Lyme disease Flashcards
What vector causes lyme disease
Ixodes tick
Epidemiology of lyme disease
Increasing instances in UK
Due to increase tick numbers
Ixodes tick when active and risk factors
Newt stage - small
Late spring and early summer
On deer
Bacteria causing lyme disease
Borrelia burgodorferi
Europe - B.garninii, B.afzelii
US - B.burgdorferi sensu lato
Spirochaete
Commonest vector borne disease in northern hemisphere
Skin feature of lyme disease
Erythema migrans
Features of erythema migrans
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
Less common features of early lyme disease
Neuro - weeks to months
Cardiac
Neurological problems early lyme disease
Facial plasy - may be bilateral/unexplained CN palses
Lymphocytic meningitis
Mononeuritis multiplex or other unexplained radiculopathy - radicular pain
Cardiac problems from lyme disease
Heart block - 1st degree
Pericarditis
Myocarditis
Late features of european lyme disease
Late curatnoeus
Chronic arthritis
Encephalopahty
Peripheral neuropathy
Acrodermatitis chronica atrophicans
Lymphocytoma - classically earlobe
What is acrodermatitis chronic atrophicans
Violacious rash, thickening of skin on extremities
What is lymphocytoma
Fleshy nodular lesion
Non specific symptoms of lyme disease
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
Diagnosing lyme disease
IgM and IgG antibdody serology
When can you give empirical treatment for lyme disease without antibiotics
Erythema migrans rash present
Serology can take up to 6 weeks to be positive
What do if positive ELISA test for lyme disease
Immunoblot test
If symptoms persist what do
Ongoing symptoms and ELISA within 4 weeks of onset - repeat ELISA in 4-6 weeks
Otherwise offer immunoblot if symptoms remain after 12 weeks
Challenges in diagnosiing lyme disease
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
treatement for early lyme disease
Oral doxycycline 21 days
Meningitis/CN palsy/radiculopathy due to lyme disease treatment
IV ceftriazone 21 dyas
Oral doxycycline may be just as effective
What warn patients about first few months after treatment
1/3 will have some post treatment persistent symptoms for few months
By 12 months shouldnt do
Is re-treatment of lyme disease beneficial
NO
Antibiotic for disseminated disease
Ceftriaxone
