What is the early features of Lyme disease?

• erythema migrans ('bulls-eye' rash)
• systemic features
  • headache
  • lethargy
  • fever
  • arthralgia

What are the late features of Lyme disease?

Seen after 30 days

• cardiovascular
  • heart block
  • peri/myocarditis
• neurological
  • facial nerve palsy
  • radicular pain
  • meningitis

How is Lyme disease diagnosed?

• erythema migrans is diagnostic

If not present

• enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi
• if positive or equivocal then an immunoblot test for Lyme disease should be done

What is the management of Lyme disease?

• doxycycline if early disease
• ceftriaxone if disseminated disease

What are the main causes of Lyme disease?

caused by the spirochaete Borrelia burgdorferi and is spread by ticks

What reaction is sometimes seen after initiating therapy for Lyme disease?

Jarisch-Herxheimer: fever, rash, tachycardia

What is erythema migrans?

• 'bulls-eye' rash is typically at the site of the tick bite
• typically develops 1-4 weeks after the initial bite but may present sooner
• usually painless, more than 5 cm in diameter and slowlly increases in size