5 hours ago The incidence of Lyme disease is highest among children 5 to 14 years of age and middle-aged adults (40 to 50 years of age), and it is slightly more common among males than among females. 3. … >> Go To The Portal
The positive lgM test alone does not warrant a Lyme disease diagnosis, since her symptoms have lasted for more than 30 days. Thus, she is not a candidate for antibiotic treatment for Lyme disease. The patient suffers from myriad nonspecific symptoms referable to every organ system, and her exam and laboratory studies are normal.
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This article has no abstract; the first 100 words appear below. Since its original description nearly 25 years ago, 1 Lyme disease has become recognized as an important infectious disease in the United States. The infection, which is caused by the tick-borne spirochete Borrelia burgdorferi, is now endemic in more than 15 states...
The patient denies having spent time in wooded areas or being exposed to ticks. Her family history includes a sister who was diagnosed with chronic Lyme disease by a physician and treated with a prolonged course of ceftriaxone as well as a daughter who is ill with similar symptoms.
Chronic Lyme disease is not a valid diagnosis. In this case, some of the patient’s subjective complaints may be compatible with late Lyme disease, but it is unlikely that Lyme disease is the cause of her symptoms. She lacks objective clinical findings and a history of tick exposure.
Acute Lyme disease may contribute to the development of de novo, or activation of previously quiescent, immune-mediated glomerular disease. Adult Anti-Bacterial Agents / therapeutic use
Most patients with erythema migrans (about 80%) have a single lesion, but the bacteria can disseminate hematogenously to other sites in the skin and to extracutaneous sites. The most common sign of early disseminated infection is multiple, often smaller erythema migrans lesions ( Figure 1C ).
Although avoidance of tick-infested areas is the best way to prevent Lyme disease, occupational and recreational activities and the proximity of residential areas to woodlands often make such directives impractical.
In a minority of patients who receive recommended treatment for Lyme disease, objective signs resolve, but subjective symptoms such as fatigue, arthralgia, and myalgia persist for weeks, months, or longer.
The Infectious Diseases Society of America has published guidelines for the management of Lyme disease 1 that are similar to those of other professional groups, including the American Academy of Neurology and professional societies in European countries. 49,50 The recommendations in this article are consistent with these guidelines ( Table 3 ).
The patient described in the vignette has a skin lesion that is consistent with erythema migrans, 6 weeks after having removed a tick from another location on her body. I would recommend that this patient take 500 mg of amoxicillin three times a day for 14 days, because doxycycline is contraindicated in pregnant women.
From the Departments of Pediatrics, Epidemiology of Microbial Diseases, and Investigative Medicine, Yale University Schools of Medicine and of Public Health and Graduate School of Arts and Sciences, New Haven, CT.
1. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006 ;43: 1089 - 1134 [Erratum, Clin Infect Dis 2007;45:941.]
The infection, which is caused by the tick-borne spirochete Borrelia burgdorferi, is now endemic in more than 15 states and has been responsible for focal outbreaks in some eastern coastal areas.
Lyme borreliosis is also endemic in Europe and Asia, where certain aspects of the disease (erythema migrans, meningopolyneuritis, and acrodermatitis chronica atrophicans) were described in the early and mid-20th century.