Lyme disease, caused by the spirochete Borrelia burgdorferi, is transmitted to humans by ticks. It is more common in the North-east and Mid-Atlantic states, where the deer tick (Ixodes dammini) is prevalent. Ticks may feed on infected white-tailed deer or white-footed mice and then serve as a vector to transmit disease to humans. Lyme disease is less common in the western U.S. states, where the California black-legged tick (Ixodes pacificus), capable of transmitting Lyme disease, prefers to feed on reptiles, which do not carry B. burgdorferi.
Lyme disease can be manifested by a wide range of symptoms and severity. In its early form, a rash is often present and may be accompanied by regional lymphadenopathy. In later stages, neuro-logic manifestations ranging from Bell’s palsy to Guillain-Barré– like syndrome or dementia are possible. Other sites that may be affected include skin, joints, heart, and eyes.
The rash frequently associated with Lyme disease, known as ery-thema migrans, is often described as having an expanding bull’s-eye appearance. It may be confused with a spider bite. The diagnosis may be made when a patient has this typical rash and at least one late manifestation (eg, arthritis, facial palsy, menin-gitis, carditis) along with laboratory confirmation of infection.
Doxycycline (Vibramycin), ceftriaxone (Rocephin), and azi-thromycin are among the commonly used antibiotics. Treatment regimens are usually for 3 to 4 weeks. Patients should be encour-aged to complete the full course of therapy and to report changes in symptoms during therapy, because the regimen may need to be altered if treatment appears to be failing.
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