Doctor123.org

Lyme Disease

para />

‚

Pregnancy Considerations

  • Because B. burgdorferi can cross the placenta, pregnant patients with active disease should be treated with parenteral antibiotics.
  • Doxycycline should not be used in pregnancy.

‚

Second Line

  • Azithromycin, 500 mg PO daily for 7 days, can be used for those allergic to Ž ²-lactams and unable to take tetracyclines but is less effective (2).
  • There is no evidence for meaningful clinical benefit from prolonged treatment or retreatment of patients with persistent unexplained symptoms despite previous antibiotic treatment of Lyme disease.

INPATIENT CONSIDERATIONS

Admission Criteria/Initial Stabilization

  • Admission is recommended for patients with Lyme carditis and symptoms of chest pain, syncope, or dyspnea, and for those with second- or third-degree heart block or first-degree heart block of ≥300 ms.
  • Admission is also recommended for patients with symptoms of meningitis.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Based on the severity of symptoms, patients with Lyme carditis, neurologic syndromes, or arthritis may require prolonged follow-up. ‚

DIET

No restrictions ‚

PATIENT EDUCATION

  • In endemic areas, patients should be advised to protect themselves against tick exposure.
  • https://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Lyme_Disease/
  • PreventionUse repellents that contains 20 " “30% DEET (N,N-diethyl-meta-toluamide) on exposed skin and clothing for protection that last up to several hours.Use 0.5% permethrin on clothing.Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) and perform tick check after outdoor activities.

PROGNOSIS

  • Early treatment with antibiotics can shorten the duration of symptoms and prevent later disease.
  • Response of late-stage disease to treatment is variable. Symptoms may take weeks to resolve after beginning treatment.

COMPLICATIONS

  • Recurrent synovitis, tendonitis, bursitis (7)[A]
  • Chronic neurologic symptoms
  • Peripheral neuropathies
  • Posttreatment Lyme disease syndrome: 10 " “20% lingering symptoms of fatigue, pain, or joint and muscle aches. Can last for 6 months (8)[A]

REFERENCES

11 Centers for Disease Control and Prevention. Statistics on Lyme disease. http://www.cdc.gov/lyme/stats/index.html. Accessed 2015.22 Wright ‚ WF, Riedel ‚ DJ, Talwani ‚ R, et al. Diagnosis and management of Lyme disease. Am Fam Physician. 2012;85(11):1086 " “1093.33 Duncan ‚ CJ, Carle ‚ G, Seaton ‚ RA. Tick bite and early Lyme borreliosis. BMJ. 2012;334:e3124.44 Marques ‚ A, Telford ‚ SRIII, Turk ‚ SP, et al. Xenodiagnosis to detect Borrelia burgdorferi infection: a first-in-human study. Clin Infect Dis. 2014;58(7):937 " “945. doi:10.1093/cid/cit939.55 Klempner ‚ MS, Baker ‚ PJ, Shapiro ‚ ED, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med. 2013;126(8):665 " “669.66 Nadelman ‚ RB, Hanincov ƒ ¡ ‚ K, Mukherjee ‚ P, et al. Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med. 2012;367(20):1883 " “1890.77 Marques ‚ A. Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008;22(2):341 " “360.88 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 Disease Society of America. Clin Infect Dis. 2006;43(9):1089 " “1134.

ADDITIONAL READING

Tickborne Diseases of the United States. A Reference Manual for Health Care Providers. Third edition, 2015. www.cdc.gov/lyme/resources/tickbornediseases.pdf ‚

CODES

ICD10

  • A69.20 Lyme disease, unspecified
  • A69.23 Arthritis due to Lyme disease
  • A69.21 Meningitis due to Lyme disease
  • A69.22 Other neurologic disorders in Lyme disease
  • A69.29 Other conditions associated with Lyme disease

ICD9

  • 088.81 Lyme Disease
  • 711.80 Arthropathy associated with other infectious and parasitic diseases, site unspecified
  • 320.7 Meningitis in other bacterial diseases classified elsewhere

SNOMED

  • 23502006 Lyme disease (disorder)
  • 33937009 Lyme arthritis (disorder)
  • 230150008 Meningitis in Lyme disease (disorder)
  • 230605007 Lyme mononeuritis multiplex (disorder)
  • 77863005 Lyme carditis (disorder)

CLINICAL PEARLS

  • The presence of EM following a tick bite in an endemic area is an indication for empiric treatment for Lyme disease.
  • Repeat episodes of EM in appropriately treated patients are due to reinfection and not relapse.
  • Lyme disease during pregnancy may lead to infection of the placenta and possible stillbirth. Amoxicillin is the preferred treatment during pregnancy.
  • Ticks must be attached for at least 24 hours or more to transmit Lyme disease.
  • There is no evidence that Lyme disease can be transmited by breastfeeding or close personal contact.
  • Vaccines for Lyme disease is no longer avaiable.