Lyme Disease

• "Lyme disease is a zoonotic, multisystem illness caused by the spirochete B. burgdorferi, which is transmitted by certain Ixodes spp ticks.
• Approximately 30,000 cases are reported to the CDC each year, primarily from high-incidence states located in the northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) and north central (Minnesota and Wisconsin) United States.
• Acute clinical illness is usually characterized by fever and constitutional symptoms combined with a distinctive rash, erythema migrans (EM), which develops at the site of the tick bite in approximately 70 to 80 percent of patients.4 However, without early appropriate antibiotic therapy, infection can disseminate to other tissues, causing peripheral and central neuropathy, arthritis, and carditis."
  

When to Provide Prophylaxis

• "For prevention of Lyme disease after a recognized tick bite, routine use of antimicrobial prophylaxis or serologic testing is not recommended. A single dose of doxycycline may be offered to adult patients (200 mg) and to children ≥8 years of age (4 mg/kg, up to a maximum dose of 200 mg) when all of the following circumstances exist:

1. The attached tick can be reliably identified as an adult or nymphal I. scapularis tick that is estimated to have been attached for ≥36 hours on the basis of the degree of engorgement of the tick with blood or on certainty about the time of exposure to the tick.
2. Prophylaxis can be started within 72 hours of the time that the tick was removed.
3. Ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi is ≥20 percent.
4. Doxycycline is not contraindicated."
   

Source: http://www.acepnow.com/article/risk-sudden-cardiac-arrest-lyme-carditis-underscores-need-timely-diagnosis-treatment/
Source: Clin Infect Dis. 2006;43:1089-1134.


Medications