Lyme Disease

Question 1

Clinical picture

Answer 1

1. Early Localized Stage (Days to Weeks)
   Main features:
   *Erythema migrans (EM):
   -Classic “bull’s-eye”شكل عين الثور or target-shaped rash
   -Appears at the site of the tick bite, usually 7–14 days after exposure
   Not painful or itchy

-Flu-like symptoms:

-Mild lymphadenopathy
2. Early Disseminated Stage (Weeks to Months)FACE
Occurs if untreated in stage (Multiple systems can be involved)
A-Neurologic:
-Facial nerve palsy (often bilateral)
-Meningitis (headache, neck stiffness)
-Radiculopathy, cranial neuritis
B-Cardiac:
-Lyme carditis (AV block, myocarditis, pericarditis)
-Symptoms: lightheadedness, palpitations, syncope
-Dermatologic:
Multiple erythema migrans lesions (due to hematogenous spread)

Systemic:

Fever, malaise, migratory joint or muscle pain
3-Late (Persistent) Lyme Disease (Months to Years)

Main features:

Musculoskeletal:

Migratory arthritis (often knees, asymmetric)

Intermittent or chronic joint inflammation

Neurologic:

Chronic neuroborreliosis (e.g., peripheral neuropathy, encephalop

Question 2

What are the treatment options?

Answer 2

شد السيفون
Cefuroxim
1-For early localized or disseminated Lyme disease (non-neurologic, non-cardiac):
Doxycycline 100 mg twice daily for 10–21 days (preferred)

Alternatives if doxycycline contraindicated:

Amoxicillin or

Cefuroxime

2-For neurologic or cardiac involvement:
IV ceftriaxone may be required
(2 g daily) for 14–21 days is first-line.

Question 3

بالمرة
Tick borne diseases

Answer 3

Table
Taularemia
Anaplasmosis
Babesiosis
Lyme
Echreliosis

Question 4

تحشيشة

Answer 4

FACE
Facial nerve palsy
Arthritis
Cardiac av block
Erythema migrans

Question 5

The following are the clinical manifestations of Lyme disease EXCEPT?
A. Skin rash.
B. Arthritis.
C. Nausea, vomiting, diarrhea.
D. Myocarditis.

Answer 5

C
التكر التحشيشة

Question 6

طيب
بما أنك بقي بتنسي

Answer 6

علاج lyme, leptospira
زي بعض
*Doxycycline 100 mg twice daily for 10–21 days
*In severe cases(ceftriaxone iv is added, (2 g daily) for 14–21 days is first-line. )
*If there is Doxycycline resistant, amoxicillin ينفع في الاتنين
*Cefuroxim السيفون ده بتاع lymeفقط

Question 7

طب علي فكرة بقي
Taularemia
بيتعالج ازاي

Answer 7

1st line:
Streptomycin 1gm im /day
Or aminoglycosides
2nd line
Oral
Doxycycline زي 2L
Or ciprofloxacin

Question 8

A 42-year-old man residing in Connecticut during the summer presented to the emergency department complaining of light-headedness and dizziness. His heart rate was 40 beats per minute, and his electrocardiogram (ECG) showed a complete heart block. The patient stated that he spends much of his time gardening and has found ticks on himself. He reports that his father had an acute myocardial infarction (MI) at the age of 50 during muscular exercise. The patient had no fever and no abnormalities were noted during the physical examination apart from a single erythematous rash on his back. His routine laboratory investigations and X-ray were within normal limits

Answer 8

Diagnosis?
Lymed disesse

Question 9

Diagnosis

Answer 9

-1-Clinically: erythema migrans is pathognomonic for Lyme disease.
2- Laboratory: antibody (IgM & IgG) detection by ELISA.or IFA
- Not recommended in presence of erythema migrans.
- Detected in 60-70% of patients in early disease.
- Can be affected by antibiotic therapy.
- Negative results don’t exclude the disease.