Lyme Disease

Question 1

What organism causes Lyme disease?

Answer 1

Borrelia burgdorferi

Question 2

How is Lyme disease transmitted?

Answer 2

Tick bite

Question 3

What is the classic presentation of Lyme disease?

Answer 3

Characteristic erythema migrans rash; becomes visible 1-4 weeks after tick bite but can appear from 3 days to 3 months after and lasts several weeks
May be accompanied by non-specific symptoms such as fever, swollen glands, malaise, fatigue, neck pain or stiffness, joint or muscle pain, headache, cognitive impairment, paresthesias

Question 4

What are the late symptoms of Lyme disease?

Answer 4

Focal symptoms (relating to one organ or system) appearing months to years after initial infection

• neurological (cranial or peripheral nerves)
• joint ache (Lyme arthritis)
• cardiac disease (Lyme carditis)
• skin manifestations (acrodermatitis chronica atrophicans)

Question 5

What is the drug of choice for treatment of Lyme disease?

Answer 5

Depends on presenting symptoms
(But usually doxycycline unless presenting symptoms include CNS involvement or Lyme carditis with hemodynamic instability)

Question 6

What is the drug of choice for a patient presenting with erythema migrans rash with or without non-focal symptoms?

Answer 6

FIRST LINE:
- Oral doxycycline

SECOND LINE:

• amoxicillin
• oral azithromycin (if amoxicillin unsuitable)

Question 7

What is the drug of choice for a patient presenting with cranial nerve or peripheral nervous system involvement?

Answer 7

FIRST LINE:
- oral doxycycline

SECOND LINE:
- amoxicillin

(This is for nervous system involvement that is NOT central in nature)

Question 8

What is the drug of choice for a patient presenting with central nervous system involvement?

Answer 8

FIRST LINE:
- IV ceftriaxone

SECOND LINE:
- oral doxycycline

Question 9

What is the drug of choice for a patient presenting with Lyme arthritis or acrodermatitis chronica atrophicans?

Answer 9

FIRST LINE:
- oral doxycycline

SECOND LINE:
- oral amoxicillin

THIRD LINE:
- IV ceftriaxone

Question 10

What is the drug of choice for a patient presenting with Lyme carditis (hemodynamically STABLE)?

Answer 10

FIRST LINE:
- oral doxycycline

SECOND LINE:
- IV ceftriaxone

Question 11

What is the drug of choice for a patient presenting with hemodynamically UNSTABLE Lyme carditis?

Answer 11

FIRST LINE:
- IV Ceftriaxone

SECOND LINE:
- oral doxycycline

Question 12

How should patients be assessed when symptoms continue to persist or worsen after abx treatment? (4)

Answer 12

1. Assess for possible alternative dx
2. Assess for re-infection
3. Assess for treatment failure or non-adherence to previous abx treatment
4. Assess for progression to organ damage caused by Lyme disease

Question 13

How are patients with signs of Lyme re-infection managed?

Answer 13

Second course of abx

Third course is not advised

Question 14

How are patients with signs of treatment failure managed?

Answer 14

Alternative abx