- Spirochete Borrelia burgdorferi infection via tick bite
- Erythem migrans - macular erythematous rash with central clearing
- Starts at bite site (3-21 days later) and spreads (spirochetes migrate from wound site)
- Rash disappears after 1 month or may never be noticed
- May have accociated "'flu" like fatigue, fever etc
Late symptoms seen in 2/3 if untreated:
- Neuroborreliosis: mononeuritis multiplex (e.g. Bell's) or meningitis
- Oligoarthralgia: (knees) - synovial ↑WCC and PCR +pos for spirochetes
- Pancarditis: AV block, or myocarditis
- Serology testing (ask labs) to confirm suspicious cases
- IgG has lower false positive rate than IgM. IgM usually indicates more recent infection butmay saty positive even after treatment.
- ECG : typically AV block
- If well with erythema migrans or strong suspicion for Lyme disease - treat with doxycycline then ask for serology testing
- If significant ECG (beware block) or clinical signs of cardiac involvement, admit for ECG monitoring (±pacing) and iv CefTRIaxone. Later switch to po doxycycline.
- If neuroborrelleisos - admit neurology
- If oligoarthritis get (sterile procedure) synovial aspirate
- Please contact microbiology for antibiotic advice
Content By Dr Íomhar O' Sullivan. Last review Dr ÍOS 10/06/21.