Infectious Disease Compendium

Lyme Disease

Diagnosis

Stage 1 : Local spreading target lesions: erythema chronica migrans.

Stage 2: Disseminated with oligoarticular arthritis, carditis and /or meningitis.

Stage 3: Chronic with arthritis and encephalitis.

Epidemiologic Risks

Tick bites > 48 hours.The tick has to be on a long time to spread the lyme, but most people fail to notice the tick, similar perhaps, to the way most people fail to notice how stupid everyone in the Bush administration is; people have a selective blindness for small brained blood suckers (written 4/20/06).

Microbiology

B. burgdorferi.

Empiric Therapy

Early infection: doxycycline 100 mg po bid for 20-30 d OR amoxicillin 500 mg po tid for 20-30 d. doxycycline or amoxicillin allergy: cefuroxime, 500 mg po bid for 20-30 d OR erythromycin 250 mg po qid for 20-30 d.

Arthritis: doxycycline 100 mg po bid for 30-60 d OR amoxicillin 500 mg po qid for 30-60 d OR ceftriaxone 2 g IV qd for 14-30 d OR penicillin G 20 million U IV in 4 divided doses daily for 14-30 d.

Neurologic abnormalities: ceftriaxone 2 g IV qd for 14-30 d OR penicillin G 20 million U IV in 4 divided doses daily for 14-30 d. Ceftriaxone or penicillin allergy: doxycycline 100 mg po tid for 14-30 d.

Facial palsy, isolated: doxycycline 100 mg po bid for 20-30 d OR amoxicillin 500 mg po tid for 20-30 d. Doxycycline or amoxicillin allergy: cefuroxime 500 mg po bid for 20-30 d OR erythromycin 250 mg po qid for 20-30 d.

Cardiac involvement: doxycycline 100 mg po bid for 20-30 d OR amoxicillin 500 mg po tid for 20-30 d. doxycycline or amoxicillin allergy: cefuroxime 500 mg po bid for 20-30 d OR erythromycin 250 mg po qid for 20-30 d.

High-degree AV block: ceftriaxone, 2 gm IV qd for 14-30 d OR penicillin G, 20 million U IV in 4 divided doses daily for 30 d.

Pearls

Rants

Chronic Lyme disease needing long term antibiotics? I think it is mostly a crock, but I also suspect the IDSA is a wee bit too conservative in recognizing the extent of chronic Lyme's symptoms. The truth probably lies between the IDSA and the Lyme wacko's, and I bet it is more akin to a Reiter's process than an actual active infection. But that is just my suspicion.