Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• Although not real common in Indiana, Lyme disease is not unusual in the northeastern US. Most cases diagnosed in Indiana were contracted on trips to the east coast.
• The ticks that transmit the Borrelia burgdorferi are really tiny and may go unnoticed.
• There are multiple stages to this disease, but vasculitis is the common element.
• The bugs are few, but the inflammatory reaction is way of proportion, leading to considerable tissue damage.
• It is quite amenable to antibiotic therapy, and as for now prophylaxis is not recommended.
• History and physical are the most important elements in making this diagnosis. Then understanding the pathology and where the disease is going is what will save your butt.
• Laboratory confirmation is frequently after the fact as time is required for the antibody titer to rise enough to be detected. Cultures are impractical, but PCR can be of help quickly.
• Where's there one case, there may be several.