Doxycycline for all, #blessed

A 37 year old woman presents with concern for a bite. She collects caterpillars for her hobby and takes a particular liking to pink fuzzy ones. She was hiking in near her lake house and when she returned home she noticed a rash on her RLQ of her abdomen. She posted the photo to instagram as #trueblood and #oncebitten, however it was too painful to touch and none of her followers offered any medical advice so she presented to the ED for further evaluation. She also added #blessed, but still no advice.

Which of the following is true?

A. Acute prophylactic management does not effectively prevent cardiac manifestations

B. The majority of patients recall being bite by a tick

C. Lyme disease manifests as arthritis within the first 2 weeks of infection

D. Amoxicillin and Doxycycline have equal efficacy for early localized disease

E. Serologic testing is often false positive during the first two weeks

——-References:

Hu LT. In the clinic. Lyme disease. Ann Intern Med 2012; 157:ITC2.

Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med 1990; 323:1438.

Nadelman RB, Nowakowski J, Forseter G, et al. The clinical spectrum of early Lyme borreliosis in patients with culture-confirmed erythema migrans. Am J Med 1996; 100:502.

Steere, A C (1987). "The clinical evolution of Lyme arthritis.". Annals of internal medicine, 107 (5), p. 725.

Steere, A. C., M.D. (1989). Lyme disease. The New England Journal of Medicine, 321(9), 586-596. doi:http://dx.doi.org.go.libproxy.wakehealth.edu/10.1056/NEJM198908313210906

Steere AC, McHugh G, Damle N, Sikand VK. Prospective study of serologic tests for lyme disease. Clin Infect Dis 2008; 47:188.

Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089.


Blake Briggs