Lyme Disease

Question 1

What spreads Lyme disease ?

Answer 1

Ticks

Question 2

What is the etiology of Lyme disease

Answer 2

spirochaete Borrelia burgdorferi

Question 3

What are the early features of Lyme disease ?

Answer 3

Early features are presented in the first thirty days

Erythema migraines - bull’s eye rash - usually at the place of tick bite
Can develop 1-4 weeks after the tick bite
Usually 5cm in diameter and slowly increases
Not painful

Other systemic features :
Headache
Fever
Lethargy
Arthralgia

Question 4

What are the late clinical features of Lyme disease?

Answer 4

Cardiovascular
Heart block
Peri myocarditis

Neurovascular
Facial nerve palsy
Radicular pain/radiculopathy - radiates from your back and hip into your legs through the spine
and meningitis

Question 5

Diagnosis of Lyme disease

Answer 5

Can be diagnosed clinically if erythema migrans is present
= this indication is only needed to start antibiotics

ELISA antibodies for Borrelia burgdorferi are the first-line test
If negative within the first 4 weeks of symptom onset and still suspecting Lyme disease then repeat the ELISA tests within 4-6 weeks

If suspected in people with the onset of symptoms more than 12 weeks than immunoblot

Question 6

What is the management of asymptomatic tick bites

Answer 6

If Tick still present , then remove it with tweezers - then the area should be washed

NICE GUIDELINES DO NOT RECOMMEND ROUTINE ANTIBIOTICS FOR THOSE WITH TICK BITES

Question 7

Management of suspected Lyme disease

Answer 7

People with erythema migrans should be commenced on abx without any further test

Doxycycline
Amoxicillin if doxy contraindicated as if for pregnancy

Ceftriaxone if disseminated

Question 8

What is Jarisch-Herxheimer reaction?

Answer 8

sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic

Question 9

Jarisch-Herxheimer reaction is commony seen in ?

Answer 9

more commonly seen in syphilis, another spirochaetal disease