe first characteristic neurological time is radicular pain followed by CSF Pleocytis

Question 8

Third stage of disease?

Answer 8

Years after initial inspection

Joint: polyarthritis with intermittent oligo arthritis
Neuro: Encephalitis, neurocognitive dysfunction, peripheral neuropathy

Question 9

Cardiac manifestations of lyme disease? Can progress to?

Answer 9

Conduction disturbances, myocarditis, pericarditis.

Cardiomyopathy or permanent Heart block

Question 10

Neurological manifestations of lyme disease? Present when?

Answer 10

Facial palsies, meningitis with lymphocytic pleocytosis, encephalitis, sensory radiculoneuropathy

Present after several weeks or months

Question 11

Aspiration of joint food from lime disease will show?

Answer 11

25,000 WBCs with the predominance of PMNs

Question 12

Treatment choices of Lyme

Disease?

Answer 12

Doxycycline 100 mg
Amoxicillin 500 mg
Cefuroxine 500 mg
Erythromycin 250 mg

Question 13

If patient has third degree heart block or neurologic manifestations, treatment?

Answer 13

IV:
Ceftriaxone 2 g
Cefotaxime 2 g
Penicillin G5

Question 14

Treatment time?

Answer 14

14 days for localized infection
21 days for early disseminated infection
One month for patients with arthritis, neurologic, cardiac involvement

Question 15

When to treat Asymptomatic rock bite?

Answer 15

#Ixides tick identified
#tick attached for more than 24 hours
#engorged nymph-stage tick
#Endemic area