- Also suburbs of Boston, NYC, Phila.
- mid-May to late-July
- Mid-June to Dec.
** Seek Erythema Migrans rash (or Hx thereof in June through August) ** Bilateral Palsy is certainly Lyme in endemic area ** Other Sx of “Early Disseminated Lyme”:
- Migratory Arthralgias
- Multiple Erythema Migrans lesions
- Meningeal Sx (H/A, stiff neck)
- Radiculopathy / Peripheral neuropathy
- Cerebellar Ataxia (rare)
- Carditis (A-V Block, often asymptomatic)
- Long 1° (>300 msec), any 2° or 3°, need CCU & IV Tx
- If negative = No Lyme Disease
- If positive: confirm with Western Blot IgM and IgG IgM is diagnostic of “Early Disseminated Lyme”
- Note — Many residents of endemic areas are IgG Pos. from prior asymptomatic infection
WHO TO TREAT ORALLY (vs. I.V.)* Isolated CN7 Palsy can get p.o. Tx
- Non-specific arthralgias, conjunctivitis, mild HA still OK
- Maybe most useful to R/O other illnesses
- Lyme CSF: ↑ lymphs (~90%, median count 160), ↑ protein
- BUT Early Lyme w/o neuro involvement may have abnl CSF
- Uncertain if IV Tx is better than p.o. in aseptic meningitis
* Other Neuro Sx (radiculopathy, ataxia, neuropathy) probably warrant IV.Dx & Treat Facial Palsy for Lyme Empirically:
- Other Sx “Early Disseminated” above
If awaiting antibody results, Tx for idiopathic “Bell’s” while pending
SEE ALSO — Our overview of Lyme Disease (with pix) and posting Bell’s Palsy.