Lyme disease

Lyme disease is a tick-borne infectious disease caused by the gram negative spirochete borrelia burgdorferi. 

Clinical presentation is variable, but generally the first sign is erythema chronicum migrans, which is a spreading erythematous rash with central clearing. This is often accompanied by a flu-like illness. 

Complications associated with Lyme disease include:
  • Encephalitis 
  • Meningitis 
  • Arthritis 
  • Facial nerve palsy 
  • Meningoradiculitis 

In addition to erythema chronicum migrans two other skin manifestations are associated with Lyme disease: 
  • Borrelial lymphocytoma 
    • Usually occurs within 2 months of the tick bite 
    • is a purple tumour that appears on the earlobe, nipple, scrotum, nose or arms 
  • Acrodermatitis chronica atrophicans 
    • Occurs 6 months to several years after the tick bite 
    • Results in parchment-like thinning of skin, usually on extensor surfaces of limbs 

The diagnosis is often clinical. Screening for Lyme disease is done by ELISA and confirmation can be made by an immunoblot. 

CSF may show raised protein and lymphocytosis.

Treatment is 14 days doxycycline, or in more serious disease IV ceftriaxone

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