Lyme disease
was one of the topic of discussion from ambulatory clinic today. Lyme disease
is a disease cause by spirochete bacteria of the genus Borrelia (Sabatine, 2011). These pathogens are transmitted by
Ixodes ticks, which in turn is usually carried by animal host such as deer and
mice. The effects of Lyme disease can be localized (stage 1), disseminated
(stage 2), or persistent (stage 3). Its clinical features include a
characteristic bullseye lesion called erythema migrans, as well as fatigue,
arthralgia, heart block, myopericarditis, cranial neuropathy, and aseptic
meningitis.
Lyme disease
diagnosis usually involve serology assessment via ELISA, with Western blot
confirmation of postive results. ELISA alone can give false positives in the
context of other spirocheta infections and conditions such as SLE, RA, and HIV.
Treatment typically involves a course of doxycycline (e.g. 100mg PO BID x
10-21d for early disease and 100-200mg PO BID
x 2-4 weeks for disease with significant systemic effects).
A large part
of our discussion focused on the impact of overdiagnosis and overtreatment of
Lyme disease. Questionable diagnosis of lyme disease in some patients can lead
to lengthy, costly, and aggressive treatments. Lyme disease lends itself to this
phenomenon because of the possibility of false positive in serological testing
and the fact its clinical findings are often complex and non-specific. It is
important to be cautious in diagnosing Lyme disease since inappropriate
treatment, as expected, leads to negative patient outcomes and misuse of healthcare resources
(Reid, Schoen, Evans, Rosenberg,
& Horwitz, 1998).
Physical Exam
Tip from Dr. Ho Ping Kong: if you want to accentuate muscle fasciculations e.g
in the context of neuropathy, it helps to tap gently on the muscle belly.
1.
Sabatine MS. Lyme Disease. In: Pocket medicine. 2011 p. 6-21 - 22.
2.
Reid MC, Schoen RT, Evans J, Rosenberg JC, Horwitz RI
- Jenny
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