Lyme Disease Lecture Powerpoint

Question 1

Lyme disease definition

Answer 1

Multisystem inflammatory disease caused by borrelia burgdorferi spirochete spread by bite of infected ixodes ticks, first described as outbreak of “juvenile rheumatoid arthritis” in connecticut

Question 2

Early localized lyme disease presentation

Answer 2

Erythema migrans often near the axilla, inguinal region, behind knees, and belt line, typically expands over few days sometimes with central lesion (bullseye lesion) which may expand due to spirochetemia, nonspecific symptoms include malaise, myalgias, headache, lymphadenopathy

Question 3

Early disseminated lyme disease presentation (2)

Answer 3

• Carditis such as heart block or mild myopericarditis sometimes presenting as syncope
• neurologic lymphocytic meningitis, cranial nerve palsies esp. 7th, can be bilateral, radiculoneuritis

Question 4

Late lyme disease presentation (2)

Answer 4

• musculoskeletal arthralgias, intermittent arthritis, chronic monoarthritis often in knee
• tertiary neuroborreliosis presenting as encephalopathy, neurocognitive dysfunction, and peripheral neuropathy

Question 5

Lyme disease diagnosis (2)

Answer 5

• history and physical
• confirmatory serological studies (ELISA then western blot as many false positives) never diagnose on serologic studies alone

Question 6

Lyme disease and Ig trends

Answer 6

IgM seen early but may take up to 6 weeks to develop, declines after 4-6 months, IgG may appear at 6 weeks, peak at 4-6 months, mayremain indefinetly despite resolution of symptoms and therapy

Question 7

Early localized lyme disease treatment (adults and children)

Answer 7

• doxycycline in adudlts

- amoxicillin or cefuroxime in children

Question 8

Early disseminated lyme disease with no meningitis or 3rd degree heart block treatment (adults and children)

Answer 8

• doxycycline in adults

- amoxicillin in children

Question 9

Early disseminated lyme disease with meningitis or 3rd degree heart block treatment (2)

Answer 9

• ceftriaxone IV

- PCN IV