Question

In early June, a 17-year old boy who lives in rural Virginia presents to his primary care provider with an enlarging rash on his right shoulder. The rash is painless and does not itch. It began as a small red circle that has gradually expanded over the past week while resolving in the center, to given the impression of an enlarging ring.

The boy is up to date on all of his immunizations. He has no underlying diseases and is taking no medications. He participates on the cross‐country running team at his high school, and he is a member of his local boy scout explorers troop. He has no history of a tick bite.
His examination is unremarkable except for the presence of the rash shown below in Image 1. No laboratory tests are ordered, but the boy is treated with a 2‐week course of amoxicillin for Lyme disease. The rash resolves, and he has no further problems.

Image One: Rash evident on the shoulder of the patient.

a. Based only on the information provided by the history and examination, what is the most likely infectious agent?

b. Why didn’t the physician order laboratory tests to confirm the diagnosis?

Answer 1

Answer: Lyme's disease is caused by tick borne disease that is by the bite of bacterium Borrelia burgdorferi. The symptoms includes such as:

• Pain in joint or muscles
• Fatigue
• Rashes
• Swelling.

The physician didn't order laboratory test as all the symptoms were of Lyme's disease and it can be easily detected. These insect are found in the rural areas. The history of boy also reveals that he used to go for the scouts that means he was very prone to the tick bites.