Lyme disease

Question 1

what microorganism causes the infection

Answer 1

bacteria - Borrelia burgdorferi

Question 2

Borrelia burgorferi causes …

Answer 2

Lyme disease

Question 3

transmitted to humans by

Answer 3

bite of an infected tick

Question 4

where are ticks mainly found

Answer 4

grassy and wooded areas including urban gardens and parks

Question 5

what is an erythema migrans rash

Answer 5

characteristic of lyme disease
‘bulls eye rash’
It begins as a reddened area near the tick bite.
As the rash increases in size, it often clears in the middle and develops a red ring around the outside, so that it has a “bull’s eye” appearance.

Question 6

when does the characteristic erythema migrant rash appear?

Answer 6

usually becomes visible 1-4 weeks after tick bite
but can appear from 3 days to 3 months and last several weeks

Question 7

any other symptoms apart from erythema migrans rash?

Answer 7

may have non-focal (non-organ related) symptoms e.g. fever, swollen glands, malaise, fatigue, neck pain or stiffness, joint or muscle pain, headache, cognitive impairment or paraesthesia

Question 8

can you get focal symptoms with Lyme disease? focal symptoms (related to at least one organ system)

Answer 8

yes they may appear months or years after initial infection
typically focal
include neurological (cranial nerves, peripheral and CNS), joint (Lyme arthritis), cardiac (Lyme carditis) or skin (acrodematitis chronic atorphicans) manifestations

Question 9

what to do with pt who present with focal symptoms (relating to at least one organ system e.g. skin, heart, joint, neurological)

Answer 9

consider discussion with or refer to specialist
but, do not delay treatment

Question 10

what to do with pt who present with erythema migrans rash with or without non-focal symptoms (e.g. fever, malaise, swollen glands, neck pain or stiffness, joint or macula pain, cognitive headache, paraesthesia etc) - treatment + dose + duration

Answer 10

• 1st line doxycycline (unlicensed) - 200mg daily in 1-2 divided doses for 21 days
• alternative amoxicillin - 1g TDS 21 days
• if both unsuitable azithromycin (unlicensed) 500mg OD for 17 days

Question 11

what to use as treatment for pt with focal symptoms of cranial nerve or peripheral nervous stem involvement

Answer 11

1st line doxycycline (unlicensed) 200mg daily in 1-2 divided doses for 21 days
alternative amoxicillin 1g TDs 21 days

Question 12

what to do with pt with symptoms of Lyme arhtiris or acrodematitis chronic atrophicans (3 options of treatment)

Answer 12

1st line doxycycline unlicensed
alternative amoxicillin
alternative if both are unsuitable is IV ceftriaxone

Question 13

treatment for pt with symptoms of Lyme carditis who are haemodynamically stable

Answer 13

1st line oral doxycycline unlicensed
alternative IV ceftriaxone

Question 14

treatment for pt with symptoms of Lyme carditis who are NOT haemodynamically stable

Answer 14

IV ceftriaxone
when switching to oral abx treatment, give oral doxycycline (unlicensed)

Question 15

a patient comes in and says they have been bitten by a tick. do. you refer

Answer 15

no need to if there is no symptoms
if rash or flulike symptoms after being bitten, or swollen lymph noses, headache, joint pain etc see GP

Question 16

do all ticks carry Lyme disease

Answer 16

no

Question 17

dose of doxycycline for Lyme disease (erythema migrans and/or non-focal symptoms, or affecting cranial nerves or peripheral NS)

Answer 17

200mg daily in 1-2 divided doses for 21 days

Question 18

1st line for Lyme disease (erythema migrans and/or non-focal symptoms, or affecting cranial nerves or peripheral NS) is usually doxycycline 200mg in 1-2 divided doses daily for 21 days. alternative if this can’t be given is amoxicillin. what the dose ?

Answer 18

1g TDS 21 days