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Lyme Disease

Felix B. Chang Cruz, MD, FAAMA, ABIHM and Roberto S. Amado, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A multisystem infection caused by Borrelia spirochetes, transmitted primarily by ixodid ticks

    • Ixodes scapularis (deer ticks) in the Northeast and Great Lakes areas

    • Ixodes pacificus in ...

DIAGNOSIS

HISTORY

  • History of a tick bite followed by EM and/or illness. About 1/3 of patients recall tick bite.

  • Round, flat or raised, erythematous lesion that expands in diameter over days to weeks may...

TREATMENT

GENERAL MEASURES

Early and disseminated Lyme disease can usually be treated as an outpatient except when complicated by carditis or meningitis (requires parenteral antibiotics). 

MEDICATION

First Line

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Based on the severity of symptoms, patients with Lyme carditis, neurologic syndromes, or arthritis may require prolonged follow-up. 

DIET

No restr...

REFERENCES

1
Schwartz AM, Hinckley AF, Mead PS, et al. MMWR surveillance for Lyme disease—United States, 2008–2015. MMWR Surveill Summ.  2017;66(22):1–12. [View Abstract on OvidMedline]
2
Marques A,...

ADDITIONAL READING

  • Borchers AT, Keen CL, Huntley AC, et al. Lyme disease: a rigorous review of diagnostic criteria and treatment. J Autoimmun.  2015;57:82–115. [View Abstract on OvidMedline]

  • Cente...

CODES

ICD10

  • A69.20 Lyme disease, unspecified

  • A69.23 Arthritis due to Lyme disease

  • A69.21 Meningitis due to Lyme disease

  • A69.22 Other neurologic disorders in Lyme disease

  • A69.29 Other conditions associated ...

CLINICAL PEARLS

  • The presence of EM following a tick bite in an endemic area is an indication for empiric antibiotic treatment for presumptive Lyme disease.

  • Lyme disease during pregnancy may lead to inf...

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