Lyme disease Borrelia burgdorferi

• Facts:
  B. burgdoferi (Sprirochete)
  Usually in summer months, endemic to the Northeast
  Ixodes tick on white tailed deer and white footed mice
  MC vector-borne disease in N. America
• History / PE:
  Erythematous, non pruritic/painful rash
  Cranial nerve palsy (MC is facial)
  Intermittent inflammatory arthritis (lyme arthritis)
• Diagnosis:
  ELISA and Western Blot
  Tissue culture/PCR
• Treatment:
  Doxycylcine (early disease) ceftriaxone (late disease)
  
  Amoxicillin (pregnant pts and children)
  
• Pneumonic:
  Fever and rash? "Tiny GERMS"
  
  Typhoid fever
  
  Gonococcemia
  E ndocarditis
  RMSF
  Meningococcemia
  Sepsis (bacterial)
• Notes:
  PRIMARY (early, localized disease)
  
  Erythema migrans "bulls eye" rash
  
  SECONDARY (disseminated disease)
  
  Migratory polyarthropathies
  Neurologic phenomena (eg. Bell's palsy)
  Meningitis and/or myocarditis
  Conduction abnormalities (3rd degree heartblock)
  
  TERTIARY (late disease)
  
  Arthritis
  Subacute encephalitis (memory loss and mood change)
• See Also:
  Babesiosis (no rash)