Medical knowledge | Infectology » Lyme disease

The most common manifestation of Lyme disease in children • • • • • Joint pain Fever Facial nerve palsy Erythema migrans Polyneuropathy The differential diagnosis of erythema migrans includes • • • • • Nummular eczema Kawasaki syndrome Scalded skin syndrome Psoriasis Erythema multiforme The differential diagnosis of erythema migrans includes • • • • • Nummular eczema Kawasaki syndrome Scalded skin syndrome Psoriasis Erythema multiforme When treating children with Lyme disease doxycycline is always the drug of choice for oral treatment • True • False When treating children with Lyme disease doxycycline is always the drug of choice for oral treatment • True • False The tick that transmits Lyme disease feeds on lizards and deers • True • False The tick that transmits Lyme disease feeds on lizards and deers • True • False Persistence of nonspecific symptoms in Lyme disease is not an indication of failure of AB

treatment • True • False Persistence of nonspecific symptoms in Lyme disease is not an indication of failure of AB treatment • True • False Epidemiology of Lyme disease • Tick vectors – Ixodes scapularis – Ixodes pacificus • Geographic distribution in the USA – Northeast – Upper midwest – West coast • Canada, Europe, Russia, China, Japan • From April to October Incubation period for Lyme disease • Erythema migrans – 3 - 31 days (typically 7 - 14 days) • Late manifestations – months - more than 1 year CLINICAL MANIFESTATIONS OF LYME DISEASE - 1 EARLY LOCALIZED DISEASE (1-2 wk) Erythema migrans (>5 cm; medium, 15 cm) May have vesicular or necrotic areas in the center Flu-like disease often accompany the rash  Fever, malaise, arthralgia, myalgia, headache,fatigue, mild neck stiffness, Lymphadenopathy CLINICAL MANIFESTATIONS OF LYME DISEASE - 2 EARLY DISSEMINATED DISEASE (3-5 wk) Multiple erythema migrans (primary and

secundary lesions) Cranial nerve palsies Aseptic meningitis Flu-like disease  Fever, headache, arthralgia myalgia, malaise, fatigue, Carditis (rare) CLINICAL MANIFESTATIONS OF LYME DISEASE - 3 LATE DISEASE (from 1-3 mo to years) Recurrent or chronic oligoarthritis CNS manifestations  meningitis  encephalitis  encephalopathy  polyneuropathy (palsy, paresthesia) Materno-fetal transmission of Lyme disease • • • • Transplacental transmission of B. burgdorferi No abnormalities of pregnancy No congenital disease No transmission via human milk Diagnosis of Lyme disease • In patients with rash – Clinical – Culture • In patients without rash – Clinical – Serology – Western blot Serologic tests in Lyme disease • • • • • • • • IgM titer peaks between 3-6 weeks after the onset of disease IgG rise slowly; peaks weeks to months after the onset of diseas Abs may will not be detectable in early localized disease Pts treated

early with antibiotics may will never have Abs Once Abs develop, they may persist for years Tests for Abs should not be used to assess treatment Testing for Abs should be performed in a reference laboratory FALS POSITIVE SEROLOGIC TESTS – syphilis, leptospirosis, relapsing fever, varicella, SLE, oral flora Two-test approach to confirm diagnosis of Lyme disease • EIA or IFA – Positive  Western immunoblot – Negative  No immunoblot testing Hints for serology testing in Lyme disease • EARLY DISEASE – Serum testing between 1-4 weeks • Both IgM and IgG immunobots are recommended – Serum testing after 4 weeks • Only IgG immunobot is not recommended • LATE-STAGE DISEASE – Robust IgG response to borrelia antigens – Detection intratechal Abs in CNS involvement Treatment of early localized disease > 8 year of age: Doxycycline, 2x100 mg, 21 days < 8 year of age: Amoxicillin, 25-50 mg/kg/d, 21 days Treatment of disseminated and late disease

- 1 • Multiple erythema migrans – same as for localized disease • Isolated facial palsy – same as for localized disease • Arthritis – same as for localized disease Treatment of disseminated and late disease - 2 • Recurrent or persistent arthritis, carditis, meningitis, encephalitis: – Ceftriaxon, 75- 100 mg/kg/d, 21 days, IV or IM; maximum, 2 g/d – Penicillin, 300 000 U/kg/day, 21 days; maximum, 20 million U/d Lyme disease: control measures • • • • Avoidance of tick-infected areas Appropriate clothing Permethrin spray Tick repellents (Diethyltoluamide) – not to face, hands, and abraded skin • Removal of ticks (daily self-expection) Lyme disease: chemoprophylaxis • Not recommended • Exceptions: – pregnancy – engorged tick