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martes, 4 de octubre de 2016

Lyme Disease

Resultado de imagen de emdocs
emDocs - October 3, 2016 - Authors: Uryasev O and Perkins J
Edited by: Robertson J and Koyfman A
"Background
The first case of Lyme disease was documented more than 5000 years ago.Today, it is the most commonly reported vector borne disease with ~30,000 cases per year in the United States. The vast majority of cases are found in the Northeast and in the upper Midwest, but there is distribution nationally. Lyme is a manifestation of infection by the spirochete Borrelia burgdorferi. This spirochete is harbored by the deer tick Ixodes scapularis and Ixodes pacificus.
The chance of Lyme transmission depends on the duration of tick attachment. If an infected tick is attached for less than 24 hours, then there is an almost zero percent chance of transmission. However, the tick has been attached for more than 72 hours, there is an almost one hundred percent chance of disease transmission. It is important to keep in mind that patients with tick bites are at risk for many other tick borne illnesses such as Babesiosis, Rocky Mountain Spotted Fever, Southern Tick-associated Rash Illness, Ehrlichiosis, Anaplasmosis and Tularemia...
Take home points:
  1. Add Lyme disease to your differential when you see a patient with a history viral illness with headache, myalgias/arthalgias and fevers, especially in endemic regions.
  2. If Bell’s palsy is due to Lyme, systemic symptoms of Lyme should also be present. Testing for Lyme in isolated Bell’s palsy is not indicated.
  3. Initial management for Lyme meningitis is identical to any other patient presenting to the ED for bacterial meningitis.
  4. Prophylaxis is only appropriate in patients who reside in an endemic area who have had a tick attached for greater than 36 hours. Doxycycline is the only approved prophylactic antibiotic.
  5. Chronic Lyme disease is not a continued spirochete infection and is often misdiagnosed when in fact a completely separate disease process (e.g. multiple sclerosis) is the underlying etiology. Chronic Lyme disease refers to prolonged symptoms after the infectious component has been treated."