drdg
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A 28-year-old woman comes to the ED complaining of fever, headache, photophobia and mild slurred speech for 2 days. She reported that 3 weeks before onset of symptoms she went camping with her friends in upstate NEW York. On arriving heom from her trip, a family member noted a tick on her back, which was removed by her friend. Short thereafter, a rash with a central area of clearingwas noted at the site of tick bite. The following 3 weeks were uneventful until the symptoms described earlier began. T: 38 (100.4), BP: 120/70, P: 73, R: 13. PE shows mild photophobia and nuchal rigidity. She was a mild left-sided facial droop. There is no rash present. Which of the following is the most appropriate next step in management?
A. IV vancomycin
B. Oral Doxycycline
C. Determination of serum Lyme antibody
D. Lumbar puncture
E. Lyme PCR of serum
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| Kamsi
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B
Oral Doxycycline.Given in facial palsy ,with more severe dx give Ceftriaxone
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| darkhorse
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C
___________________
When going gets tough, the tough gets going
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| sprint123
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Agree with darkhorse...Serologic diagnosis is the best method to diagnose LYME. In addition, patient has meningitis too, which cannot be treated with doxy, although doxy could be used for facial palsy.
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| neuroblastoma
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B ORAL DOXYCYLINE
rash with a central area of clearingwas noted at the site of tick bite --ITSELF CLINICAL DIAGNOSE..so better treat it. even if facial palsy we give doxycyline.
for systemic features--encephalitis, balance disorders); heart block, arrhythmias, and inflammation within the sac surrounding the heart. we can go for I/V ceftriaxone
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| drdg
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| neuroblastoma
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headache, photophobia and mild slurred speech for 2 days--- SO i can choose D LP
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| me007
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e?
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| drdg
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The correct answer is D. LP
Yes, Lyme disease is diagnosed clinically. Tick bite, specific rash ( erythema migrans). This was followed by early disseminated disease such as facial palsy and mengingitis. To treat the patient appropriately, we need to know definitely if this patient has CNS involvement or isolated Bell palsy. Because the treatment is different ( Isolated palsy is treated with oral doxycycline, however, Lyme disease with mengingitis is treated with IV ceftriaxone). This can be accomplished with a lumbar puncture and CSF evaluation.
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| neuroblastoma
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 thanksssssss
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| me007
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ok, pt clinically has Lyme and clinically has not localized CNS involvment.
It is clear that Tx of choice is ceftriaxone, not doxy.
Do you really need LP?? For what reason??
When on other hand - serologic study to confirm clinical suspicious is most commonly used test.
Also PCR is not the best one..
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