By vgreene, 21 June, 2021 In pts w potential tick exposure in a Lyme dz endemic area who have 1 skin lesions suggestive of but atypical for EM consider Ab testing performed on an acute phase serum sample followed by a convalescent phase serum sample 2 3wk later if initial result i
By vgreene, 21 June, 2021 Perform 2 tier testing when Lyme being considered in absence of EM initial ELISA1 2 or IFA 1 then Western immunoblot or FDA approved 2nd EIA4 if 1st test is or equivocal don t r o dx if tests are but there s high clinical suspicion of Lyme dz2
By vgreene, 21 June, 2021 Consider Lyme or other tick borne illness 3 in absence of EM in pts w acute onset of multiple sx fever sweats lymphadenopathy malaise fatigue neck pain stiffness migratory joint or muscle pain cognitive impairment HA paresthesia inquire about possible tic
By vgreene, 21 June, 2021 Use combo of clinical presentation sx h o possible tick exposure and lab testing to guide dx tx of pts w o erythema migrans EM 1 2 consider starting tx while awaiting labs2
By vgreene, 21 June, 2021 In endemic area consider Lyme dz in pts w certain sx or conditions even in absence of distinct tick bite
By vgreene, 21 June, 2021 Monitor for erythema migrans EM or other s sx of tick borne infxn in wks following tick bite avg onset of EM 7 days after bite range 3 90 days 1 3 STARI rash looks similar but occurs slightly earlier after Amblyomma americanum bite 8 an earlier inflammato
By vgreene, 21 June, 2021 Provide abx ppx w in 72h of removal only to pts w an identified high risk tick bite 6 7 doxycycline 200 mg PO x1 for adults or 4 4 mg kg dose max 200 mg for children 4 5 watch wait appropriate for pts w low or equivocal risk4 5
By vgreene, 21 June, 2021 Don t test tick for B burgdorferi 3 4 result poorly predicts clinical infxn or asymptomatic seroconversion3
