lyme disease

Question 1

definition

Answer 1

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

Question 2

s/s

Answer 2

Features

• early: erythema chronicum migrans + systemic features (fever, arthralgia)
• CVS: heart block, myocarditis
• neuro: cranial nerve palsies, meningitis

Question 3

investigation

Answer 3

• serology: antibodies to Borrelia burgdorferi. These an take 3-8 weeks before they are detectable

Question 4

Management

Answer 4

1. doxycycline if early disease. Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
2. ceftriaxone if disseminated disease
3. 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)