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Lyme disease 

Lyme disease
Chapter:
Lyme disease
DOI:
10.1093/med/9780198729228.003.0086
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date: 19 November 2019

Lyme disease is caused by the spirochaete Borrelia burgdorferi, spread by ticks of the Ixodes genus. Disease first manifests with a characteristic spreading rash (erythema chronicum migrans) at the site of the tick bite, with or without a systemic illness with fever and malaise. Central nervous system involvement or arthritis may follow, the former including an aseptic meningitis, cranial neuritis—most commonly causing unilateral facial nerve palsy, as well choreiform or cerebellar signs. Headache may be a prominent symptom. Arthritis is usually monoarticular and may persist or recur. Diagnosis is based on detailed serology performed at a reference laboratory or demonstration of a positive polymerase chain reaction test on cerebrospinal or joint fluid. Treatment for non-meningitic disease comprises a 14- to 21-day course of doxycycline or amoxicillin. Meningitis is treated with a prolonged course of ceftriaxone. Prevention involves avoidance of tick bites in endemic areas. Currently, there are no licensed vaccines.

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