Question

A 27-year old white female presented at the walking clinic of her local physician on August 15. On physical exam, the patient had a fever of 38.5C. She appeared fatigued, had tender joints, and complained of a headache, a stiff neck and a backache. The physician noticed a circular "rash" about 5 inches in diameter, with a bright red leading edge and a dim center in the form of a "bull’s eye". The physician noted an irregular heartbeat. The patient complained of lack of ability to concentrate.

The patient gave the following history:

She is a graduate student in the wildlife program at the university in town. She was in the field for three weeks in Wisconsin during the months of May and June. She tracks small mammals in the field and studies their behavior. It had been a warm, wet spring and she complained of a large number of biting flies, mosquitoes and ticks in the area. She felt well until about 2 weeks after returning to her home. Since that time, many of her symptoms had progressed. She finally found that she could take it no more.

1.         What is your best diagnosis of this case?

2.         What features are critical to your diagnosis?

3.         What further steps should be taken to clear up the problem?

Answer 1

1).

1). Lyme disease is caused by the bacteria Borrelia burgdorferi, which is transmitted by the blacklegged ticks. The most common symptoms is its characteristic rash that looks like a bulls’s eye, The rash is not painful but the patients suffer from palpitations, joint pains, neck stiffness, headache, etc.

2). The symptoms including the "rash" about 5 inches in diameter ("bull’s eye"), stiff neck and a backache, fatigue, decreased concentration and memory are the characteristic symptoms of lyme's disease.

3). Treatment of Lyme disease include, the antibiotics, and nonsteroidal anti-inflammatory drugs. Doxycillin is used for adults, and for children below 8 years old, cefuroxime, and amoxicillin are used.