August week 4: Lyme Disease


1. Steere, A.  Lyme Disease.  New England Journal of Medicine.  Vol 345, No 2.  July 12, 2001.

Case 1:
A mother brings in her 6 yo son because of a new rash. The rash is ring shaped, erythematous, with central clearing.  The family has spent the last 3 weekends in Rock Creek park and they have seen ticks on the dogs but not on the children.  

What is this rash?  

What is the course of Lyme disease?  

What complications are associated with disseminated lyme infection?  

How do you diagnose lyme disease?  

How will you treat this patient? 

How does the treatment differ if the patient developed neurologic abnormalities or EKG changes?

Case 2:
A mother brings her 2 children to see you.  Mom says her 11 yo daughter  had a tick bite 6 years ago and now complains of joint aches, difficulty concentrating in school, and occasional headaches. She has never missed school or soccer practices due to symptoms.   Mom has done “extensive internet research” and wants to do a trial of IV ceftriaxone for post lyme syndrome.  Her other daughter, age 6, had a tick attached behind her left ear.  Mom knows it was on less than 12 hours because she checks them daily for ticks.  Mom wants the 6 yo treated as well to “prevent what happened with my other daughter.”

What is Post-Lyme Syndrome? 

How is Post-Lyme Syndrome treated? 

What do you do for the 6 yo girl?  

Prep question:
2008 #171
A mother brings in her child because she found a tick on the girl’s shoulder yesterday and is worried about Lyme disease. The mother found a site on the Internet that suggests her daughter needs an antibiotic called ceftriaxone. You assure the mother that only very few children who suffer tick bites actually develop a tick-associated disease.
Of the following, the manifestation of Lyme disease for which ceftriaxone is most appropriate is

A.     Acute arthritis

B.    Carditis

C.    Disseminated erythema migrans

D.    Isolated facial palsy

E.    Peripheral neuropathy