Lyme disease

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Lyme disease

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12 Posts

Kamsi
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09/09/07 - 04:12 PM

A 29-year-old man comes to see you because of difficulty with drooling and a unilateral dry eye. On physical examination, he has unilateral facial palsy. He lives in Massachusetts and frequently goes trekking in the mountains. His serologic test is positive for an IgM antibody to Borrelia burgdorferi. What is the most appropriate management?

(A) Repeat the serology in four weeks
(B) Perform a lumbar puncture
(C) Oral doxycycline for three weeks
(D) Intravenous ceftriaxone

dermatology
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09/09/07 - 04:22 PM

D . iv ceftriaxone

GOGETA
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09/09/07 - 06:07 PM

Ceftriaxone
also remember you give doxyci because is secreated in the liver

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Justice
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09/09/07 - 08:13 PM

(D) Intravenous ceftriaxone

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Kamsi
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09/09/07 - 08:50 PM

I agree with U guys but from Fischer where I saw the question said facial palsy is adequately treated with oral doxycycline.IV therapy does not give a greater efficacy when compared with oral doxycycline

me007
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09/09/07 - 11:51 PM

it is not only facial palsy, it is serious CNS complication

Kamsi wrote:
[color=#000000]A 29-year-old man comes to see you because of difficulty with drooling and a unilateral dry eye. On physical examination, he has unilateral facial palsy.

sukhs
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09/10/07 - 05:24 AM

According to Kaplan lecture notes....."the rash,the facial palsy and the first degree heart block are treated with oral doxycycline and the more serious menifestations like the myocarditis ,meningitis or encephlitis are treated with intravenous ceftriaxone"

I do not see any signs or symptoms of meningitis or encephlitis in this case.....it is simply a facial palsy case...drooling,drynes of the eyes b'cos of improper closure etc....no neck rigidity,no kernigs or brudinski positive, no altered sensorium......so no meningitis or encephlitis likely so the answer is oral doxycycline for three weeks....

elitoki
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09/10/07 - 07:20 AM

Good Point sukhs!
Thanks grin

kpmle2
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09/10/07 - 08:45 AM

epica

09/10/07 - 08:48 AM

#10

C ( from step 1 )

'I do not see any signs or symptoms of meningitis or encephlitis in this case"
Agree w your explanation Sukhs

starcraftbw
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Topics: 13
Posts: 166

09/11/07 - 03:58 PM

#11

D: IV ceftriaxone
1) Stage 1: rash --> rx: Doxycycline or amoxicillin (preg)
2) Stage 2: Neurological problem (meningitis, CN palsy (7) --> IV ceftriaxone
3) Stage 3: Cardiac heart block --> IV ceftriaxone
4) Arthralgia --> doxycycline x 3wks

usmle-china
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Topics: 1
Posts: 21

09/11/07 - 08:09 PM

#12

Kaplan Notes and UW regarding management of Lyme disease:

1. The rash, the facial palsy, and first-degree heart block can be treated with oral doxycline ( x3 week). Joint manifestions can be treated with a month of oral doxycycline as well.
2. More serious manifestations such as high-grade heart block, memingitis, myocarditis or encephalitis are treated with intravenous ceftriaxone.
3. If pregnancy and children , mild Lyme disease should use amoxicillin. If allergy to amoxicillin, then use erythromycin.

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