Lyme Disease

Abstract

A 32-year-old pregnant woman from southeastern Connecticut presents to her physician in July at 26 weeks' gestation because of a skin lesion. She reports she has had fatigue, arthralgia, and headache for 2 days and a rash in her left axilla for 1 day. She lives in a wooded area and works in her garden frequently. Six weeks earlier, she had removed a small tick that was attached behind her right knee. On physical examination, she is afebrile. She has an erythematous, oval macular lesion, 7 to 8 cm in diameter, in her left axilla, with enhanced central erythema; no other abnormalities are noted. How should her case be managed?

In vitro evaluation of antibacterial activity of phytochemicals and micronutrients against Borrelia burgdorferi and Borrelia garinii

“…This lesion called erythema migrans is one of the hallmarks of Lyme disease. It is often accompanied by fever, fatigue, body aches and headache (Steere 1989; Burgdorfer 1991; Shapiro 2014). Approximately 4–6 weeks or months after the first symptoms appear, the systemic signs may surface and are much more severe with musculoskeletal indications, neurologic problems, cardiac abnormalities, and eye and liver inflammation (Burgdorfer 1991; Stanek et al .…”

“…Approximately 4–6 weeks or months after the first symptoms appear, the systemic signs may surface and are much more severe with musculoskeletal indications, neurologic problems, cardiac abnormalities, and eye and liver inflammation (Burgdorfer 1991; Stanek et al . 2012; Shapiro 2014). Interestingly, not all Lyme patients have all the symptoms.…”

“…2013; Cameron et al . 2014; Shapiro 2014). For early stages of Lyme disease, administration of doxycycline is generally the first choice; however, this antibiotic cannot be taken by children and pregnant or breastfeeding women (Loewen et al .…”

“…1999; Stricker et al . 2004; Larkin 2008; Hansmann 2009; Shapiro 2014), and for late stages of the disease ceftriaxone or cefotaxime (Maraspin et al . 2011; Delong et al .…”

Therapy of Lyme Disease

“…Borrelia burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Antibiotic selection, dose and route of administration, and duration of therapy for LD depend on the patient's clinical manifestations and stage of disease, age, pregnancy status, as well as the presence of other concomitant diseases and/or allergies [11,12]. Importantly, about 10-20% of patients (especially those who are diagnosed later), following appropriate antibiotic treatment, may have persistent or recurrent symptoms and are considered to have "post-treatment Lyme disease syndrome" [13].…”