Lyme disease

Question 1

what is Lyme disease?

Answer 1

Lyme disease is caused by the spirochaete Borrelia burgdorferi and is spread by ticks.

Question 2

early features of Lyme disease>

Answer 2

erythema migrans:
‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner

headache
lethargy
fever
arthralgia

Question 3

late features of Lyme disease?

Answer 3

cardiovascular
heart block
peri/myocarditis

neurological
facial nerve palsy
radicular pain
meningitis

Question 4

ix for Lyme disease?

Answer 4

erythema migrans is therefore an indication to start antibiotics

enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi are the first-line test
- if positive or equivocal then an immunoblot test for Lyme disease should be done

Question 5

mx for asymptomatic tick bites?

Answer 5

if the tick is still present, the best way to remove it is using fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upwards firmly. The area should be washed following.

Question 6

mx of Lyme disease?

Answer 6

doxycycline if early disease. Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)

ceftriaxone if disseminated disease

Question 7

what is a complication of Lyme disease?

Answer 7

Jarisch-Herxheimer reaction

Question 8

what is Jarisch-Herxheimer reaction?

Answer 8

Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)