Lyme Disease

Question 1

What organism causes Lyme disease?

Answer 1

Borrelia burgdorferi

This is transmitted to humans primarily through the bite of infected Ixodes ticks.

Question 2

Where is Lyme disease prevalent?

Answer 2

North America, Europe, and Asia –> highest incidence in heavily wooded and grassy areas.

Question 3

What are the 3 stages of Lyme disease?

Answer 3

1) Early localised

2) Early disseminated

3) Late disseminated

Question 4

What features characterise the ‘early localised’ phase of Lyme disease?

Answer 4

• Erythema migrans –> bull’s eye rash
• Flu like symptoms e.g. fever, malaise, joint aches

Question 5

What are some later features of Lyme disease (after 30 days)?

Answer 5

CVS:
- heart block
- peri/myocarditis

Neuro:
- facial nerve palsy
- radicular pain
- meningitis

Question 6

What 2 heart complications can Lyme disease cause?

Answer 6

1) heart block

2) peri/myocarditis

Question 7

Diagnosis of Lyme disease?

Answer 7

Lyme disease can be diagnosed clinically if erythema migrans is present.

I.e. people with erythema migrans should be commenced on antibiotic without the need for further tests

Question 8

1st line mx of asymptomatic tick bites?

Answer 8

1) remove tick if still present

2) wash area

3) NICE does NOT recommend routine Abx treatment to patients who’ve suffered a tick bite

Question 9

Is routine Abx indicated in anyone who has had a tick bite?

Answer 9

No

Question 10

1st line mx of suspected/confirmed Lyme disease (early stages)?

Answer 10

1st line abx –> doxycycline (or amoxicillin if doxy contraindicated e.g. pregnancy)

Question 11

What abx is indicated in mx of disseminated Lyme disease?

Answer 11

ceftriaxone

Question 12

What reaction is sometimes seen after initiating therapy for Lyme disease?

Answer 12

Jarisch-Herxheimer reaction after 1st dose of Abx –> fever, rash, tachycardia