Lyme disease

Question 1

What vector causes lyme disease

Answer 1

Ixodes tick

Question 2

Epidemiology of lyme disease

Answer 2

Increasing instances in UK
Due to increase tick numbers

Question 3

Ixodes tick when active and risk factors

Answer 3

Newt stage - small
Late spring and early summer
On deer

Question 4

Bacteria causing lyme disease

Answer 4

Borrelia burgodorferi
Europe - B.garninii, B.afzelii
US - B.burgdorferi sensu lato
Spirochaete
Commonest vector borne disease in northern hemisphere

Question 5

Skin feature of lyme disease

Answer 5

Erythema migrans

Question 6

Features of erythema migrans

Answer 6

Bullseye rash from where tick attached
painfless and not itchy
>5cm grows in szie
Shows 1-4 weeks after tick bite
May be ass w fever, headahce, flu like

Question 7

Less common features of early lyme disease

Answer 7

Neuro - weeks to months
Cardiac

Question 8

Neurological problems early lyme disease

Answer 8

Facial plasy - may be bilateral/unexplained CN palses
Lymphocytic meningitis
Mononeuritis multiplex or other unexplained radiculopathy - radicular pain

Question 9

Cardiac problems from lyme disease

Answer 9

Heart block - 1st degree
Pericarditis
Myocarditis

Question 10

Late features of european lyme disease

Answer 10

Late curatnoeus
Chronic arthritis
Encephalopahty
Peripheral neuropathy
Acrodermatitis chronica atrophicans
Lymphocytoma - classically earlobe

Question 11

What is acrodermatitis chronic atrophicans

Answer 11

Violacious rash, thickening of skin on extremities

Question 12

What is lymphocytoma

Answer 12

Fleshy nodular lesion

Question 13

Non specific symptoms of lyme disease

Answer 13

Fever and sweats
Swollen glands
Malaise
Fatiuge
Neck pain, stiffness
Migratory joint or muscle aches and pain
Cognitive impairemnt eg memort problems, brain fog
Headache
Paraesthesia

Question 14

Diagnosing lyme disease

Answer 14

IgM and IgG antibdody serology

Question 15

When can you give empirical treatment for lyme disease without antibiotics

Answer 15

Erythema migrans rash present
Serology can take up to 6 weeks to be positive

Question 16

What do if positive ELISA test for lyme disease

Answer 16

Immunoblot test

Question 17

If symptoms persist what do

Answer 17

Ongoing symptoms and ELISA within 4 weeks of onset - repeat ELISA in 4-6 weeks
Otherwise offer immunoblot if symptoms remain after 12 weeks

Question 18

Challenges in diagnosiing lyme disease

Answer 18

History of tick bite not noter, erythema migrans may not be present
Non specific symptoms
Early infection = negative serology
Early treatent -> serological response (difficult for retrospective diagnosis)
No diagnostic test is perfect
Over testing in patients with low pre test probability

Question 19

treatement for early lyme disease

Answer 19

Oral doxycycline 21 days

Question 20

Meningitis/CN palsy/radiculopathy due to lyme disease treatment

Answer 20

IV ceftriazone 21 dyas
Oral doxycycline may be just as effective

Question 21

What warn patients about first few months after treatment

Answer 21

1/3 will have some post treatment persistent symptoms for few months
By 12 months shouldnt do

Question 22

Is re-treatment of lyme disease beneficial

Answer 22

NO

Question 23

Antibiotic for disseminated disease

Answer 23

Ceftriaxone