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34 Cards in this Set
- Front
- Back
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this is the most common vector borne disease in the US
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lyme disease
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if a patient has unexpected hives and itching what should you always check
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lyme disease
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what areas have higher prevelance of lyme disease
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wooded areas - NY and Pennsylvania
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is the prevelence decreasing or increasin for lyme disease
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increasing
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what is the tick born spirochete in lyme disease
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borrelia burgdorferi
tick - primary vector |
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What part of the tick invades the host and when
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spirochete
may to july |
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what are the symptoms in acute localized LD
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vague - flu like
80% develop erythema migrans lymphadenopathy Rash fades after 3-4 weeks |
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what are the symptoms of Disseminated subacute LD
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malaise/fatigue
HA Neck pain and stiffness athralgia myalgia Skin: annular lesions, small, malar butterfly rash, uticaria, diffuse erythema Cardiac: HB lasts 3-6 weeeks Neuro: lasts weeks to months, cranial and peripheral neuropathy, lymphocytic menengitis, enchephalopathy, Bells Palsy, radiculopathy MS: lasts 4-6 months, acute, mono or up to 3 joints, asymmetric, knee most common site, cause effusion |
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when does the disseminated LD occur
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several days to a few weeks after acute phase if not treated
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when does late disseminated LD occur
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months to a year after initial infection
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what are the symptoms of latent dissemination
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Skin - acrodermatitis, atrophic skin
MS: 3 joint pain, knee most common, lead to joint erosion Neuro: memory loss, distal paresthesia, radicular pain, dementia |
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differentials for LD
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rocky mountain spotted fever
SLE RA Reiters Syndrome Bells Palsy Fibromylagia Vrial Encephalitis Bacterial menengitis Depression/Somatoform |
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What systems would you look at in the patient history for LD
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Palpitations
HB Fatigue Rash Stiff neck Near syncope Facial weakness Athralgia/myalgia MS change |
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what are some physical exam findings in a patient with LD
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first - erythema lesions, single or multiple annular lesions
neck stiffness lymphadenopathy facial nerve palsy HB - irregular joint effusion memory loss |
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can you diagnose LD based on clinical findings
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yes
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what two serologic tests are used to diagnose LD
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IGM b burgordorferi antigen
IGA b burgordorferi antigen test ELISA and confirm with Western Blot |
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what is the 3 criteria for LD
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erythema migrans
at least one late manefistation of disease laboratory confirmation |
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does early stage LD require lab testing
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no
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what is required to diagnose late LD
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objective findings - arthritis, CN neuritis, menengitis, neuropathy, HB,
ELISA and western blot test |
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what percent of those infected will spontaneously resolve
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20
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what percent will develop early dissemination with articular symptoms being most common
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80
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what percent will develop chronic neuro and MS manifestations - fatigue, myalgia, and athralgia
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5 - 10
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what are some physical exam findings in a patient with LD
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first - erythema lesions, single or multiple annular lesions
neck stiffness lymphadenopathy facial nerve palsy HB - irregular joint effusion memory loss |
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can you diagnose LD based on clinical findings
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yes
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what is the treatment for LD
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Doxicycline 500 BID or Amox 500 TID or Cefuroxime 500 BID for 3-4 weeks
If HB - admit, IV ceftriaxone 2grams dialy or PCN G for 2-4 weeks |
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what two serologic tests are used to diagnose LD
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IGM b burgordorferi antigen
IGA b burgordorferi antigen test ELISA and confirm with Western Blot |
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what is the 3 criteria for LD
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erythema migrans
at least one late manefistation of disease laboratory confirmation |
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does early stage LD require lab testing
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no
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what is required to diagnose late LD
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objective findings - arthritis, CN neuritis, menengitis, neuropathy, HB,
ELISA and western blot test |
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what percent of those infected will spontaneously resolve
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20
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what percent will develop early dissemination with articular symptoms being most common
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80
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what percent will develop chronic neuro and MS manifestations - fatigue, myalgia, and athralgia
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5 - 10
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what is the treatment for LD
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Doxicycline 500 BID or Amox 500 TID or Cefuroxime 500 BID for 3-4 weeks
If HB - admit, IV ceftriaxone 2grams dialy or PCN G for 2-4 weeks |
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what are some prevention measures for LD
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avoid late spring early summer tick infected areas
where DEET or tick repelent if going into those areas wear light colored clothing cover arms and legs inspect pets daily for ticks |
