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Lyme Disease, Emergency Medicine

Reviewed 06/2017



  • Most common tick-borne illness in North America

  • Endemic in Northeast, Upper Midwest, and northwestern California


  • Peak April–November; 80–90% in summer months

  • Spirochete Borrelia...


Signs and Symptoms

Stage I (early): 
  • Onset few days to a month after tick bite (arthropod transmission)

  • 30–50% of patients recall tick bite.

  • Erythema chronicum migrans (ECM):

    • Pathognomonic findin...


Initial Stabilization/Therapy

  • 20 mL/kg of 0.9% NS IV fluid bolus for dehydration

  • IV access for neurologic and cardiac involvement

  • Cardiac monitoring

  • Temporary pacemaker for heart block

Ed Treatment/Procedures



Admission Criteria

  • Meningoencephalitis

  • Telemetry/ICU admission for carditis

Discharge Criteria

Patients treated with oral therapy 

Pearls and Pitfalls

  • Duration of treatment for later organ involvement will be ≥30 days.

  • Be aware of coinfections with Anaplasmosis and Babesiosis.

Additional Reading

  • American Academy of Pediatrics: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove, CA: Ill; 2012.

  • Kowalski  TJ, Tata  S, Berth  W, et al. Antibiotic treatment durat...



  • 088.81 Lyme Disease

  • 320.7 Meningitis in other bacterial diseases classified elsewhere

  • 711.80 Arthropathy associated with other infectious and parasitic diseases, site unspecified

  • 422.0 Acute my...

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