PANCE REVIEW: Spirochetal infections

Those pesky spirochetal infections:

General Borrelia burgdorferi, deer tick must feed for 24-36hrs to pass dz, *Most common vector born-dz Rickettsia rickettsii (wood tick), common in eastern US
Clinical Stage 1:local infx (7-10d after bite) - erythema migrans "bull's eye", flu-like sx in 50% pts, Stage 2: early dissemination - HA, stiff neck, malaise, fatigue, MS sx, cardiac sx in 20% cases, Stage 3:late persistent infx, MSD, central/perip NS fever/chills/ N/V, insomnia can develop in 2-14 days, face is flushed and conjunctiva injected, small rash develops on extremities
Lab antibody detection (immunoflu assay or ELISA), western blot to confirm, Ig M wanes after 6-8 wks, IgG can be indefinite, high likelihood of false+ leukocytosis, thrombocytopenia, hypONa+, proteinuria, hematuria, transient rise in bili, rise in antibody titers in 2nd wk, CSF = pleocytosis, hypocorrhachia
Tx doxy for erythma migrans or lyme, NSAIDS, prevention mild, untx cases wane in 2wks, doxy or chloramphenicol hasten recovery, poor outcome for advanced age

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