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Lyme disease

Jul 25, 2019

Lyme disease is an infectious disease caused by Borrelia type bacteria which is spread by tick bites. It presents as an expanding area of redness on the skin, known as erythema migrans, that begins at the site of a tick bite about a week after it has occurred. Initially starting with fever, arthralgia, it can progress to cardiac problems like heart blocks or can lead to Bell’s palsy (facial nerve palsy).

Medications:

  • For stage 1 or stage 2 of the infection – Cap. Microdox-LBS (Doxycycline 100 mg, Lactobacillus-5billion spores) 1 capsule twice a day for 21 days.
  • If age less than 18 years – Tab. Wymox 500 (Amoxicillin 500mg) 1 tablet 3 times a day for 14 days instead of Doxycycline.
  • If suspected cellulitis – Cap. Moxikind-CV 1gm (Amoxicillin 875 mg and Clavulanic acid 125 mg) 1 capsule thrice a day for 5 days.
  • For stage 3 Lyme disease like arthritis – Tab. Forcef 500mg (Cefuroxime 500 mg) 1 tablet twice a day for 14 days.
  • For meningitis – Inj. C one (Ceftriaxone 1 g) 1 g i.v. twice a day for 14 to 21 days. In children: 75-100 mg/kg/day i.v. for 14 to 21 days.

Supplementary therapy:

  • Tab. Calpol 650 (Paracetamol 650 mg) 1 tablet thrice a day for fever or arthralgia.
  • Cap. Pro-wel (probiotic and prebiotic) 1 capsule twice a day along with antibiotic prescription.
  • Tab. Tryptomer 10 (Amitryptilline 10 mg) 1 tablet at night for chronic pain. Gradually increase till 50 mg at night if needed.

General advice:

  • Advice regular exercise to prevent chronic fatigue.
  • Ensure adequate nutrition and sleep hygiene.
  • Advice gradual return to work.
  • Advice patients that some symptoms (especially pain and fatigue) may be long term.

Investigations:

  • Serum Lyme titre (ELISA) – it can be positive in initial stages.
  • Serum antinuclear antibody and rheumatoid factor – to rule out other causes of arthralgia.
  • Complete blood count – low platelets and white cell count and raised ESR is often observed.
  • Renal function test.
  • Liver function test.

Referral:

Consider referring patient to the specialist in communicable disease department in delayed presentation, persistent symptoms or complications of the disease. Patients will require referral to cardiologist for heart blocks and neurology for Bell’s palsy.