AM Report

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AM Report

• 6/29/06

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• LYME DISEASE
• Clinical Features
• Diagnostic challenges
• Treatment

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Endemic Regions
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Diagnosis

• Serology
• ELISA
• 59 sensitive, 93 specific early stage
• 95 sensitive, 81 specific late stage
• Western blot
• 50-75 sensitive and 99-100 specific
• False positive in 2-5 of population
• Lacks sensitivity early
• Abx effects

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Serology who needs it?
Diagnosis of Lyme Disease                       
                                                  
          
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Diagnosis

• Lumbar puncture
• Useful if neurologic symptoms /- Bannwarths
  syndrome-facial palsy and/or radiculoneuropathy
• Newer testing
• Urinary antigen
• PCR

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Treatment

• Choice of antibiotic
• doxycyclineamoxicillincefuroxime
• Macrolides not as effective
• Duration of therapy
• Early localized-10-21 days po or IV
• Early disseminated-IV therapy with ceftriaxone or
  cefotaxime for 2-4 weeks
• Neurologic disease-needs IV unless isolated
  facial palsy without csf involvement
• AV block-oral therapy unless 3rd degree heart
  block
• ?corticosteroids
• Late disease-treat 2-4 weeks
• Arthritis-po but IV if failed two oral regimens
• Neuroborreliosis-IV ceftriaxone or cefotaxime

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