ID

Question 1

Lyme PPx after Tick Bite

1. List the 5 criteria that must be met for ppx
2. List medication including dose and duration for ppx in adults

Answer 1

ALL CRITERIA MUST BE MET:
1. Identified Ixodes tick (Ixodes scapularis or pacificus)

2. Tick attached ≥ 36 hours (or engorged)
3. Prophylaxis can be started ≤ 72 hours of tick removal
4. Local Lyme prevalence ≥ 20% or patient in a known endemic area (many parts of southern ON, QC, Maritimes, BC)
5. No contraindication to doxycycline
   _________
   Recommended prophylaxis

Adults: Doxycycline 200 mg PO x 1 dose

Children: 4.4 mg/kg PO once (max 200 mg)

Question 1

What bacteria causes lyme disease ?

What is the vector?

Answer 1

Borrelia burgdorferi

**Ixodes scapularis (black legged tick)

Question 2

List 3 Cardiac manifestations of Lyme Disease

Answer 2

1. FLuctuating AV block (Most common)
2. Myocarditis
3. Pericarditis
4. Reversible Heart Failure

Question 3

List 3 early neurologic manifestations of lyme disease

Answer 3

1. Facial nerve palsy (bilateral CN 7 palsy)
2. Aseptic Meningitis
3. Radiculopathy (Severe, migratory radicular pain)
4. Peripheral Neuropathy

Question 4

List 3 late manifestations of Lyme Disease

Answer 4

1. Lyme arthritis
2. Encephalitis
3. Acrodermatitis

Question 5

List 3 ophthalmic manifestations of Lyme Disease

Answer 5

1. Conjunctivitis
2. keratitis
3. choroiditis
4. retinal detachment
5. optic neuritis
6. blindness

Question 6

List 5 DDx for erythema migrans

Answer 6

1. Spider Bite
2. MRSA Cellulitis
3. Erythema multiforme (can involve mucous membranes/palms and soles)
4. Erythema nodosum
5. Erythema marginatum (acute rheumatic fever)