Tick Borne Illness

Lyme Disease

Pt with h/o spending time in grassy and heavily wooded areas presents with a non-tender erythematous rash with central clearing . Reports an episode of fatigue, headache, myalgia, and arthralgia following a tick bite that occured approximately two weeks. Denies any recent rhinorrhea, cough, or diarrhea [PE] on exam.

  • Labs

  • Imaging

  • Treatment

    • Administer prophylactic doxycycline 200 mg (4 mg/kg for pediatric ≥ 8+ years old) to non-pregnant patients only if ALL of the following criteria are met:

      • Attached deer tick in a region with ≥ 20 percent B. burgdorferi prevalence (New England, Wisconsin, Minnesota)

      • Tick attached for ≥ 36 hours (i.e. engorged)

      • Prophylaxis is started within 72 hours of tick removal

    • Erythema migrans: Doxycycline 100 mg BID for 14 days

    • Cardiac complication, and/or neurologic involvement: Doxycycline 100 mg BID for 21 days

    • Monoarticular arthritis: Doxycycline 100 mg BID for 28 days

  • Pt advised that cardiac involvement, monoarticular arthritis, and/or facial palsy may develop if Lyme disease is not appropriately treated

  • Pt counseled that non-specific symptoms such as fatigue, headache, and arthralgias may persist for 6 months to one year after treatment, however, there is no evidence that these symptoms are dangerous, represent ongoing infection, or can be improved with ongoing antibiotic treatment

  • Pt advised to wear protective clothing and apply insect repellent when spending time outdoors to prevent re-infection

Notes

  • Viral symptoms such as rhinorrhea, cough, and/or diarrhea suggest an alternate etiology

  • Symptom onset

    • Erythema migrans: 14 days after infection

    • Cardiac complications, monoarticular arthritis, and neurologic involvement: 28 days after infection

  • Lyme arthritis most commonly affects the knee

Babesiosis

Anaplasmosis