10.1016/j.surg.2004.05.010 Surgery 201 WoolleyC
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Epidemiology Incidence most common tick-borne illness in the US 19,931 cases in 2006 most cases occur in June, July, and August Demographics bimodal age distribution geographic locations Etiology Pathophysiology mechanism of transmission pathophysiology pathobiology Classification Stage 1 (rash) - early localized 1 to 30 days after bite erythema migrans (bull's-eye rash) is hallmark rash may be found on head, neck, arms, legs, back, abdomen, axilla, groin, and chest flu-like symptoms Stage 2 (neurologic and cardiac) - early disseminated weeks to months after bite progresses to stage 2 in 15-20% of untreated patients neurologic symptoms Lyme carditis relatively rare prognosis good with complete resolution following treatment Stage 3 (arthritis) - late months to years after bite occurs in 60% of untreated patients arthritis (usually the knee) acrodermatitis chronica atrophicans Presentation History tick bite in May through November Symptoms fever, headache, myalgia, arthralgia, fatigue neurologic symptoms carditis (complete heart block) acute joint pain acute or chronic arthritis Physical exam erythema migrans ("bullseye rash") in 60-80% of patients acute, self limiting joint effusions acrodermatitis chronica atrophicans Studies Serum labs WBC normal or elevated ESR, CRP elevated ELISA (sensitive, not specific) 2 steps seroconversion takes weeks to become positive prior Lyme disease might have persistently positive results vaccination gives positive ELISA, negative Western blot CSF (patients with polyradiculitis and CN VII neuropathy) increased protein lymphocytic pleocytosis Joint aspiration / Synovial fluid 10,000-25,000 WBC/mm3 PMN predominance Skin biopsy culture Culture on Barbour-Stoenner-Kelly medium use skin edge punch biopsy from erythema migrans lesion PCR Differential Bacterial septic arthritis features that differentiate Lyme's diseae from bacterial septic arthritis include Treatment Non-operative oral antibiotics for mild disease IV antibiotics Operative synovectomy Complications Persistent joint pain may have a slightly increased incidence of persistent joint swelling despite therapy Chronic Lyme disease disabling musculoskeletal pain neurocognitive symptoms fatigue Chronic arthritis rare Create a free account or log in to see the cards.
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For example, several bnAbs, including some directed to the base of the HIV Env spike, may be more effective in vivo than would be anticipated from their in vitro neutralization titres 10,11,12
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