Lyme Disease

Question 1

• Is the most common vector-borne disease in the US
• c/b the bacterium Borrelia burgdorferi & rarely, Borrelia mayonii
• Transmitted to humans through bite of infected blacklegged ticks (deer ticks)
• Bacterium causes a chronic immunity response & inflammation in the individual

Answer 1

• NE, incl MA, has a high incidence of lyme dz
• Greatest risk of being bitten exists in the spring, summer, & fall in the NE, upper Midwest, & mid-Atlantic
• All life stages bite humans, but nymphs & adult females are most commonly found on people

Question 2

Which stage is this?

• Erythema migrans, aseptic meningitis
• Iritis, heart block, pericarditis, heart palps
• Orchitis, hepatitis
• Loss of muscle tone, neck stiffness
• Facial/Bell’s palsy, swollen lymph nodes
• Large joint arthritis (knees)

Answer 2

Stage 2 - Early Disseminated Lyme Disease

Question 3

Which stage is this?

• Asymptomatic
• erythema migrans (60-80%)
• Bullseye rash
• Headache, malaise, fever, myalgias, arthralgias

Answer 3

Stage 1 - Early Lyme Disease

Sx’s may occur 3-30 days >the bite & may disappear wks later w/o treatment; h/e, sx’s may disseminate more systemically in stage 2

Question 4

Which stage is this?

• Aches & pains of soft tissues & joints
• Neurological impairment
• Iritis
• Optic neuritis

Answer 4

Stage 3 - Chronic Persistent Lyme Disease

Question 5

Post-Treatment Lyme Disease Syndrome

> 10-20% sx’s continue >conclusion of abx therapy
- Restarting abx is not warranted

Answer 5

Diagnostics

• Lab tests are not req’d before beginning treatment in pts who exhibit erythema migrans & are in an endemic area. Otherwise, wait 4-6 wks before attaining lab work. Labs aren’t reliable until >this time

Question 6

Step 1

ELISA/EIA negative → stop

ELISA/EIA positive → step 2

Answer 6

Step 2: Western blot for IgG or IgM antibodies

Positive for Lyme if Western blot AND ELISA are positive

Question 7

Treatment

Prevention: 72 hrs from tick removal = doxycycline 200mg x1po

Answer 7

Stage 1: Doxycycline, Azithromycin, Amoxicillin, Erythromycin po x7-21 days as ordered

Question 8

Severe Stage 2 & Stage 3: Ceftriaxone, Cefotaxime, Penicillin G IV x 30 days

Prevention & Stage 1 treatment responds well to abx

Answer 8

! Doxycycline contraindicated for pregnant/breastfeeding women & another IV abx should be used b/c the bacterium can cross the placental barrier (OBGyn consult is warranted)

! Tetracycline can lessen the effectiveness of oral contraceptives

Question 9

Prevention

✓ Use insect repellent w/20-30% DEET
✓ Permethrin-treated, light-colored clothing
✓ Pants tucked into socks
✓ Avoid underbrush of woods
✓ Shower >time in woods & check skin
✓ Remove tick w/tweezers & apply alcohol to site
✓ Check pets for ticks & apply prophylactic