Borrelia burgdorferi (Lyme Disease)
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Bacteria - Gram Negative
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- Klebsiella pneumoniae
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- Borrelia burgdorferi (Lyme Disease)
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Borrelia burgdorferi
- Characteristics
- Spirochete (spiral-shaped with axial filaments)
- Doesn’t gram-stain well due to thin cell walls
- Spirochete (spiral-shaped with axial filaments)
- Transmission
- Common in northeastern US
- Often in patients who do outdoor activities (hiking, camping) in northeast US
- Transmitted by the Ixodes tick
- Also a vector for Anaplasma spp. and Babesia; coinfection is common
- Natural reservoir is the mouse
- Common in northeastern US
- Lyme disease
- Stage 1 – localized
- flu-like symptoms
- Erythema migrans ("bulls-eye" or “target” lesion)
- Expanding ring-shaped erythematous rash that begins 1-2 weeks around site of bite
- Stage 2 – early disseminated
- Occurs weeks to months after inoculation without treatment
- “FACE” mnemonic: facial nerve, arthralgias, cardiac block, erythema migrans
- Facial nerve (Bell) palsy
- Extremely rare presentation of Lyme disease
- Migratory arthralgias
- Transient migratory joint pain
- Heart block (AV block)
- Due to Lyme carditis and localized inflammation in conductive tissue of heart
- Stage 3 – late disseminated
- Occurs months or years after inoculation without treatment
- Encephalopathy
- Chronic arthritis (knees)
- Stage 1 – localized
- Diagnosis
- Visualized by dark-field microscopy, or direct fluorescent antibody (DFA) microscopy
- Can use ELISA to detect serologic immunoglobulins
- Treatment
- Doxycycline (1st line)
- Amoxicillin (and ceftriaxone if severe illness – CNS signs or heart block)
- Macrolides
- Second line in those who are allergic to first line