headache in lyme...CNS lyme or not...amoxy or ceftriaxone ? - USMLE Forums
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Old 06-23-2012
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Default headache in lyme...CNS lyme or not...amoxy or ceftriaxone ?

A 7 -year-old Caucasian boy is brought to the clinic due to malaise and headache for the past 2 weeks. He
was apparently normal until 3 weeks ago, when he went on a hiking trip with his family to Connecticut. His
father found a tick attached to his thigh; however, a red macule remains at the site where the tick was
attached. One week after the tick was removed, a red ring developed around the macule, and then the ring
appeared to grow larger by expanding outward, leaving an area of central clearing. What is the most
appropriate next step in the management of this patient?
A Doxycycline
B. Amoxicillin
C. Ceftriaxone
D. Penicillin G
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Old 06-23-2012
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Amoxicillin

the criteria for CNS involvement is -- meningitis/encephalitis/cranial nerve involvement

just headache is nonspecific.
there is no fever/neck rigidity etc

Last edited by mbbs2010; 06-23-2012 at 10:33 AM.
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Old 06-23-2012
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Quote:
Originally Posted by mbbs2010 View Post
A Doxycycline

the criteria for CNS involvement is -- meningitis/encephalitis/cranial nerve involvement

just headache is nonspecific.
there is no fever/neck rigidity etc
doxycycline in 7 year old?? i thnk it shud be amoxicillin
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Old 06-23-2012
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Quote:
Originally Posted by umajeed90 View Post
doxycycline in 7 year old?? i thnk it shud be amoxicillin
yup-- amoxi
confused it with rickettsial organisms.. where you give doxy anyways.
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y is doxycyline contraindicated??
i thot it was jus teratogenic
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Quote:
Originally Posted by mbbs2010 View Post
yup-- amoxi
confused it with rickettsial organisms.. where you give doxy anyways.
amoxi in <8 years and doxy in >8 years.
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B. Amoxicillin

Lyme disease

Quote:
Early symptoms may include fever, headache, fatigue, depression, and a characteristic circular skin rash called erythema migrans
Quote:
Various acute neurological problems, termed neuroborreliosis, appear in 1015% of untreated patients.[14][18] These include facial palsy, which is the loss of muscle tone on one or both sides of the face, as well as meningitis, which involves severe headaches, neck stiffness, and sensitivity to light. Radiculoneuritis causes shooting pains that may interfere with sleep, as well as abnormal skin sensations. Mild encephalitis may lead to memory loss, sleep disturbances, or mood changes. In addition, some case reports have described altered mental status as the only symptom seen in a few cases of early neuroborreliosis.[19]
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