Lyme Disease

Question 1

things that can happen in early disseminated lyme dz

Answer 1

Carditis: 8% of patients
Heart block (electrical) or mild myopericarditis

Neurologic:
Lymphocytic meningitis – stiffness in neck, LP may have some lymphocytic WBC predominance
Cranial nerve palsies (esp. 7th nerve – bilateral or unilateral)
Radiculoneuritis – follow nerve in radicular pattern of pain and numbness
This triad (the above 3) is more common in Europe and known as Bannwarth’s syndrome

Question 2

late dz of lyme

Answer 2

Late disease can occur months to years after the onset of the infection

Musculoskeletal:
Arthralgias
Intermittent episodes of arthritis- usually monoarthritis often involving the knee
Chronic monoarthritis (often in knee)

Tertiary Neuroborreliosis- uncommon
Encephalopathy
Neurocognitive dysfunction
Peripheral neuropathy

Acrodermatitis chronica atrophicans in Europe
Atrophy of skin, whitish discoloration distal parts of ams and legs, hes never seen it

Question 3

how do you dx lyme dz

Answer 3

not based off of serology- used to confirm

historical and physical features that explicitly suggest the diagnosis is dx basis

Question 4

dx tests

Answer 4

ELISA

Western blot

Question 5

if ELISA is - do you do the WB

Answer 5

no

Question 6

what do you do if ELISA is +

Answer 6

confirm with WB

Question 7

tx of early localized lyme

Answer 7

Doxycycline 100 mg BID for 10-21 days
        Avoid doxy and tetra below 8 y/o b/c can cause 
        yellowing of the teeth 
Amoxicillin 500 mg TID for 14-21 days
Cefuroxime 500 mg BID for 14-21 days

Question 8

tx for Early disseminated disease (no meningitis or third degree heart block)-if they have Bells

Answer 8

Doxycycline 100 mg BID for 14-21 days

Amoxicillin 500 mg TID for 14-21 days

Question 9

tx for Early disseminated disease with meningitis or third degree heart block

Answer 9

Ceftriaxone 2 grams IV daily for 14-28 days
Preferred
Cefotaxime 2 grams IV every 8 hours for 14-28 days
Penicillin G 18-24 million units in 6 divided dosages for 14-
28 days