LYME DISEASE
BORRELIA BURGDORFERI(SPIROCHETE)
PRIMARY RESERVOIR=DEER TICK- IXODES DAMMINI PACIFICUS
SECONDARY RESERVOIR=WHITE TAILED DEER & WHITE FOOTED MOUSE
3 STAGES
STAGE I (FLU LIKE Sx)
ERYTHEMA CHROMICUM MIGRANS(RED SPREADING RING) MALAISE, MYALGIAS, FEVER, LAD–CUTANEOUS MANIFESTATIONS SPARE THE PALMS AND SOLES
STAGE II (NEURO Sx)
WEEKS TO MONTHS LATER–HEADACHE, 15% CNS SIGNS(VARIABLE)
50% FACIAL PARALYSIS(10% OF PTS)
STAGE III (ARTHRALGIAS)
WEEKS TO YEARS LATER–60% RECURRENT ARTHRALGIAS
Dx: WARTHIN STARRY STAIN FOR BORRELIA
HIGH ESR, HIGH IgM ANTI-BORRELIA–SEROLOGY POSITIVE AFTER 2 WEEKS
10% OF HEALTHY PEOPLE IN ENDEMIC AREAS HAVE POSITIVE TITERS
Rx: TETRACYCLINE P.O. FOR 10 DAYS
SECOND LINE=AMOX/PCN OR CEFTRIAXONE 2 G IV QD X 14